1 About This Guide

PATIENT SKILLS DEVELOPMENT PROGRAMME Guide to Facilitator Training, Skills and Assessment

1 About this Guide

This Guide is written for people who are responsible for recruiting, managing or supporting facilitators on the patient skills programme.

The facilitators are the single most important resource for the programme. It is therefore essential that the right people are recruited and that they are appropriately trained, supervised and supported to fulfil their role.

This guide sets out: the core competencies of a facilitator standards for facilitator recruitment standards for facilitator training standards for running training for trainers standards for facilitator supervision and support support for self reflection ensuring the quality of facilitation quality assurance template

It is supported by a series of separate more detailed guides: guide for facilitators 3 Facilitator Manuals each covering the activities for the relevant module (see below) guide for programme leads guide to quality assurance participant Workbook and Handouts

All of the guides and further information about self management and self management support are available on our Resource Centre at http://www.health.org.uk/resource- centre/new-sms/. The Resource Centre also includes a wide range of resources that can be given to people with long term conditions to help them self manage and a wide range of resources to help those running Patient Skills Programmes. 12112 2 Core competencies of a facilitator

This section sets out the core competencies for Facilitators and Trainers of Facilitators. Those who are providing training to new facilitators should be able to demonstrate the same competencies, but at a higher level.

Competency Description Outcome measure / assessed by Manage and Because the workshops are interactive with Observation make effective a flexible number of participants on initial use of time timekeeping and time management is a training. core competence. Sessions start and finish Ongoing on time. -quality outcomes Participants report that they all had chance to participate.

Facilitators are able to adjust activity length to meet group needs whilst keeping to overall time Appropriate use The ability to support participants to set Observation of goal setting achievable and appropriate goals is a on initial fundamental competence for self training. management and to enable behaviour Ongoing change. quality outcomes Participants report that they were supported to set realistic and achievable goals Appropriate use Helping participants to analyse problems in Observation of problem their own everyday experience and when on initial solving and goal faced with difficulties is a core competency. training. follow up For participants, believing that progress can Ongoing be made and they have choices are key to quality improving perceived self efficacy and outcomes increasing activation.

Facilitators should be able to support participants to identify barriers to change and facilitate them to identify solutions

Understanding Facilitators should have a basic Observation by of the bio- understanding of the theoretical models trainers in psychosocial underlying the workshops. This will enable delivery of

Guide to Facilitator Training, Skills and Assessment 2/12 model of health them to understand the importance of core modules facilitation and coaching role. They should have a understanding of why the enablers are important and their application to all areas of a person’s life. Use a solution- It is important to have the skill and insight to PAM/increase focussed recognise when it is appropriate to work d self efficacy approach one-to-one as well as in a group. This approach may involve facilitating the group to focus on each issue as required. The focus should be on analysis and action planning mixing in ways that enhance wider learning. Participants supported in this way regularly achieve good outcomes. Create and Involves being non-judgemental and HEIQ quality maintain a safe inclusive by ensuring all participants have domain/attritio and inclusive time to be involved and no single person is n rates. environment allowed to dominate the group. The ability Observation of to challenge inappropriate behaviours and practice speech in a way that is respectful. Results in participants willing to recommend PSP to others and low attrition rates Group Management of group dynamics is a key Attrition rates facilitation and skill. It includes many of the other Observation by active listening competencies within it and skills such as trainers on skills managing group energy, group discipline initial training. according to agreed rules, being aware of All outcomes emerging dynamics between group members and the affects of these upon the individuals involved and others, being aware of individual moods and the effects of these on group feeling and progress.

The competence to manage the group is based upon valuing each individual and ensuring that they have equal access to the resources within the group.

Skills in observation and listening can be taught and learned.

