Title Page

Table of Contents

Introduction

About the SDM

Why Introduce the SDM?

Needs Assessment

SDM Programmatic Framework

Establishing Norms/Guidelines

Training Providers

Counseling Clients

Inform. / Educ. / Comm.

Assuring Quality

Procurement and Logistics

Other Service Delivery Issues

SDM Resources

References

Abbreviations

1. Orient policymakers and program decision makers to the SDM
   Before providers are trained, conduct orientations to familiarize policymakers and program managers with the SDM. This will help build political and programmatic support for the method and is an integral part of the overall training plan. These can be meetings of 2-3 hours in duration, where the scientific basis of the SDM is presented, and experiences of introducing the SDM elsewhere are discussed. An orientation package which includes a PowerPoint presentation is available and can be adapted to local situations.
   
   

   Resources Packet for SDM Orientation

   SDM Overview - PowerPoint Presentation SDM Field Notes SDM Efficacy Results: article in Contraception, 2004 SDM Overview, Limitations and Advantages Tailor this packet to your audience by selecting other materials from the SDM Resources section in this document

   
   
2. Identify primary and secondary providers of the SDM and determine training activities for them.
   In most programs, there will be both primary and secondary providers of the SDM. Primary providers are responsible for SDM screening for medical and behavioral eligibility and for counseling clients on how to use the SDM. There may be clinically trained staff offering other methods of family planning, or they may be community-based providers with limited family planning experience and counseling skills. Secondary providers often are community motivators or health educators who offer general information and support to clients, but do not screen or counsel clients on the SDM. Nevertheless, they need to know enough about the SDM to be able to answer basic questions about the method and who can use it.
3. Determine appropriate training approaches for the population to be trained.
   The learning objectives for training providers are standard, but the length and content of the training will depend on the trainees’ counseling skills. Well qualified personnel experienced in family planning counseling may require a brief 3 to 4 hour training. Other types of providers, such as non-health personnel and community-based workers, may need up to two days of training to acquire the knowledge and skills needed to appropriately counsel clients. Training of secondary providers may consist of formal training or more informal briefings during meetings or workshops.
   
   While it may not be feasible to train all levels of providers at once, the overall implementation of training activities will be easier if the population to be trained is identified, the appropriate training approach is determined and a schedule to complete the training events is established.
   
   Different approaches for training providers in the SDM have been tested and are available along with corresponding support materials. These approaches range from traditional class room training to online and distance learning packages. The different training approaches and available resources are summarized in Table 2.
   
   Supervisors and senior clinical personnel should be included in the training. Knowledge of the SDM will enable them to support providers, and assist in the integration of SDM. In addition, policy makers and program managers should be briefed on the SDM to build their support for SDM introduction.
   
   

   Table 2. Training Curricula and Resources to Support SDM Introduction
   Objective	Staff to be trained	Type of training	Resources
   Build support for SDM introduction	Policy makers and program managers	Briefings and orientations	PowerPoint presentation SDM Overview
   Train providers in the SDM	Trainers	Classroom training of trainers	SDM of Family Planning: A Training for Trainers SDM Counseling Video
   Screen and counsel women in the SDM	Counselors (all levels of service providers)	Classroom training Online Training Distance Learning Contraceptive Technology updates	SDM: A Training for Services Providers Participant Notebook SDM Counseling Video SDM Online Training Course for Healthcare Professionals SDM Distance Learning Manual (June 2006)
   Screen and counsel women in the SDM	Potential providers	Pre-service included in their course of study	Pre-service training curriculum – Contact irhinfo@ georgetown.edu to receive a printed copy
   Provide information on the SDM	Clinicians Supervisors Auxiliary Personnel Health Educators	Brief SDM Presentation	Tutorial (CD/ROM or online) English Spanish Online resources: - Technical updates - Newsletters - Research articles
   Provide information on the SDM	Volunteers Outreach Workers Promoters Pharmacists	Informational Talk	Lesson Plan for informational talk CycleBeads Brochure CycleBeads Insert
   Ensure quality services	Supervisors Providers	On the job, as part of the supervision process	Knowledge Improvement Tool (KIT)

   
   These resources are available in print free of charge to organizations in developing countries. They can also be downloaded online at www.irh.org.
   
4. Match curriculum and training design to skill level of trainees
   A variety of materials have been developed for training providers in the SDM. They vary in the level of skills they intend to achieve, and training length and methodology. In cases where providers have little experience and skills in family planning counseling the curriculum must address key family planning content and provide opportunities for practicing new skiils and receiving feedback. Consideration also should be given to incorporating SDM into pre-service curricula to impart an understanding of SDM to nursing and medical school students.
   
   
   

   Training Providers to Offer the SDM Effectively

   Using Community Health Workers to Offer the SDM IRH experience using community health workers as providers of the SDM in several countries (Ecuador, El Salvador, Honduras, Guatemala, India, the Philippines, Benin) suggests that they offer a number of advantages. They are comfortable with a user-dependent method that involves men and they tend to be good at counseling couples, discussing sex and the couple’s relationship. Since they live in the community they are available for follow-up as needed, and they are often free of the biases that many clinically trained staff have about natural methods. Depending on their educational levels and family planning counseling skills, however, they are likely to require more training time as well as materials specifically geared to their level of literacy. They may also need more supervision and support, at least initially. Skilled providers can learn to offer SDM in just a few hours Providers with clinical training, knowledge of STI prevention and counseling experience can learn to offer the SDM in just a few hours. A two hour workshop for skilled providers, covers the scientific basis of the method and how to counsel clients. An on-line course provides another alternative for them to learn about the SDM.

   
   
5. Incorporate SDM job aids and tools in training exercises.
   Provider job aids have been tested, adapted and used in diverse programs. To ensure that providers are familiar with these job aids —and eventually use them in their work sites— the trainers should make these available and use during training exercises, role plays, and general discussions. Peer-feedback and self-evaluation tools also are effective strategies for strengthening counseling skills.
6. Assess the capacity of participating organizations to support and conduct training and sustain follow-up activities.
   Follow-up actions should be considered as an integral component of the training effort. When training of trainers (TOTs) are conducted for example, plans should be developed to training providers and ensure that resources, such as a dedicated cadre of trainers, are available for the training. Although cascade training, (training trainers to train providers) offers a potentially efficient approach to in-country SDM training, it only works where there are training professionals who devote most of their time to training. Where a cadre of trainers does not exist, personnel will need to be drawn from the ranks of providers, thus burdening the service delivery system. When providers are trained, plans should be made for addressing the factors necessary to support service delivery, such as provider and client materials. The availability of personnel trained in SDM must be accompanied by organizational commitment to offering SDM, and systems in place to support SDM services. These systems include IEC to inform women about the availability of a new family planning option, SDM materials for providers and clients, an adequate supply of CycleBeads, and policies and procedures for incorporating SDM into the service delivery system.
7. Establish mechanisms to assess the effectiveness of training activities.
   Effectiveness of SDM training can be assessed through immediate evaluation of changes in knowledge and skills, and evaluation of the training rom the participants’ perspective. SDM training curricula include a pre- and post-test and a participant evaluation. Responses should be analyzed after the training to determine whether the training met the objectives and participants are competent to provide the method to clients. The training evaluation can also help identify areas where reinforcement or adjustments are needed as well as:

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