Rendering Accompaniment Visible Facilitator Training Modules in Chiapas, Mexico
Bernadette Miramontes, CJ Humes, Marco Lorico-Rappa, Megan Wright, Rahul Ramani, Sarah Fracci
Client: David Giber; Partners in Health
Table of Contents Introduction 3 Training Module 1 4 Training Module 2 7 Training Module 3 11 Survey 14 Blank Calendar Templates 1&2 15
Introduction Partners in Health is a non-profit healthcare organization that seeks to bring modern medicine to the most impoverished and thus vulnerable in the world. As such, it provides healthcare in the poorest areas of developing countries. Compañeros en Salud is a sector of Partners in Health that works to strengthen the healthcare system in Mexico through collaboration with the government in order to bring greater access to high quality healthcare. Compañeros en Salud operates out of ten rural public clinics in the Sierra Madres mountains of Chiapas, one of the most marginalized regions in the country. Within Companeros en Salud there are facilitators at each of the ten rural public clinics. These facilitators are given the role of managing the community health workers that are within each community. The concept of accompaniment, which is the idea of two individuals walking side by side during times of joy and adversity, is taught widely across Partners in Health and Companeros en Salud in order to make healthcare implementation more effective on an personal level. As facilitators, it is essential that these individuals have both the understanding of accompaniment and the skill set to effectively implement it in their daily personal and work lives. This project attempts to create training modules for the facilitators of Companeros en Salud. These training modules seek to make accompaniment more visible in the personal and professional lives of the facilitators. In order to determine the topics of the training modules, we reached out to Matt Hing and Becky Warnhoff, interns of Partners in Health who have been working with the facilitators of Compañeros en Salud. These individuals provided insight on how to best train the facilitators on accompaniment related skill sets. Through their advising, our DAT team has chosen to develop training modules for the facilitators on Professionalism, Initiative and Negotiation, and Time Management. The goal of the the Professionalism training module is to allow the facilitators to better understand what it means to be a working professional as for many of the facilitators, it is their first time holding a professional role within the community. It is also important to make it more obvious to the facilitators on how to take initiatives in their roles and negotiate when necessary. Becky and Matt described how it is not uncommon for the facilitators to ignore issues due to a lack of confidence in negotiation skills. This is the reasoning behind creating the Initiative and Negotiation training module. Becky and Matt also described how many facilitators struggle with time management and feel overwhelmed by their schedules. In order to ease this stress and allow the facilitators to better understand how to effectively use their time, the Time Management training module was developed.
To implement the use of the training modules and determine their effectiveness, Becky Warnhoff will use these three half hour training modules to train the facilitators over a three month period. The trainings will be carried out on an individual basis unless all facilitators meet at one meeting. Group based activities within the modules can then be used as well. Whether these trainings occur on an individual or group basis, the trainings are aimed to focus on experiential learning. Through dynamic conversation implemented with the Circle of Trust model, we hope that the facilitators will incorporate their individual life stories and experiences in order to make the trainings more personalized. We developed the trainings in a way so that facilitators cam learn the lessons by focusing on things they may already know and on their own personal experiences. Following the training modules, the facilitators will receive a pamphlet with the main take-aways of the lessons in the training modules. In order to evaluate the effectiveness of these trainings, the facilitators will be asked to complete a survey with any assistance needed. This survey will help us better understand how to improve the training modules in the future. Changes can then be made within the modules in order to more effectively convey the ideas of professionalism, initiative, negotiation and time management. There are several unknown variables at this time that may lead to changes of the modules in the future. For example, the exact level of education for all of the facilitators is unknown. Varying reading and writing skill levels will alter the effectiveness of various activities. However, it is important for the content to be tested as it currently exists in order to gather baseline data and create changes based on observed success and failures.
Professionalism Training Module 1 OBJECTIVES: • Empower facilitators so that they are confident in their professional relationships with staff, doctors, and members of their community. • Help facilitators to better understand their responsibilities that come with being a professional for Partners in Health. • Demonstrate to the Facilitators how maintaining a higher degree of professionalism will allow • •
them to better accompany other individuals in their work and personal lives. Develop facilitators’ understanding of professionalism in a way that they are able to convey the lessons to community health workers. Building opportunities for facilitators to share their own experience and design their own solutions (accompaniment based approach).
TIME: 30 minutes DISCUSSION SCRIPT: Understanding Professionalism
Opening thought question: • •
What do you think of when you think of a “professional?” What words do you associate with “professional?”
To prompt more discussion: •
Does anyone in your life have jobs or roles in which they are in charge of a task or people? Can you give an example? These are professionals!
If needed, provide examples of other professionals that may be in their lives already to associate the term (Becky, religious leaders, doctors, business owners, etc.) •
What qualities do they possess? These are qualities of a professional!