Support and This is the ability to listen to the tone and Demonstrated encourage inflection of a person during goal setting and over 24 hour behaviour knowing when it is appropriate to encourage training and change by using raising or lowering of confidence levels, workshop motivational and adjustment of the goal and linking the goal delivery. coaching skills to importance and relevance to the person’s HEIQ/PAM during goal- life. Participants supported in this way will and other

Guide to Facilitator Training, Skills and Assessment 3/12 setting and goal- be able to make positive life changes outcome follow-up measures

Work in equal, The workshops are designed to run with two Demonstrated supportive facilitators working with the group at all over 24 hour partnership with times. Their relationship must potentially training HEIQ co-facilitator add value by modelling all the behaviours quality domain/ and skills being developed in participants observed by through the programme, in particular trainers modelling a equal partnership between a health professional and lay person and between them create a effective learning environment

Participants will see that the skills of lay people and health professionals are complementary with one not more important the other. Working Ability to frame participant and group Demonstrated understanding responses within a framework that enables over 24 hour of social the facilitator understand how to move training learning and people to a point of action Observed by self- trainers determination theory Be responsive Ensures that participants feel engaged and HEIQ quality to the needs of the content of the workshop is relevant to domain the group them. Underpinned by agenda setting. Participants report that the workshops were relevant to them

Make effective Facilitators should be able to adapt the Observation use of the materials to their own style whist adhering on initial materials to the core processes and content. A person training and observing a session should be able to follow first workshop where the facilitator is in the lesson plan.

Recognise and A key feature of making changes to health On 24 hour safely challenge behaviour involves working with participants training unhelpful health on recognising beliefs that may act as a Observation by beliefs barrier to change. This learned skill is a key trainers competence when trying to establish if the lack of engagement in exercise or dietary control is due to poor confidence, lack of knowledge or skill or a belief that it may aggravate their condition

This is not about challenging clinical advice but gently working with the participant to understand why they may not be willing to take on a new behaviour without blaming or undermining them in the group.

Guide to Facilitator Training, Skills and Assessment 4/12 Model/support Facilitators should model a self managed On 24 hour effective self- life with a long term condition, whether this training management is turning up on time, creating a safe and Observation by comfortable environment to work, being trainers aware of the wellbeing of others, addressing and tackling unexpected situations, managing momentum and direction in the work together, reflecting on progress and willingness to learn etc.

Guide to Facilitator Training, Skills and Assessment 5/12 3 Standards for facilitator recruitment

There is an open and fair recruitment process for facilitators There is a Recruitment Pack provided to everyone who expresses an interest It is preferable, but not essential, that those selected to become facilitators have themselves attended the programme. Those expressing an interest are required to provide relevant information that enables short listing to take place Those short-listed are interviewed against required competencies References are taken up All candidates are sent a letter informing them of whether they have been accepted as a facilitator Those accepted receive an induction to organisation An Enhanced Criminal Records Bureau (CRB) Check is undertaken Each person is provided with a named supervisor who will support them

4 Standards for facilitator training

Training: potential facilitators attend a minimum of 24 hours training to fulfil their role through the training, potential facilitators demonstrate competence in core self care skills, including goal setting, goal follow up, problem solving in the training, potential facilitators Practice delivery skills and receive and act on feedback given

Assessment of competence: facilitators must deliver their first patient skills workshop within 3 months of initial training facilitators are observed on first course they deliver and receive feedback against core self care competencies of needed, additional training and support is provided facilitators are accredited to deliver the course following the successful delivery of their first 3 workshops and proof of satisfactory quality outcomes.

5 Standards for the on-going monitoring and development of facilitators

On-going monitoring and development facilitators keep a personal learning log on an on-going basis ongoing monitoring based on attrition rates and participant feedback and outcomes there is regular monitoring of quality outcomes and attrition rates facilitators receive annual skills development and update facilitators receive regular supervision

Guide to Facilitator Training, Skills and Assessment 6/12 6 Standards for running training for trainers

Not only is high quality facilitation key to the effectiveness of the programme for participants, but also facilitator training is a form of intervention in its own right and can have a significant impact on the lives and health of the trainees. It is therefore vital to the quality and integrity of the programme that those who are providing training to facilitators, providing supervision and signing facilitators off as competent to deliver, themselves have sufficient skills, knowledge and expertise in self management.

Trainers of facilitators and those carrying out supervision, observing and supporting new facilitators should have extensive experience of programme delivery themselves.

Recruitment of trainers: nominated individuals to have delivered minimum 5 SMP Programmes those expressing an interest are required to provide relevant information that enables short listing to take place those short-listed are interviewed against required competencies all candidates are sent a letter informing them of whether they have been accepted as a facilitator trainer each person is provided with a named supervisor who will support them

Training for trainers each trainer co-delivers a ‘training for facilitators’ course with an experienced trainer

Assessment of competence each trainer is the lead in delivering‘training for facilitators’ course, during which they are observed and assessed against core competencies set out in section 2 above if needed, additional training and support is provided facilitators are accredited to deliver the course following the successful delivery of their first course and proof of satisfactory quality outcomes.

