participant manual · use style that’s curious, accepting, and eliciting. “congratulations on...

Motivating Change in GroupsParticipant Manual

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Participant Manual, 5th edition Visit online learning programs at kphealtheducation.org

The contents of this workbook may not be reproduced in whole or in part in any form or by any means without written permission from Regional Health Education, The Permanente Medical Group, Inc.

©2016 The Permanente Medical Group, Inc. All rights reserved.

Contents

Overview

Health Behavior Change Tree 2

Adult Learning & Behavior Change

Adult Learning: Telling Isn’t Teaching 4

Effective Visual Aids 5

Behavior Change: Personal Experience 6

Stages of Change 7

Behavior Change 8

Activity: Promoting Behavior Change in Groups 9

Learning and Change: Moving toward Success 10

Change Talk 12

Assessing Readiness 13

Tools for Planning & Developing Content

Participant Profile 15

Content Organizing Tool 16

Facilitation Style

Personal Style 18

Ask, Listen, Summarize 22

Involving Participants 0

Open Ended Questions 25

Managing Involvement Activities 27

Managing Challenging Situations 28

Personal Growth & Journaling Worksheets

Personal Growth and Development 34

Personal Growth and Journaling Worksheets 35

Appendix 36

2

Health Behavior Change Tree

ADULT LEARNING & BEHAVIOR CHANGE

Organizing Content

Facilitation Style

Involving Participants

3

What elements of curriculum design have enhanced your learning?

Reflecting on your learning experiences, what percentage of information does a person remember after hearing a lecture?

%

If you add audio-visual materials? (e.g., slides, videos, props)

%

If people are involved in a learning activity? (e.g., group activity, brainstorm, demo)

%

Implications

Based on what you currently know about how people learn, how would you design a curriculum to best support learning?

Personal Experience


4 ADULT LEARNING & BEHAVIOR CHANGE

Adult Learning: Telling Isn’t Teaching

People learn best when:

• They want to solve a problem.

• Content is connected to something familiar.

• They are in charge of their own learning.

• They are actively involved in the learning process.

5ADULT LEARNING & BEHAVIOR CHANGE

Effective Visual Aid

Creating Effective Visual Aids

• Use bold colors, simple images and white space. Glitzy busy visuals will compete with, not support your message.

• Limit content to 3 main points to increase retention. Make the points brief. Use phrases or main points, not complete sentences.

• Use readable lettering. The size of your lettering must be visible and readable by all of your audience.

Using Visuals Aids

• Use visuals only as support. The visual should aid in clarifying and enhancing your presentation. If it doesn’t, then consider not using it.

• Pick the appropriate visual to meet your objectives.

• Stand away from your visual and always face the audience.

• Practice using the visual before class to increase your confidence and comfort level. Assume that things could go wrong, and be prepared.

REMEMBER ... You are your most important visual aid.

6

Behavior Change: Personal Experience

Think about a time you made a health behavior change – a change you’ve maintained for at least one year.

1. What change did you make?

2. What motivated you to make the change?

3. How did you prepare to actually make the change?

4. What setbacks did you experience while making the change?

5. What strategies and techniques did you use to maintain the change?

6. Did you have the help and support of someone else in making and sustaining the change? If so, what did this person say or do that was most helpful?

6 ADULT LEARNING & BEHAVIOR CHANGE

When are people most likely to make a change?

7

Stages of Change

7

How might the Stages of Change Model influence your facilitation or teaching?


Relapse & Recycle

Action

Preparation

ContemplationPre-contemplation

MaintenanceHabit

Adapted from Prochaska & DiClemente’s Transtheoretical Stages of Change Model

8

Behavior Change

ADULT LEARNING & BEHAVIOR CHANGE8

People are likely to change when:

• They believe the outcome is worth the effort needed to change.

• They are confident that they are capable of making the change.

• They have positive social support.

• They accept change as a process with relapse and changing levels of commitment as common events.

