SDM Implementation Guidelines
 

Training Providers to Offer the SDM Effectively

The SDM is an information-based method, and while it is not difficult to provide and does not require any special procedures or equipment, the accuracy of the client screening and the quality of the counseling are critical to successful method use. Successful SDM introduction involves training not only the providers who will offer the method, but other personnel who will inform clients and supervise service delivery. To ensure that providers competent, programs can rely on existing training resources that can be easily adapted for different levels of providers. Basic guidelines on how to organize and conduct the training also are included in these resources.

Learning Objectives
for SDM Providers

Key Actions

  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

  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:
  • Providers’ acceptability of the SDM
  • Provider competence in offering the method
  • Whether providers find the service delivery tools appropriate and can use them correctly

A Knowledge Improvement Tool (KIT) is available to help supervisors identify areas of SDM counseling that need to be strengthened. The KIT consists of a series of questions about the SDM that assesses provider knowledge, skills and practices in offering the SDM. The use of the KIT reinforces knowledge and provides immediate, individualized feedback during follow-up visits.

Key Training Materials:

The training materials the Institute has developed and tested include:

  • SDM Training for Service Providers. Developed to guide trainers through the process of training providers on the SDM, it includes information for designing, conducting, and evaluating training programs. A companion Participant Notebook is also part of the Manual.
  • Counseling Clients in the SDM : Online Training for Healthcare Professionals. This Internet-based course provides a comprehensive orientation on how to counsel clients in the SDM. This interactive course takes approximately 2 hours to complete and features case studies, video clips of sample counseling sessions, downloadable provider job aids and a variety of SDM resources.
  • Standard Day Method Tutorial: A Simple Fertility Awareness-based Approach to Family Planning. (CD ROM). This 21-minute tutorial brings an SDM expert to the learner through a multimedia experience that includes an audio presentation and downloadable text transcript and resources, frequently asked questions and a self-grading quiz. Ideal for those interested in providing SDM services in their programs, the tutorial explains how the method works, its development, biological basis and contraceptive effectiveness, the service delivery process, and how to incorporate the SDM into existing services.
  • SDM Counseling Video. This companion video to the SDM Training Manuals is an eight-part video designed to assist healthcare providers learn about the key aspects of counseling clients in the SDM. The video supports and reinforce trainer-led courses in the SDM and helps engage participants in problem solving and discussions of real situations encountered in counseling. Available in English, French and Spanish (NTSC, PAL , SECAM, DVD formats). Order from irhinfo@georgetown.edu

Most materials are available in English, French and Spanish. A number have also been translated into other languages, including Hindi, Swahili, Albanian, Amharic, Romanian and Portuguese.