On-going monitoring and development there is regular monitoring of quality outcomes and attrition rates trainers receive annual skills development and update trainers receive regular supervision

7 Standards for supervision and support

All self management facilitators should have access to regular supervision both one to one and group, which covers skills development, quality assurance, personal and professional development and training and which allows the facilitators to reflect on their and continue to develop core skills.

Group Supervision / Skills Events

Guide to Facilitator Training, Skills and Assessment 7/12 You should provide a minimum of one event a year which facilitators attend as a group. The event should: provide skills development and training based on learning needs allow facilitators to compare practice include information on programme changes- facilitators should be involved in any changes share evaluation and quality data

Individual Supervision Sessions You should provide on-going individual supervision, which: provides support where there are issues with group participants or group dynamics reviews participant feedback with the facilitator to support the identification of further training addresses individual training and development needs, as well as being an opportunity for two way feedback identifies problems that have been encountered on either side and how these might be resolved supports the development of productive relationships with others supports time management

Access to supervision is particularly important when the facilitator may have concerns about difficult behaviour in a group. A named person should always be on-call when workshops are running, to help the facilitator resolve any issues.

You may find it useful to use the following grid to ensure that you track the training and support you are providing to your facilitators:

Name Healthcare Date Date refresh Date of last Leave Average no. Profession training training supervisio date of courses al or lay complet completed n delivered facilitator? ed per year

8 Support for self reflection

Continued learning and development is essential to all facilitators and reflecting on their experience is an important component in this. Making some key reflective notes following

Guide to Facilitator Training, Skills and Assessment 8/12 each workshop can begin to identify areas where progress is being made and where skills need further development. These reflective notes can then form the basis for supervision and for identify support needs

This six step process can be a helpful tool:

Experience What was my experience here- what happened?

Feelings How do I/did feel?

Evaluation What was good? What was difficult?

Analysis Why?

Learning point What can I learn from this?

Learning process How do I/did learn it?

Action Planning What will I do differently

9 Ensuring the quality of facilitation

The facilitators and the quality of the facilitators are the most important resource for the programme. It is therefore essential that the right people are recruited and that they are appropriately trained, supervised and supported to fulfil their role.

Effectiveness of facilitator recruitment, training and support is a key aspect of ensuring the quality of the programme. The diagram below shows how ensuring the quality of facilitator recruitment, training, supervision and support should form part of a wider approach to quality assurance.

Guide to Facilitator Training, Skills and Assessment 9/12 Guide to Facilitator Training, Skills and Assessment 10/12 10 Quality Assurance Template

We have set out below a Quality Assurance Template, to help you quality assure the facilitator aspects of your programmes.

Facilitator training Ref Question Yes No Evidenced by 26 Are the necessary experience and/or qualifications required of facilitators clear and used in the recruitment process 27 Are new facilitators given an induction? 28 During training, do the new facilitators have the opportunity to observe programme delivery by a qualified facilitator? 29 Is all training recorded? 30 Do new facilitators receive written feedback?

Facilitator supervision and support Ref Question Yes No Evidenced by 15 Do the facilitators’ have access to regular supervision? 16 Is there a clear process for facilitator accreditation? 17 Are those involved in providing training, accreditation and supervision of facilitators suitably qualified and experienced in self management and developing facilitators? 18 Do facilitators have a CRB cheque 19 Do facilitators where volunteers have a clear volunteer policies in place 20 The model of volunteer/professional co facilitation at the heart of the model. How much of the course are volunteer facilitators trained to deliver and what is the mechanisms for supporting this?

11 Further Resources

Guide to Facilitator Training, Skills and Assessment 11/12 There are a wide range of further resources available through The Health Foundation’s Self Management Support Resource Centre, at http://www.health.org.uk/resource-centre/new- sms/patient-skills-programme/resources/.

The Quality institute for self management education and training has a range of standards for self management education www.qismet.org.uk.

For further information: Tel: 0207 257 800 www.health.org.uk

Guide to Facilitator Training, Skills and Assessment 12/12