• They feel physically and emotionally ready to change.

9

Activity: Promoting Behavior Change in Groups

ADULT LEARNING & BEHAVIOR CHANGE 9

Facilitator Skills What Facilitator May Say

Affirm strengths, efforts, and past successes of participants.

Use style that’s curious, accepting, and eliciting.

“Congratulations on trying [insert behavior] out.”

“You worked hard to put this plan into action.”

“You’ve learned that triggers are important to your success with walking.”

Ask questions to elicit change talk.

Listen and reflect change talk and feelings.

Promote autonomy. Acknowledge participant’s choice in making changes in the way that’s best for their life.

Normalize the change process and relapse.

Discuss how to make change: small steps, setting up environment for change, having support, creating rewards.

10

Learning and Change: Moving toward Success

ADULT LEARNING & BEHAVIOR CHANGE10

Less Effective Education

• Lecture - information oriented

• Lack of involvement and control

• Lack of link to experience and current knowledge

• Tedious repetition

• Unsolicited advice and information, paced according to educational content

Education for Change

• Learner involvement and control –participant oriented

• Allows for group problem-solving and peer support, builds self-efficacy

• Builds on past experience, knowledge

• Varied format

• Information, advice, and pace tailored to participant need

Not Ready for Change Ready for Change

• Believe the change is too difficult • Believe that outcome is worth the effort

or not worth the effort • Social support

• Lack of social support • High level of self-efficacy

• Low level of self-efficacy • Realistic goals/attainable action

• Unrealistic goals • Willingness to begin again if relapse • Derailed by relapse occurs

1111ADULT LEARNING & BEHAVIOR CHANGE

Change Talk

Recognizing Change Talk

Change talk is any language that the patient says as an argument for change. The patient’s statements will fall into 2 categories, using the acronym DARN CATS (Miller and Rollnick, 2013).

Preparatory Change Talk indicates early change language:

Desire (for change)

Ability (to make change)

Reasons (to make change)

Need (for change)

Mobilizing Change Talk indicates the person is closer to making a change:

Commitment (to change)

Activation (leaning toward taking action)

Taking Steps (toward change)

Examples of Change Talk

“I really want to get my blood sugar under better control. Paying more attention to my diet should help. (Desire)“

“I’ve walked in the past and I know I can do it. (Ability)“

“If I don’t start taking my medicine regularly, I’m going to wind up in the emergency room again. I really don’t want that to happen. (Reasons)“

“I think cutting back on alcohol would help me feel better. (Reasons)“

“I need to sleep more. I’m falling asleep in the middle of my day. (Need)“

“I will quit smoking to set an example to my children. (Commitment)“

“Once I sit down tonight and make myself a specific schedule, I’ll be able to keep up with regular exercise. (Taking Steps)“

Importance of Change Talk

When people verbalize their motivation for change, they are more likely to attempt and succeed in making behavior change (Miller & Rollnick, 2002). We know that people are more strongly influenced by what they hear themselves say than by what others tell them (Bem, 1972). Our primary aim as clinicians/facilitators is to assist people to talk themselves into making a positive change.

12 ADULT LEARNING & BEHAVIOR CHANGE12

Change Talk

Eliciting Change Talk

Within a group, there is often a wide range of readiness and ambivalence (feeling two ways) toward making behavior changes. You can guide your participants toward change by using a neutral, curious style to elicit change talk. During group discussions, some participants may spontaneously offer change talk. As a facilitator, you can elicit change talk asking strategic open ended questions. You can elicit more change talk by reflecting the participants’ change language or by asking more about it.

Tips for Success

• Communicate a non-judgmental and empathic stance.

