Integrated Management of Childhood illness (IMCI): Directors Guide

DIRECTOR GUIDE

ORG ANIZE ICATT BASED IMCI TRAINING

DIRECTOR GUIDE

GENERAL PART

ICATT based IMCI training

2 | P a g e

Director guide – General part

3 | P a g e

CONTENTS GENERAL PART .................................................................................................................................................................. 1

1. Introduction ................................................................................................................................................................ 5

2. General considerations for planning and organizing an ICATT based IMCI training .................. 7

2.1 . Plan for ICATT based training and IT support .................................................................................... 7

2.1.1 Computers and ICATT training player ......................................................................................... 7

2.1.2 Physical conditions for ICATT based training ........................................................................... 8

.1.3 2 IT support ................................................................................................................................................. 8

2.2 lan . P for clinical practice ............................................................................................................................... 9

2.2.1 Training sites .......................................................................................................................................... 9

2.2.2 Guide for clinical practice ............................................................................................................... 11

2.2.3 Schedule of inpatient and outpatient clinical practice ....................................................... 11

2.2.4 Prepare for clinical practice at outpatient clinics ................................................................. 12

.2.5 2 Prepare for clinical practice at inpatient ward ...................................................................... 14

2.3 elec S t trainers and plan for their preparation ................................................................................. 15

2.3.1 Facilitators ............................................................................................................................................ 15

.3.2 2 Inpatient instructor ........................................................................................................................... 19

2.4. Select participants ....................................................................................................................................... 20

2.5 lan . P for data collection .............................................................................................................................. 21

2.5.1 Monitoring tools in ICATT training set ..................................................................................... 21

2.5 .2 Data collection forms ........................................................................................................................ 23

3. hec C klist for planning and administrative arrangements ............................................................... 24

3.1 Initial planning ......................................................................................................................................... 24

3.2 At the training location, before beginning .................................................................................... 27

3.3 During the classroom based training .............................................................................................. 28

3.3 Distance learning training: During the initial facilitator ‐ participant encounter ........ 29

3.4 Distance learning training: Before the intermediate and final facilitator ‐ participant encounters ................................................................................................................................................................ 29

4. Preparing the clinical instructor ..................................................................................................................... 30

5. Training facilitators .............................................................................................................................................. 31

5.1 Introduction ................................................................................................................................................... 31

5.2 General structure ......................................................................................................................................... 31

5.3 Daily schedule ............................................................................................................................................... 33

5.4 Suggested schedule for facilitator training ....................................................................................... 34

5.5 Conducting activities .................................................................................................................................. 36


4 | P a g e

5.5.1 Day 1 ........................................................................................................................................................ 36

5.5.2 Day 2 ........................................................................................................................................................ 42

5.5.3 Day 3 ........................................................................................................................................................ 45


5 | P a g e

1. INTRODUCTION The aim of this guide is to provide you, the training director, an assistance to plan, organize and conduct an ICATT based IMCI training with the help of training support materials appropriately selected and, if needed, adapted by the local ICATT adaptation team.

This Director guide consists of two parts: a general part designed for planning and organization all training configurations and a training configuration specific part. Annexes apply to all

ing configuratrain tions.

The general part presents first the general considerations for planning and organizing an ICATT based IMCI training then a summary checklist for planning and administrative arrangements for the entire training. Next the general part provides instructions how to prepare the clinical

uctor and lastly how to train facilitatorsinstr for an ICATT based IMCI training.

The training configuration specific part presents possible training structures and schedules for three different training configurations. Training configuration is the basic type of training and training structure is a detailed description of how a particular training configuration will be organized. Suggestions for classroom based training with individual computers, classroom based training with LCD projector and distance learning training, are provided.

Before ICATT can be used, the relevant body responsible for introducing and implementing IMCI n the country, usually at MOH level must adapt the generic ICATT training set content according to the national IMCI guidelines. Also the training configuration specific part of this guide and training support materials available in the generic ICATT should be adapted, if needed. Ideally this is done well before the training.

