Module A3: Setting, Communication and Interviewing Skills, Multidisciplinary Working & Networking


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Module A3:
Setting, communication and interviewing skills, multidisciplinary working & networking

Entry Scenario

The entry scenario addresses a variety of issues and problems associated with the module topic. It may be used at the beginning of the course to stimulate the students to identify their own needs and interests. The results may be utilized by the individual to assess own learning process, or be integrated with class objectives.

The director of your hospital thinks that it would be a good idea to have an adolescent clinic. Because he cannot decide if the clinic should be limited to outpatient care or if it should include some hospital beds, he asks you to prepare a project. He specifies clearly that the budget is very limited and therefore your project should use existing resources to the degree possible. Unless you have a better idea, he wants to situate the clinic in the pediatric ward.

General Goals for Learners
by completing the module the participant will be able to :

Describe the characteristics of adequate settings for adolescent inpatient and outpatient care
Describe and show proficiency in effective communication with adolescents
Skillfully use the interview to build partnerships with the adolescent patient and his/her parents
Demonstrate proficiency in building a multidisciplinary network and in managing effective communication within the network

Goal 1 : Describe the characteristics of adequate settings for adolescent inpatient and outpatient care

Knowledge

Training Objectives
Key topics to be covered

Educational Methodology

Activities, Issues, and Questions

Pertinent resources

A. Delineate the areas to be considered in the design of an appropriate setting for adolescent health care

staff
waiting room and literature
practice/clinic structure (geographical access, hours, billing)
scheduled time of visit
language
confidentiality policy

Mini lecture or group “discovery”

Discovery during group discussion: participants define adolescent-friendly and -unfriendly with examples taken from own experience, and compose a list of what would characterize an appropriate setting. Trainer guides discussion to include all topics listed under training objective A.

What should be the “minimum” characteristics of an appropriate adolescent facility?

Refs 1, 2, 3, 4

B. Recognize the particular importance of the staff…

attitude
role
motivation
values

Class discussion

What are the minimum staff requirements to efficiently run an adolescent-friendly clinic?

Define what would be the role of each person on the staff and what specific training is needed. Compare the importance of the physical setting versus the importance of the staff.

Skills

Training Objectives Key topics to be covered	Educational Methodology	Activities, Issues, and Questions	Pertinent resources
C. Constructively evaluate the qualities in an adolescent facility	On-site visits	If an on-site visit is not possible during the course, participants give examples from their own facilities of positive and negative features. What potential barriers can participants identify in the facilities? How could changes be made, and how would the results of these changes be assessed?	Refs 1, 2, 3, 4

Goal 2 : Describe and show proficiency in effective communication with adolescents

Knowledge

Training Objectives
Key topics to be covered

Educational Methodology

Activities, Issues, and Questions

Pertinent resources

A. Reflect on the aim of effective communication in adolescent health care

Class discussion

Class defines the hallmarks or criteria of “good” communication. What characterizes the atmosphere around “good” communication (eg. trust, respect, openness) and what is the health provider’s goal? (eg. Get/give information, “partnering”/directed health care)

Refs 5, 6, 7, 8

B. List health provider’s behaviors and attitudes that facilitate, or hinder, good communication with adolescents

Class discussion

Class draw up list of negative and positive behaviors and attitudes. Participants give tips from own experience about what works and what does not work in establishing a good rapport. Trainer guides discussion with list in appendix.

Appendix 1

Ref 8

Attitudes

Training Objectives Key topics to be covered	Educational Methodology	Activities, Issues, and Questions	Pertinent resources
C. Identify personal feelings and expectations regarding professional role as « communicator »	Self-awareness questions	What do you feel when talking to cynical or defiant teens? What do you think they expect from you and what do you expect from yourself? What makes you personally satisfied that the interaction was “good”? Does practitioner perceive him or herself as “authentic”?	Refs 7

Skills

Training Objectives
Key topics to be covered

Educational Methodology

Activities, Issues, and Questions

Pertinent resources

D. Create an atmosphere and establish rapport with an adolescent that is conductive to effective communication

Role-playing

Practice interviews with patients with feed-back and discussion with a tutor

Video-taped recordings of real consultations

Prior to role playing, participants formulate sentences, review gestures, and body language that might be used. Feedback from colleagues and from real or simulated patients is important.