• Ask strategic open-ended questions, for example:

How might your life different if you made this change? (Desire)

Tell me what you want to be different in the future. (Desire)

If you decide to do this, how might you go about it? (Ability)

What are your ideas for how you could make this change? (Ability)

What are some reasons for you to consider this change? (Reasons)

What would be some advantages of making this change? (Reasons)

Why is this change important to you now? (Need)

What needs to happen for you to do this? (Need)

• Use reflective listening to encourage patients to continue to talk about and explore their issues / attitudes / plans / concerns.

• Invite the patient to elaborate on change talk by asking, “What else?”

• Allow silence: Give participants time to think and consider on a deep level and express their insights.

Heading

13

Assessing Readiness

Overview

Assessing readiness helps the clinician and the patient to gauge how ready the patient is to consider adopting a new behavior. The readiness ruler is an efficient tool for measuring how a patient feels about making a change. Exploring readiness helps the patient uncover and build his/her motivation for change and guides the clinician to effectively tailor the intervention to support movement toward change.

Goals

• To assess the patient’s level of readiness to adopt a new behavior

• To elicit change talk

• To assist the patient to identify positive aspects of the behavior

• To assist the patient to identify barriers to success

• To mirror for the patient his / her thoughts and feelings about the behavior

Tips for Success

• Try the ruler! Think of motivation as a vital sign and the ruler as a way to measure it.

• Demonstrate a neutral stance throughout this process with your language, tone, and body language

• Ask the straight question to understand the patient’s perception of the readiness number chosen. The patient’s five might be your three!

• The backward question is a simple way to elicit change talk. This question invites the patient to consider the reasons making a change might be important for him/her.

• The forward question can help to identify barriers to success. It can also help the patient begin to imagine what it would be like to make the change

• When summarizing, begin with the ideas that support the current behavior and end with the ideas that support movement toward change - -this can help enhance motivation.

• Remember, the ruler starts with zero. When asked to rate their readiness, people will rarely pick a zero. This allows you room for the backward question, “Why a 1 and not a zero?” to elicit change talk.


14 ADULT LEARNING & BEHAVIOR CHANGE14

Assessing Readiness

• Ruler or Readiness Scale 0 - 10

• Straight Question: Why a 5?

• Backward Question: Why a 5 and not a 2?

• Forward Question: What would need to be different for you to move from a 5 to a 7 or 8?

• Summarize

10 2 53 4 6 7 8 9 10

Not at all ready Completely ready

EXAMPLE:

Provider So walking is of interest to you. To help us both get a picture of how you feel about beginning a walking program, I have a ruler here that goes from zero to ten. If zero is not at all ready and ten is completely ready, how ready would you say you are right now to begin a regular walking program?

Patient Hmm ... I guess I’m a five

Provider What does a five mean to you?

Patient Well, it seems like a good idea, but I’m not sure how I’d find the time. I know you said I’d start out slow, but knowing I’d eventually need to find an hour a day ... I don’t know.

Provider So it’s hard to know when you’d fit it in. And, you picked a five and not a three. Tell me about that.

Patient I know I need to get this blood pressure down! I don’t want to worry about a heart attack or stroke.

Provider It sounds like managing your blood pressure is important to you. What would it take to move you up a bit, say to a seven or eight?

Patient I don’t know ... maybe it would be easier to start next month, after I finish this big project I’m doing at work.

Provider So you’re pretty busy and it’s hard to imagine fitting in the walking. But you would like to get your blood pressure under control and not have to worry about your health. You think you would be most successful if you start a walking program after you finish your big project at work. Did I get it all?

Patient Yes, you sure did.

15TOOLS FOR PLANNING & DEVELOPING CONTENT 15

Participant Profile

A critical “prep step” for any type of presentation or group facilitation is knowing your audience. Consider talking with colleagues or others who know the group well to help you develop the participant profile.

Who is my audience? • Patients?

• Colleagues?

• Administrators or leaders?

• Others?

• Homogeneous or mixed?

What are their characteristics? • Demographics?

• Knowledge level?

• Experience?

• Size of group?

• Specific diagnosis?

What are their attitudes? • Are they eager to participate?