Transition: • • •
Aside from being a Facilitator now, have you ever had a professional role in the past? If so, what role was that? If you have not had a professional role in the past, do you consider this role as your first professional position? What are you least comfortable about for this position?
To prompt, for example: Talking to doctors? Staff? Superiors? Your health workers? Suggest to focus on the factor that makes them least comfortable in the future. Relate back to this factor in future discussions. •
Explanation and empowerment of professionalism: • •
Can you describe your role as a facilitator? That makes you a professional! Because you … • • • •
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Hold specific tasks that are important for Partners in Health to be successful in implementing health care for community members. Maintain relationships with members of Partners in Health: Community Health Workers, Doctors, etc. Must meet certain expectations in order to keep this role as a facilitator. Are respected by individuals in Partners in Health and in your community for your work.
Having confidence in these aspects of your role is important to serving your community. All paid professionals, no matter what the sector, are expected to meet certain expectations and roles. As a facilitator, it is important for you to understand your professional roles, your significance and how this can help you better accompany your community health workers, patients and other members of your community.
Let’s take a look at what your expectations as a professional can and may be! • • • • •
Communicate issues with others when they arise. If issues do arise, provide constructive feedback to others so that the issue can be resolved in a timely manner. Initiate conflict resolution when necessary. Maintain positive relationships with other workers in your organization. Create a positive working environment for your own benefit and for the community health workers.
Now that you have a better idea of what your role as a professional is, let us discuss how this is going to help you grow into a more effective model of accompaniment. • • • •
As an empowered professional, you can reach out other employees and members of Partners in Health with any issues that need to be dealt with. As an empowered professional, you can lead community health workers on their professional journeys as well. As an empowered professional, you can strive for personal growth in your personal life, your work life and in your community. As an empowered professional, you can use your ideas and suggestions in order to allow Partners in Health to become a more effective organization within your community.
Now that you understand your significant role as a professional for Partners in Health, it is important to discuss two additional concepts that will allow you to become an even better professional than you were in the past. These two concepts are: initiative & negotiation and time management. We will discuss these concepts the next two times that we meet.
(Suggestion if available) At the end of this discussion before skills modules 2 and 3, distribute a Partners in Health vest or other piece of apparel to the Facilitators to wear while they are working. Ideally, this apparel would be regularly worn by other PIH staff members too. This item will give them a better sense of membership to Partners in Health and also will encourage them to feel a greater sense of professionalism, collaboration, partnership, and equality with staff and colleagues.
Initiative and Negotiation Training Module 2 OBJECTIVES: • Help Facilitators better understand the significance of negotiations in their role as a Facilitator. • Teach Facilitators techniques for negotiation and conflict resolution. • Practice negotiation skills with the Facilitators. • Demonstrate to Facilitators how they can have their voices heard. • Demonstrate how the ideas of initiative and negotiation can be used to better accompany other individuals within Partners in Health. • Develop facilitators’ understanding of initiative/negotiation in a way that they are able to convey the lessons to community health workers. TIME: 45 minutes DISCUSSION SCRIPT: Understanding Negotiation and Communication 4 Part Discussion • Communication skills and finding similarities • Listening and having your voice heard • Practicing negotiations • relating these skills to your work and accompaniment 1. Communication Skills Discussion Question • How do you deal with disagreements between children? o Do you listen to both children before making a decision? o Are the children content after the disagreement? o What does a successful agreement look like in this case? • You already have experience with negotiation skills as a parent/older sibling o Do you see similarities between the scenario with the children and disagreements in your work as a facilitator? o As a facilitator, how can you use these skills you have to handle differences in opinions (disagreements) between yourself and other members of CES? Lesson/ Takeaways: • Communication as an important tool in achieving goals. • Finding similarities with other people → building sense of community, having similar tasks/concerns and working towards common goal in CES • Finding common ground is important in negotiations. Being able to find similarities in goals or objectives helps advance both sides of a negotiation. • When negotiating, begin with finding deeper motivation within yourself and others • finding similarities with you and your patients → better accompany them
Group Teaching Activity Icebreaker: “Make a Team With…” This activity strengthens communication skills. It also teaches team members how to think on their feet. 1. Explain to facilitators that they will have to form a group of 3 based on the instructions that you shout out. For example, some instructions could include "Get into a team with people who have the same number of children as you" or "Get into a team with people who like the same food." 2. Shout out instructions. Facilitators can shout out or sit down to signal that their team is "complete." Anyone that is not in a group is out of the game and can step aside. Encourage facilitators to work as quickly as possible. Repeat the exercise until there are only three people left.
