Frontline Training Literature Review
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  • 1. Frontline TrainingCurriculum
  • 2. Frontline TrainingGoals:To help participants… • Understand and empathize with adolescents’ concerns about health care, including but not limited to confidentiality. • Identify concrete strategies to establish trust with their adolescent patients, such as ensuring confidential and low cost services.LEARNING OBJECTIVESBy the end of this workshop, participants will be able to… • Understand the role of frontline staff in improving sexual and reproductive health outcomes for adolescents. • Articulate crucial factors influencing adolescent behavior as it relates to sexual and reproductive health care. • Identify the policies regarding the 4 Cs, i.e., Consent, Confidentiality, Care, and Cost, at their state, local and clinic levels and communicate those to adolescent patients. • Describe TACT: Tone, Attitude, Communication, and Time Out and concrete strategies for improving communication with adolescents.MATERIALS: • Adolescent Development worksheets • 4 C’s: Clinic Personnel Needs to Know laminated handouts • TACT: Communicating Effectively with Teens laminated handouts • Frontline Standardized Patients Feedback Checklist • Poster Sized Post-It’sAGENDA: Introductions (5 min) Icebreaker (10 min) Adolescent Development (20 min) Need to know: 4 C’s Discussion (10 min) Adolescent Experiences (10 min) Communication Strategies Lecture (10 min) Practice (15 min) Conclusion (5 min)
  • 3. Post Test (5 min)Begin the workshop by introducing yourselves as well as telling the groupwhat TORCH is.Then explain that today, TORCH will be implementing AHCCP’s program. Thegoal of AHCCP is to reduce communication barriers between adolescents andhealth care providers. They achieve this by training TORCH teens to giveworkshops both to their peers and to providers.ICE BREAKER-Relating to the Adolescent ExperienceLearning objectives: To get everyone comfortable and excited about theworkshop.Time: 10 minutesMaterials needed: NoneDirections: a. Each Frontline Staff selects three words that described themselves as a teen of about 16 years old and shares them with the group. b. Break group into dyads (2’s) if there are more than 10 participants. If group is small, just keep them together. A peer will facilitate the groups. c. In dyads, they will discuss their responses to the following questions: i. What was it like when you first tried to access reproductive health care? Who did you reach out to? How? What were the results? ii. What challenges do you face with your adolescent clients? How are those similar to what you experienced as an adolescent?Transition (read aloud by Peer Leader): Now that we have thoughtabout what it was like to go to a sexual and reproductive health visitas an adolescent, Pauline is going to discuss the stages ofadolescence with you.Adolescent Development-(Pauline/Intern)(Adapted from the NYC DOH Frontline Training Program)Learning objectives: To help frontline staff have a better understanding ofadolescents at each stage of development (early, middle, and late).Time: 20 minutesMaterials needed: Adolescent development worksheet
  • 4. Directions: a. Hand out adolescent development worksheet to each participant but allow them to stay in their dyads to complete the worksheet. b. Give participants 5 minutes to complete the worksheet in their groups. c. Review the worksheet, explaining each answer. d. Hand out the worksheet answer key with explanations.Transition (read aloud by Peer Leader): Sometimes it is difficult toremember all the information needed when interviewing anadolescent who has come to the clinic for care. We have created amnemonic to help you remember the necessary information.Need to Know: 4 C’s DiscussionLearning objectives: To ensure participants can identify their policiesregarding the 4 C’s (i.e., consent, confidentiality, care, and cost)Time: 10 minutesMaterials needed: Poster Sized Post-It’s (4 C’s laminated hand out comesafter the post-test)Directions:Facilitate each “C” by having participants guess what each C could stand for.Then write down each “C” on poster sized post-its and explain each one.Care and Cost vary by on clinic and will be altered for each presentation. a. Consent: If you are 17 or younger, you have the right to get sexual health services without parental consent in New York. That includes STI prevention, birth control access, and abortion. The ONLY exceptions are the HPV vaccine and sterilization. b. Confidentiality: Teens have the right to confidential sexual and reproductive health services. That means that no one involved in their care can disclose any information about those services to anyone, including parents/guardians, partners, and friends. Often teens do not know this is their right, so it is important to remind them. c. Care: ______________ Health Clinic offers the following sexual and reproductive health services: pregnancy testing, STI testing and treatment (including HIV testing), pap smears, routine gyn exams, prenatal care, contraceptive management (including IUD placement). d. Cost: ____________ Health Clinic offers the following payment options: sliding scale and a variety of insurance (too many to