• What are their expectations?

• What resistance might they have?

So what? • How does the Participant Profile affect your curriculum design?

• How might you overcome resistance?

• What are the implications for your content delivery?

• How does the Participant Profile influence your choice of involvement activities?

Bridge to Content Planning

16

Content Organizing Tool

TOOLS FOR PLANNING & DEVELOPING CONTENT 16

Topic: ___________________________________________ Time: ___________

Position

• Why is this topic important?

• Where do you stand? Why?

• What do you believe? Why?

Benefits

• Why should participants listen to you?

• What will participants get from your time together?

Actions

• What do you want participants to do today?

• What do you want participants to do beyond today (next steps)?

Position

• Restate why the topic is important from your point of view

Benefits

• Review the benefits from the participants’ point of view, including points brought out by participants during discussions and activities

Actions

• Summarize what you are asking patients to accomplish

• Express confidence

OPENING: Tell them what you are going to tell them.

BODY: Identify and develop main points that support your position.

CLOSING: Summarize. Tell them what you told them.

Key Points Sub Points Involvement Activities

1. a.

b.

c.

2. a.

b.

c.

3. a.

b.

c.

17

Older Adults & Physical Activity

Position

• Physical activity important at any age

• exercise enhances health and well-being

Benefit

• Numerous physical and psychological benefits

• Improved quality of life

Action

• Assess current level of activity

• Develop personal plan for activity over next 2 weeks

Key Points

Exercise benefits are numerous

Sub Points

• Increased energy

• Decreased blood sugar

• Improved immune function

• Improved balance & strength

Involvement Activities

• Video “Why Exercise?”

• Q & A : encourage patients to share personal experiences with benefits from exercise

Content Organizing Tool

Topic: ____________________________________

OPENING

BODY

Content Organizing Tool - Example

17TOOLS FOR PLANNING & DEVELOPING CONTENT

Defining exercise • Types of activities

• Duration of activities

• Intensity of activities

• Making daily activities/ chores count

• Adapting and personalizing activities

• Participate in 5 minute of “chair dancing”

• Elicit ideas from group

Developing a plan for regular exercise

• Barriers

• Strategies for success

• Rx for exercise:

F – frequency

I – intensity

T – time of day

T – time per session

• Discuss barriers and how to overcome them

• Specify short and long-term goals

• Fill in personal FITT Rx and share with group

• Group problem-solving/support

Position

Exercise one of the best things you can do to stay healthy

Benefits

Improved quality of life

Action

Confident when the time is right for you to carry out your plan, you will find a way to make it work for you.

CLOSING

18

Personal Style

Supporting Learning & Change

Empathy Listen, summarize and reflect. Respond genuinely, focusing on the participants’ experience. Pay attention to verbal and non-verbal cues that reveal participants’ positions. Be aware of your own issues and don’t react if your buttons get pushed.

Acceptance Accept behavior or viewpoint without condoning or agreeing. Be non-judgmental & neutral. Understand that resistance & ambivalence are part of the process and welcome them.

Collaboration Engage participants as experts in developing strategies that will work for them. Support personal choice.

Self-efficacy Express confidence.

Respect Treat all participants with respect – listen, summarize, no put downs or criticism, follow group agreement.

Choice Reinforce that change is a choice that always resides with the individual. The individual knows what is best.

Interactive Emphasize involvement over information delivery. Increase involvement; decrease content.

Safety Create a safe environment where participants feel comfortable exploring new ideas and contemplating change.

FACILITATION STYLE

Personal Style

19

Delivering Your Message

Posture What participants notice first. Stand tall & breathe. Ready position.

Movement Movement can help you manage the group and your nervous energy. Use purposeful movement. Move, pause, move. Reflects confidence and control. Frees you from podium or overhead projector. Creates visual variety.