Discussion • Talk with the facilitators about how this activity encouraged them to communicate. How could they learn to open up and communicate more effectively in work situations in the future? 2. Listening and Having Your Voice Heard Intro: CES is able to support the community through your individual efforts - through the work of individuals like you. You are an integral part of CES and your voice is important. Voicing your concerns, goals, and ideas are important. We want to hear from you. Discussion Questions Instructions: Discuss with partner then with small group. Then have spokes person from each group share with everyone. • •
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Why did you take on this job as facilitator? What are your goals as a facilitator? What are you main motivations? Mission of CES: Strengthen the public health system to ensure that vulnerable populations receive high quality medical care thorugh innovations and transformational medical education o How do your goals relate to the mission of CES? How are they different? What do you do to reach your goals? Do you ever find it difficult to ask questions? What are things that prevent you from asking questions? Do you wish you had more possibilities to communicate with leaders? o Openly communicating your goals with others can help you achieve them. How can we make it easier for you to talk about these goals? • What can be done differently so that it’s easier to ask questions?
Lesson/ Takeaways: • Importance of using your voice • Voicing your needs and opinions • Listening in order to find common interest • As a facilitator/acompañante, you already use listening skills as you work with patient. You can apply these skills in other ways as you work with other acompañantes and doctors.
Group Teaching Activity • •
Materials: index cards with questions written on them Introduction: This activity is designed to encourage using your voice and active listening. These are skills that are important in both negotiations and accompaniment. First introduce the topic of negotiation, as the discussions questions will relate to negotiations. Everyone partners up, or alternatively this can be done one-on-one between teacher and facilitator. Each pair is given a set of index cards with questions written on them. A discussion question will be announced from the list below and one person will voice their opinion for 3 minutes. The partner will listen without interrupting, and then spend one minute repeating what the first person said.
Discussion Topics •
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Warm up questions: • What’s the best food and why? • What will the world be like in 200 years? Talk about a time you had to negotiate with a family member or friend. What did you do to come to an agreement? Talk about a time you had to negotiate with another acompanante or patient. What did you do to come to an agreement?
Explanation/discussion How did you feel about not being able to speak about your own views about the topic? What did your partner do that you liked about their listening? How well did they listen? Did you improve in summarizing what your partner was saying with each topic? How can you use lessons from this activity in your work? How can you use these lessons in your everyday work?
3. Practicing Negotiation One-on-one activity: hypothetical situation • After realizing a child is not making regular visits to the CES clinic for treatment anymore, the facilitator goes to the patient’s house and attempts to discuss why the child has been missing his appointments. o Set-up: trainer will play the role of the parent of the child and the facilitator will play the role of the facilitator making the house call • Potential reasons for child missing appointments: o Parent is busy o Costs too much or too difficult to bring the child to the clinic o Parent forgetting o Scared of treatment or does not see the need for it • How to approach situation o Listen to concerns o Provide resources and help is possible o Answer any questions parent might have o Stress importance for child’s treatment and danger if left untreated
Discussion Questions o What was the most difficult part of the interaction? o What did you learn form this activity that might help you in a similar interaction? Lesson/ Takeaways • Promoting initiative and effective negotiation skills • Finding common goals or interests to reach an agreement • Digging into deeper interest to find the best option Group Teaching Activity Activity 2 METHOD: Dynamic activity with paper clips and discussions between instructor and acompanantes on negotiation TIME: 15 minutes MATERIALS: paper clips Instructions: This activity is designed to promote creativity and initiative as well practicing effective negotiation skills that lead to a common interest. •
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First give everyone a paperclip and ask them to spend 2 minutes individually thinking of as many creative uses for the paperclip. After 2 minutes, split them into 2 groups. They have 5 minutes to share their findings in their groups and come up with 1 choice per group. After 5 minutes, the two groups join together and have 5 minutes to decide on which of the two choices they can all agree on.
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You can vary the amount of time, but it works best if it is completed fairly quickly. Discussion •
Leads to figuring out more productive ways of influencing others, such as task oriented negotiation. Trying to see the overall goal of the activity, which is to come up with the most creative use of a paperclip, and realize that in the end they are all on the same team. Is it difficult to give up your idea/position for someone else’s? How did you come up with an agreement?
Overall goal is the same. Everyone has the same goal of having a creative idea. Everyone has initiative and uses negotiation to decide on best idea but there is one main goal of getting to the best idea → getting to accompaniment of patients having different positions (my idea is best), but having similar interest (best idea for whole group)
4. Applying Lessons to Your Work and Accompaniment Discussion Questions • • • •
You are an important part of CES. The relationships you build with patients and the work you do with individuals helps build a better community. How does good listening make you a better acompañante to other acompañantes and patients? As an acompañante you frequently practice good listening when you are with your patients as talk about what is important to them. How does this help you better accompany patients? they What are areas where you can apply listening skills and using your voice in new ways?
Time Management Training Module 3 OBJECTIVES: • • • •
Help facilitators to uncover potential causes of stress resulting from their roles at work, at home and in the community and resulting full schedule. Provide insight and tips for improving time management and scheduling for Facilitators. Demonstrate how time management and more effective scheduling of tasks will improve a Facilitator’s ability to accompany individuals. Develop facilitators’ understanding of time management and scheduling in a way that they are able to convey the lessons to community health workers.