  • 5. list). Additionally, adolescents are seen regardless of their ability to pay. Montefiore has a special billing code for these patients ("S13") which means that they can receive confidential services without charge and without sending explanation of benefits (EOB) information to their homes.Transition (read aloud by Peer Leader): The 4 C’s were designedas a way to remember what information is most important toadolescents, and can make or break their health care experience.Because of this we are going to share some positive/negativeexperiences we have had at health clinics.Adolescent ExperienceLearning objectives: For participants to understand positive and negativebehaviors of frontline staff from real life adolescent experience.Time: 10 minutesMaterials needed: NoneDirections:Teens will share positive and negative experiences they have had withfrontline staff in clinical settings, identifying specific issues. Number ofpositive and negative experiences told by each peer leader will bedetermined by time availability. **Think of mystery shopper calls orpersonal experience**Transition (read aloud by Peer Leader): Now that you have a betteridea of what makes a positive and negative healthcare experiencefor an adolescent, we are going to discuss communication strategiesyou can use to make adolescents’ visits as healthy and productive aspossible, using our acronym TACT.Communication Strategies LectureLearning objectives: To provide an acronym that reminds participants ofcommunication strategies to use with adolescentsTime: 10 minutesMaterials needed: Poster Sized Post-its (TACT laminated hand-out will bedistributed after the post-test)
  • 6. Directions:Teens should read the introduction and then write TACT acronym on poster-sized post-its and have the participants try and guess what the letters standfor. As participants guess, teens will write the terms on the board and givethe following explanations for each term.Introduction: As frontline staff you are often the first people that teensencounter so your communication strategies can make or break their visit.Teens are going to recognize not just what you say but how you say it andyour body language. We will now explain what each letter of our acronymTACT means. a. Tone: Have welcoming body language (open, facing teen) and friendly tone of voice, not rushed. b. Attitude: Be non-judgmental, avoid assumptions about age, gender, sexual orientation, ethnicity, religious and cultural/language backgrounds. c. Communication: Ensure confidentiality; limit use of medical terminology; practice active listening; and use age-appropriate language. d. Take Time Out: Check in with the teen to be sure s/he understands the conversation; know the next steps to take to ensure the best health care possible for the teen, and confirm that you have used the appropriate communication strategies.Transition (read aloud by peer leader): Now that you can identifyhow to best communicate with an adolescent, you are going to get achance to practice the 4 C’s and TACT.PracticeLearning objectives: To give participants a chance to watch and learnbest practices of interacting with adolescent patients.Time: 15 minutesMaterials needed: NoneDirections:Split group of participants up depending on their interaction with teens.Group one, which primarily interacts with teens on the phone goes to oneside of the room while group two, which primarily interacts with teens inperson, goes to the other side.
  • 7. Once on each side of the room, each of us is going to play a character withan adolescent health issue. We will either pretend to be on the phone askinga questioning about health services, or we will pretend to come into theclinic.Follow up questions: After completing practice rounds with each group,ask the following questions of the group. a. How did you feel during this activity? b. Was there anything that surprised you?Conclusion and Post-TestLearning objectives: To wrap up the workshop and confirm participants’understanding of main ideas.Time: 5 minutesMaterials needed: Post-Tests, 4 C’s laminated handouts, TACT laminatedhandouts, AHCCP brochuresDistribute post-tests and explain this is to measure their understanding ofthe workshop and demonstrate improvements for the workshop.After collecting the post-tests, hand out the 4 C’s and TACT laminated hand-outs. Explain that these can be hung or kept near their desk to remind themof what topics are necessary to cover with adolescents and the bestpractices on how to communicate with teens.Also, hand out AHCCP brochures so the clinic has more information aboutthe program.