Gesture Reinforces message and paints a picture, accentuates a point. Vary gestures to keep listeners interested. Make gestures congruent with your message. Start from ready position, gesture, return to ready position. Avoid distracting, repetitive gestures. Avoid common pitfalls – prayer position, thumb twiddler, hands in pockets, fig leaf, Venus de Milo, sergeant, stuck elbows, heel grinder.

Eye Eye contact communicates sincerity, honesty, and confidence. Lasts about 3 seconds Communication or until a sentence or thought is completed. Avoid sprinkler effect, looking above participants, slow blink, orphans. May be appropriate to shorten eye contact when asking a question. Be culturally appropriate.

Voice Your voice is the vehicle of your message. Speak slowly & clearly. Use appropriate tone.

Pause Helps listeners absorb what you just said and get ready for next point. Adds emphasis to an important point. Takes place of filler words such as “um”. Allows you time to breathe and prepare for next point!

Facial Smile! Keep facial expressions consistent with your message. Expressions

FACILITATION STYLE

20

Heading

20

Personal Style

FACILITATION STYLE

• Empathetic

• Non-judgmental, respectful

• Curious

• Genuine interest

• Quiet, eliciting stance

• Collaborative spirit

• Emphasis on choice

• Coercing, Arguing, Imposing

• Blaming, Shaming, Criticizing

• Judging, Labeling, Warning

• Commanding, Threatening

• Moralizing, Preaching, Lecturing

• Assuming the expert role

• Overriding the patient’s agenda with your own

Introductory content: Susan to write

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21

Heading

21FACILITATION STYLE

Personal Style Assessment

Consider each style element below. Do you do this easily, would you like to work on it, or is it something that doesn’t fit your style?

Empathy • Listen and reflect ❍ ❍ ❍ • Respond with a focus on participants’ experience and interpretation

Acceptance • Accept points of view without condoning ❍ ❍ ❍ or agreeing with it • Set aside judgment & communicate an open neutral stance

Collaboration • Engage group in problem solving ❍ ❍ ❍

Self-Efficacy • Affirm positive efforts ❍ ❍ ❍ • Express confidence in ability to make change when group members are ready

Respect • Recognize group’s wisdom & experience ❍ ❍ ❍

Choice • Support personal choice of group members ❍ ❍ ❍

Interactive • Emphasize involvement over information ❍ ❍ ❍ delivery. Consider the groups needs and interests ahead of delivery content

Safety • Create safe environment for group to explore ❍ ❍ ❍ ideas & consider change

What do you like about your style? What might you do differently?

If you choose to, identify one style aspect to work on in your Day 2 teaching session.

Posture • Use the ready position ❍ ❍ ❍

Movement • Move with purpose ❍ ❍ ❍ • Use movement to manage group & burn off nervous energy

Gesture • Use gestures to reinforce message ❍ ❍ ❍ & provide visual variety • Limit distracting gestures

Eye • Connect with group as appropriate ❍ ❍ ❍ Communication using 3-6 second guideline

Voice • Modulate voice with content. ❍ ❍ ❍ • Utilize Pause to emphasize points & create transitions.

INTERESTED INWORKING ON THIS

FEEL CONFIDENT

NOT MY STYLE

Learning & Change

Delivering Your Message INTERESTED INWORKING ON THIS

FEEL CONFIDENT

NOT MY STYLE

Heading

22 FACILITATION STYLE

The key to solving

any problem is asking the right

questions.

Albert Einstein

Ask - Listen - Summarize

Ask

• Using questions effectively is a learned skill that requires time and practice to develop.

• Ask questions strategically. Understand the purpose for asking a particular question and know where you want the responses to lead the group.

• Both open and closed ended questions are useful when facilitating a group. Each has a specific purpose.

Closed Ended Questions can be answered with “yes”, “no”, or a brief reply (one or two words), and are useful for eliciting specific information.

Examples:

“What time do you take your medication?”

“Do you have a history of heart disease?”

“Have others in the group found it challenging to maintain an exercise program?”