Case study: John is a 15 year-old boy who has been dragged into your office by his angry parents. They have recently discovered that John has been skipping school during the last two months, blaming it on headaches. The parents suspect other things. John is equally angry and sullen, answering only with yes/no/ don’t know when you try to interview him.

Goal 3 : Skillfully use the interview to build partnerships with the adolescent patient and his/her parents

Knowledge

Training Objectives
Key topics to be covered

Educational Methodology

Activities, Issues, and Questions

Pertinent resources

A. Examine elements of skillful listening and questioning for use with adolescents

Lecture by communications specialist, readings, group discussion

Lecture should cover areas such as styles of listening and styles of questioning, as well as skills such as restatement, summation, and clarification. Apply theories to working with adolescents. Include definition of what is “developmentally appropriate” questioning.

Refs 5, 7, 8

B. Increase familiarity with existing interviewing tools

Mini-lecture on interviewing and demonstration of tools.

Topics: Purpose and parts of interview, bigger picture, hidden agendas.

Review of Five Boxes, HEEADSSS, SAFE TIMES

Self-administered questionnaires (CRAFT, AUDIT, etc)

Refs 9, 10, 11

Websites 1, 2

Attitudes

Training Objectives
Key topics to be covered

Educational Methodology

Activities, Issues, and Questions

Pertinent resources

C. Know how to interview parents

inclusion/exclusion in consultation with patient
parental expectations
techniques of reassurance

Small group work

Role play

Discuss when it is appropriate for the parents to be present, and when not, during the course of an interview with an adolescent. Develop strategies for seeing an adolescent alone. Discuss parental expectations and methods of reassuring parents.

Case study: The parents of a 14 year-old want you to perform urine screening because they suspect drug use. They don’t want the teen to know about it and they want you to tell the adolescent that it’s just to rule out a “urine infection”.

Ref 8

Skills

Training Objectives Key topics to be covered	Educational Methodology	Activities, Issues, and Questions	Pertinent resources
D. Conduct a developmentally appropriate interview. Elicit information and respond skillfully	Role-playing Practice interviews with patients with feed-back and discussion with a tutor Video-taped recordings of real consultations	Utilize interview tools. Assure that information obtained includes who asked for consultation, patient’s goals for consultation, hidden agenda, and emotional issues. Case study: A 14 year-old boy is suffering from a chronic headache that interferes with his school attendance; in fact he is bullied at school (hidden agenda). Case study: A 15 year-old girl with multiple piercing and tattoos is brought to you by her mother who thinks her daughter is using cannabis. When the mother tells you about it, the adolescent screams at her mother, “You are paranoiac; you see things that don’t exist!”
E. Increase skills for interviewing problematic patients	Small group work with role play	Participants list the kinds of patients and the kinds of parents that are a particular challenge to them personally (eg. uncooperative patient, depressed patient, aggressive patient, inappropriately talkative patient, sexy patient). Small groups help formulate strategies (sentences, gestures, comments), which are then role played. Discuss how the gender of physician and gender of patient is a factor. Case study: The parents of a 15 year-old asthmatic complain that he often refuses to take his medication. The adolescent claims that everything would be easier if his parents wouldn’t treat him as a child, and would let him take responsibility for his own medication.
F. Increase skills for communicating bad news	Small group work with role play	How do you communicate the diagnosis of insulin dependent diabetes to a 11 year-old or to a 17 year old? Compare similarities and dissimilarities in a group discussion	Ref 12
G. Use the interview for own purposes build relationships with parents/legal representatives and other significant adults as resources use interview of adolescent as opportunity to introduce prevention and health promotion messages.	Small group work with role play	Case study: A 15 year-old girl is being insulted by her peers in school. She does not know how to solve the problem and does not want to bother her family. How would you ask her permission to contact the school principal? Case study: An obese, sedentary adolescent comes for a regular check-up. Where in the interview will you introduce the topic of prevention?