TIME: 30 minutes DISCUSSION SCRIPT: Understanding Time Management and Scheduling
Opening Activity Here we are giving you a list of tasks that must be done by a facilitator and a parent like yourself during a typical week. Please take some time to use the blank calendar template to organize these tasks in the manner that you would. [Use Blank Copy of attached Week Calendar at this time] Possible Tasks to include for every day/week: (may include additional tasks that the facilitator deems important in his/her life) • • • • • •
Attending to family Meeting with community health workers Meeting with other PIH Staff Checking with community members and patients Household Chores Personal time (rest, exercise, socializing)
Follow Up Question Did this exercise you or overwhelm you at all? Why did it overwhelm you? Let us now better understand how scheduling and organizing can help reduce this feeling of being overwhelmed.
Question: Does your own personal list of daily tasks ever overwhelm you? If so, why?
Follow up discussion based on responses of the facilitator. Topic Introduction and Clarification : Post - Activity Today, we are going to discuss how overbooked schedules can lead to unhealthy stress in our lives. As a facilitator, we do not want you to be overwhelmed or stressed by your schedules and roles. This stress can negatively affect your happiness and your relationships. Instead, we hope that you can live stress free with manageable schedules. This will then allow you to both be more productive and happy in the home and also when you are working as a facilitator. You may even be able to better train the community health workers on their schedules so that they can better accompany their patients.
Now let’s work on discussing your daily/weekly/schedule! What are the main tasks you must complete every day and every week? Let’s list those out. •
Facilitator will list out tasks
Now that we have those listed out, let’s work on understanding how you prioritize the tasks. Which tasks do you find most important and do you focus on completing first each day/week? Why do you choose those specific tasks? What are the tasks that you almost always never have time to complete but wish you did? [Use pie chart templates] On this pie chart below, divide the chart into segments according to how much time you currently spend on each task. Be honest and thoughtful! Now, on the second pie chart, divide the chart into segments according to how much time you want to be spending on these tasks. Feel free to add segments for other activities or tasks you wish to be participating in. Discussion: • Does the second pie chart look a lot better? Well, you can achieve that! Now that you know what tasks you want to prioritize and know what tasks during which to be more time efficient on, you can target them specifically.
As you move forward and attempt to better schedule your days/weeks, remember these tips: • • •
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Remember that creating a schedule may require time upfront, but this initial investment will pay off in the end. Avoid stress-If you are ever feeling stress, step back, focus on an attainable task and complete the task. Understand the difference between urgent and important tasks. Urgent tasks demand immediate attention, but whether you actually give them attention may or may not matter. Important tasks matter and not completing them may have serious consequences for you or others. Recognize the time of the day that you work best (ex. Morning or night person). It is best to schedule difficult tasks during those times of the day. Do not try to multi-task. It is much better to finish off one job before moving onto another and overwhelming yourself. Keep your work-space and home tidy. Clutter can be a distraction. Cleaning up can improve selfesteem and motivation. Stay calm and keep things in perspective. You’re doing great!
(Suggestion if available) Provide Facilitator with laminated weekly calendar so that the facilitators can keep track of their weekly tasks more easily. They can then write and erase as needed on these calendars.
Post-Training Survey for Facilitators Professionalism 1. How do you now think of the word “professional” when you hear it? 2. Do you view your role as a facilitator any differently now? If so, how? 3. Have you confronted any issues this past month? If so, how did you work to resolve them? 4. How do you view your role in Partners in Health? Has this view changed recently? If yes, why? Initiative/Negotiation 1. Have you used any negotiation strategies this past month? 2. Why are negotiation skills useful? 3. How did you find common interest and similarities with patients, doctors, and acompañantes? 4. Have you been able to ask more questions and get your questions answered? Why or why not? 5. How do negotiations relate to accompaniment? Time Management/Scheduling 1. Have you been able to keep a schedule this past month? 2. Did you write a schedule at all this past month? If so, did you stick to it? 3. What new or different challenges have you faced with your schedule this past month? 4. Have you felt more or less stressed due to scheduling this past month? Or no change? 5. What things have you done or hope to do in the future in order to accomplish your tasks in a more timely manner? Interactions with Community Health Workers 1. Have you had the opportunity to share what you learned in the training with community health workers? If so, what did you share with them? And when? Use of Pamphlet 1. Do you still have the pamphlet that we gave you during the last training? 2. Have you referenced the pamphlet we gave you during the last training? If so, when and how often? 3. How did the pamphlet help you or not help you? 4. Will you use the pamphlet in the future?
Blank Calendar 1 for time management activity use
PIE CHARTS for time allocation activity use