Open Ended Questions are generally thought-provoking and encourage reflection or analysis on the part of the respondent.

Examples:

“What are your ideas for ________________________________________ ?”

“Why might you choose to ________________________________________ ?”

“What have others in the group done to ______________________________________ ?”

23FACILITATION STYLE


Listen

• Listen without interruption.

• Listen with empathy.

• Pay attention to body language, facial expression, and other non-verbal communication.

• Use reflective listening / short summary to let patient know he has been heard. Restate, paraphrase, or reflect emotional content of response as appropriate to validate the participant’s experience and support your point.

Examples:

“It sounds like you are feeling ________________________________________.”

“What I’m hearing you say is ________________________________________.”

“So on the one hand ________________________________________, and on

the other hand, ________________________________________.”

Check in for clarity and understanding.

Examples:

“Did I get it all?”

“Is my understanding accurate?”

“Is there anything else?”

24

TOOLS FOR PLANNING & DEVELOPING CONTENT 24


Summarize

• A skill that requires careful listening and synthesizing of participant responses.

• Helps participants know they have been heard.

• Ties participant responses back to the point of the discussion and heighten understanding.

• Brings closure to a discussion and/or bridges to the next topic.

Examples:

“As we can see from the experiences you have shared, there are many activities that can help us stay fit for life. One might choose to (list activities shared by participants).

In addition, we have discovered that it can be difficult at times to stay with an exercise

program, but some excellent ideas for staying on track were offered. They include

________________________________________. A few other ideas you might find useful are

________________________________________. Now that we’ve had a chance to look at

types of activities and strategies for exercising regularly, we can move on to developing

personal action plans.

INVOLVING PARTICIPANTS 25

Open Ended Questions

Plan and Ask• Identify your point

• Formulate and ask an appropriate question

• Pause to allow participant response

Listen and Respond• Short summary – reflective listening

• Clarify – probe further, ensure understanding

• Comment – add detail as needed, bridge to next response

Summarize and Conclude• Long summary – weave together several responses

• Tie back to your point - add detail and emphasis as needed

• Bring closure to discussion, restating benefits and objectives

1

2

3

26

INVOLVING PARTICIPANTS26

Activity: Open Ended Questions

Practice designing strategic open ended questions that link to a point that you would like to make with your group.

1. Identify a point you’d like to make in your practice teach.

2. Design a question to elicit appropriate responses from your participants.

3. Test your question by practicing with your small group. Does your question elicit the responses that reinforce your point?

Example:

You are teaching a class on Healthy Eating and would like to open section on dining out.

What is your point? You may want participants to develop criteria for selecting low fat menu items.

Next, what question could you use to guide the participants to your point?“When you eat out, how many of you try to select low fat items?” (close ended)

“When you look at the menu, how do you decide which items are low fat?” (open ended)

My topic: ______________________________ My point is: ______________________________

My open ended question is: _______________________________________________________

_________________________________________________________________________________

In your small group:

• Ask your open ended question

• Listen and respond

• Summarize and tie back

27INVOLVING PARTICIPANTS 27

Managing Involvement Activities

Introduce• Create a climate of safety and choice

• Set the time

• State objectives clearly

• Give complete instructions

• Answer any questions about the activity

Managee• Monitor time, adjust as needed

• Monitor progress, offer assistance as needed

• Stay on track, ensure that objectives are met

Conclude• Discuss and debrief the activity

• Summarize and state the key points

• Re-state the objectives and benefits

1

2

3

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Susan will purchase

28 INVOLVING PARTICIPANTS28

Managing Challenging Situations: Prevention

Set the tone• Establish ground rules if necessary

• Clearly define the purpose of the group

• Begin and end on time

• Treat all participants with respect and empathy

Address Logistics• Ensure appropriate room size and configuration

• Ensure audio visual equipment is functioning properly

• Have all materials ready and easily available

• Acknowledge any logistical deficits

Model Appropriate Behavior• Listen attentively

• Respond with respect and empathy

• Encourage collaboration

• Remain non-judgmental

• Express confidence

29INVOLVING PARTICIPANTS 29

Managing Challenging Situations: Intervention

Awareness• Notice the behavior

• Evaluate the impact of the behavior on the group

Response• Identify your internal reaction and judgment

• Reframe your reaction if necessary

• Focus on the needs of the individual and the group

Management• Acknowledge and validate – use reflective listening

• Touch or move physically close

• Ask open-ended questions for clarification

• Deflect: summarize and move back to the topic

• Use the group to increase understanding of the bigger picture

• Offer to talk with the person at a later time

• Seek support or help as needed

1

2

3

30

Managing Challenging Situations

INVOLVING PARTICIPANTS

Argumentative, combative

Challenges instructor or group member statements, negative and disruptive

• Keep your own temper firmly in check. Discourage the group from escalating this behavior. Maintain and model a calm voice and posture.

• Acknowledge the concern, then deflect back to your main points.

• Focus on a positive aspect of the question or statement and bridge to your points or solicit comments from others.

• Yes, and …” vs. “Yes, but …”

• Open it up to the group for comment.

• Offer to talk with him at a break so the group can move forward to meet objectives.

• Stop all proceedings, silently waiting for group to come to order.

• Ask if they have some ideas on the subject to share with the group.

• Acknowledge the points made then ask, “What do others think about this?

• Reduce eye contact, increase physical distance.

• If talking over another participant who is trying to make a point, pause a moment and ask the group, “Can everyone hear her response?”

• If ground rules were set, refer to them: speak one at a time, respect others, etc.

• Take the blame: “Something I said may have led you off the subject. What we need to focus on right now is ...”

• Watch carefully for any signs that the person wants to participate (body language) call on the person if he indicates permission (nodding, raising a hand).

• Talk with him at break – find out how he feels about the class. Solicit experiences/ knowledge he may have to contribute to the group and ask if he’d be willing to share it after the break.

• Respect the wishes of the person who truly does not wish to talk: this may be his preferred learning style.

Talkative

Carries on private conversations, excessive talking unrelated to the topic at hand, dominates discussions

Silent

Does not speak in discussion, avoids involvement in activities

Behavior Management Strategies

31

Managing Challenging Situations

INVOLVING PARTICIPANTS

Overly helpfulGenuinely trying to help, but dominates and cuts others out

• Thank her and invite others to participate.

• Use her for summarizing.

• Pair her with a quiet participant with a suggestion to try to help him become more involved.

• Give her a specific task.

• Find one link from the participant’s response that can tie back to the main focus of the group. Re-state the focus and move on to another participant.

• Thank the person for an interesting point of view, re-state the point and move on.

• Take the blame. “Something I said must have led you off track a bet. Your ideas are interesting; however it is important that we focus on _____________________ today.”

• Approach him and raise the level of your voice a bit to get his attention.

• Arouse his interest by asking for his opinion.

• Check with him at a break – is he tired, bored, timid? Seek to understand and meet his needs .

• Assign him a specific activity or role in the group.

• Don’t bluff if you don’t know the answer. “I don’t know, but I’ll find out.”

• Redirect to the group. “Does anyone in the group have a response to this question?”

• Suggest resources he might use to research the answer – invite him to share the results with the group later.

• Offer to discuss his concerns at a break and return to your point.

• Have tissues at hand, silently offer the box of tissues and move on to focus on other participants while the crying person regains a calmer state.

• Acknowledge that it’s okay to cry – having a chronic condition can be challenging – move on to your next point.

• If the participant is very distraught or is distracting the group, have your co-facilitator take the person to another location and assist her there, or call a break and offer your assistance.

Behavior Management Strategies

TheorizingDiverts from the subject, gets on a pet idea or irrelevant personalexperience, gets group off the subject

SnoozingFalls asleep, engages in unrelated tasks(checking a cellphone, reading a newspaper, etc.)