Goal 4 : Demonstrate proficiency in building a multidisciplinary network and in managing effective communication within the network

Knowledge

Training Objectives
Key topics to be covered

Educational Methodology

Activities, Issues, and Questions

Pertinent resources

A. Appreciate the advantages of a multidisciplinary approach over an interdisciplinary approach

Interactive lecture

Presentation covers the following characteristics of the multidisciplinary approach, and compares it to the interdisciplinary approach:

global view of the problem
different professionals for different approaches
role of each professional
role of the “case manager”

Class examines case study in light of the approaches.

Case study: A 14 year-old girl who is sexually abused by her stepfather is admitted to the emergency room after a suicide attempt. Who should be involved in her follow-up?

Skills

Training Objectives
Key topics to be covered

Educational Methodology

Activities, Issues, and Questions

Pertinent resources

B. Build or contribute to a multidisciplinary network, and manage effective communication within the network (e.g. case management)

Class task

Role play

Class “brainstorm”, naming factors that need to be addressed when building a multidisciplinary network. Trainer observes that the following elements are covered: time constraints, common language among professionals, integration of different views and objectives, and inter-professional relationships.

Role play the case studies, showing sensitivity to the above issues.

Case study: A school nurse calls you because she has a 13 year-old student who is acting out. She knows that the girl has a difficult family background (father deceased, mother alcoholic). She has also contacted a social worker. How would you manage this situation?

Case study: A 16 year-old anorexic patient comes to the practice of a general practitioner. The girl explains that her gynecologist insists that she be put on oral contraceptives, while her psychiatrist is absolutely against it. How do you as the general practitioner manage the situation?

References

World Health Organization. Adolescent friendly health services – An agenda for change. WHO/FCH/CAH/02.12. WHO, 2002. Available at: http://www.who.int/reproductive-health/publications/cah_docs/cah_02_14.pdf
Mmari KN, Magnani RJ. Does making clinic-based reproductive health services more youth-friendly increase service use by adolescents? Evidence from Lusaka, Zambia. J Adolesc Health. 2003 Oct; 33(4):259-70.
Dickson-Tetteh K, Pettifor A, Moleko W. Working with public sector clinics to provide adolescent-friendly services in South Africa. Reprod Health Matters. 2001 May; 9(17):160-9.
Klein JD, Slap GB, Elster AB, Schonberg SK. Access to health care for adolescents: A position paper of the Society for Adolescent Medicine. J Adolesc Health Care 1992; 13:162.
Coupey SM. Interviewing adolescents. Pediatr Clin North Am. 1997 Dec; 44(6):1349-64.
Ehrman WG, Matson SC. Approach to assessing adolescents on serious or sensitive issues. Pediatr Clin North Am. 1998 Feb;45(1):189-204.
Hampton HL. Examination of the adolescent patient. Obstet Gynecol Clin North Am. 2000 Mar;27(1):1-18.
Woods ER, Neinstein LS. Office Visit, Interview Techniques and Recommendations to Parents. In Neinstein LS. Adolescent Health: A Practical Guide, 4th Edition, Lippincott Williams and Wilkins, Philadelphia , 2002.
Schubiner H, Tzelepis A, Wright K, Podany E. The clinical utility of the Safe Times Questionnaire. : J Adolesc Health. 1994 Jul;15(5):374-82.
Goldenting JM, Rosen DS. Getting into adolescent heads: an essential update. Contemporary Pediatrics 2004; 21 (1): 64-90.
Knight JR, Shrier LA, Bravender TD, Farrell M, Vander Bilt J, Shaffer HJ. A new brief screen for adolescent substance abuse. Arch Pediatr Adolesc Med. 1999 Jun;153(6):591-6.
Krauss-Mars AH, Lachman P. Breaking bad news to parents with disabled children: a cross-cultural study. Child Care Health Dev. 1994 Mar-Apr; 20(2):101-13.