Excessive QuestioningAsks a lot of questions, some of which may be irrelevant and designed to challenge or “stump” the leader

CryingDiscussion may bring up painful emotions

Heading

32 INVOLVING PARTICIPANTS


Managing Challenging Situations Worksheet

CHALLENGING ACTION OR BEHAVIOR

POSSIBLE REASONSFOR BEHAVIOR

FACILITATOR'S INTERNALREACTION AND

REFRAME OF REACTION

FACILITATOR'SMANAGEMENT

STRATEGY

33INVOLVING PARTICIPANTS


Managing Challenging Situations Worksheet

CHALLENGING ACTION OR BEHAVIOR

POSSIBLE REASONSFOR BEHAVIOR

FACILITATOR'S INTERNALREACTION AND

REFRAME OF REACTION

FACILITATOR'SMANAGEMENT

STRATEGY

PERSONAL GROWTH AND JOURNALING WORKSHEETS34

Personal Growth and Development

• Write several comments you would like learners to say about you after teaching. Be specific about qualities or behaviors you would like your learners notice about your facilitation skills and style.

• Review this list before leading a group. Consider using the list to assist you in setting your intention for the experience.

• Add to the list as you identify new areas of focus for your growth as a facilitator.

An ounce of practice is worth more than a ton of preaching.

Mahatma Gandhi

Personal Growth and Journaling Worksheets

PERSONAL GROWTH AND JOURNALING WORKSHEETS

What did you like about your teaching?

What might you do differently in the future?

What did you learn from others?

What opportunities exist to practice in your personal or professional life?

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Learning Pyramid: Retention

APPENDIX

Lecture 5%

Reading10%

Audio Visuals 20%

Demonstration 30%

Group Discussion 50%

Practice 75%

Teach Someone Else or Use Immediately

90%

NTL Institute for Applied Behavioral Science, 300 N. Lee Street, Suite 300, Alexandria, VA. (800) 777-5227.

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Curriculum Review Checklist

APPENDIX

Use this checklist as you design curricula that incorporates adult learning and behavior change principles.

1. Are there clear openings and closings for each section with your Position-Benefit-Action statements?

2. Does each section contain approximately three main points and sub-points?

3. How does the curriculum engage participants? What involvement activities are included?

4. Is there too much content? How could you reduce content and increase involvement?

5. How is adult learning supported? ❍ Learner involvement & control❍ Content connected to something familiar❍ New information reviewed, reinforced❍ Group problem solving and peer support encouraged.❍ Informa tion, advice, & pace tailored to participant need❍ Varied format❍ Other?

6. How is behavior change encouraged? ❍ Ambivalence normalized and explored❍ Readiness assessed❍ Choice emphasized❍ Confidence expressed❍ Change talk encouraged❍ Empathy, respect, and acceptance demonstrated❍ Other?

7. What ideas do you have for enhancing learning and change in your curriculum?

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Notes

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AcknowledgementsThe Motivating Change in Groups (MCG) training, previously known as Education for Health Action, was created in 1991. This training was initially developed as a collaborative effort between the Northern and Southern California Regions of Kaiser Permanente.

Over the years, the Northern California training has evolved into a 2 day training, including an online tutorial. MCG is available for Kaiser Permanente staff who either teach classes, facilitate groups, or deliver presentations ... the goal of their work being to enhance change. The training is designed to empower its participants to discover their best qualities, embrace their growing edges, and build confidence in their abilities.

Motivating Change in Groups Project ManagerSusan Lebe, MS RDRegional Health Education

Creating, editing and updating previous editionsAnn Gordon, MPH Tim Regan, MPH Sandra Roberts, RN Beth Noland, MSN Lisa Morgan, MPH

Thanks also to TPMG MCG Training Staff, past and present.

participant manual · use style that’s curious, accepting, and eliciting. “congratulations on...

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