If the training support materials have not been adapted to reflect the national IMCI guidelines and/or the training configuration and structure that you plan to conduct, refer to Step three: Select training support materials in the Adaptation and planning guide for guidance and select and modify the training support materials as needed.

You, the training director, should be an experienced IMCI facilitator who has already acted as a facilitator or a director in several standard IMCI training courses.

If are not thoroughly familiar with the ICATT training player, you will need to invite an outside ICATT consultant who will help you to conduct facilitator training and assist in supervision of facilitators during the computer part of the training.

If you are not yet familiar with ICATT, you should obtain ICATT training player for you and your facilitators before the training starts and work through it in order to get acquainted with its concept and content. Be sure to obtain the latest version available ‐– one or more test versions may be circulating.

Your re irector are: sponsibilities as the tra

•

ining d• to plan and organize the training,

• to introduce the training, to coordinate all training activities,

• • to supervise the facilitators,

to supervise the inpatient instructor, • to conduct facilitator meetings during the training days,


6 | P a g e

• training, to collect or organize collecting data during the

• • to organize the participant evaluation,

to organize the end of training evaluation, and • to close the training and present training certificates (if given).


7 | P a g e

2. GENERAL CONSIDERATIONS FOR PLANNING AND ORGANIZING C TT BA MCI TRAINING AN I A SED I

2.1. PLAN FOR ICATT BASED TRAINING AND IT SUPPORT

2.1.1 COMPUTERS AND ICATT TRAINING PLAYER ICATT is a computer program which uses the software on the host computer to display documents, images, videos and any other kind of resources. Computers used for ICATT training must meet the minimum hardware and software requirements (See Annex 1 of this guide).

Approximately 4 GB of free space is needed for installing the generic ICATT training player on a computer. Check with your national ICATT adaptation group ‐ space needed for a national adaptation may be different. This space is not needed if the ICATT training player will be run from a DVD or USB.

The training configuration and the number of participants will depend, among other factors, on the availability of computers. How many computers that meet the minimum requirements for ICATT are available or can be located and their use for the training negotiated.

• Classroom based training with individual use of computers: One computer per each participant and one computer for presentation are needed. If the number of computers available is not sufficient for the intended number of participants, find out early during the planning phase if participants have and can bring and use their own notebooks.

• Classroom based training with LCD projector: One computer (and an LCD projector as for all other configurations) is needed. The number of participants should not exceed 20;

ts’ active involvement in the training diminishes or the time if it is larger, the participanneeded

• for facilitator‐participant interaction increases. e learning training:Distanc

o Each participant needs an access to a computer for approximately 4 hours a week during the whole 8 week training period.

o Facilitator – participant encounters: One computer per 1‐2 participants is needed during the initial encounter when the participants learn and practice navigation in ICATT. One computer is needed during the intermediate and final encounters. If the number of computers is not sufficient for the intended number of participants, conduct the initial encounter for smaller groups of participants on different days.

• When considering the number of computers needed in any training, remember that each facilitator MUST have one computer during the facilitator training and an unrestricted access to a computer during the whole duration of the participant training. Find out before the training if each facilitator of ICATT based training has a computer and if not, make appropriate arrangements. Facilitators of the clinical sessions only should also attend the facilitator training but they do not need a computer during the participant training.

Classroom based training should not be conducted or a power generator should be procured if the electric power supply is not reliable.


8 | P a g e

A decisi lash disk or DVD will be used for ICATT training player is needed. on whether USB f

• In favour of DVD: lash disk o Cheaper than USB f

o • In favou

Cannot be infected with a virus r of USB flash disk

o g the Student k.

Permits transfer of Student profile; in a Distance learning traininprofile can be brought to a facilitator for checking participant’s wor

o Some computers do not have DVD drive (CD drive is not sufficient)

Use of an antiviral program is STRONGLY RECOMMENDED for all computers used, especially if computers of participants, facilitators and/or participants’ health facilities will be used. A number of free antiviral programs are available at the internet, for example:

o us‐downloadavast! Free antivirus http://www.avast.com/free‐antivir o ree antivirus – Avira Antivir F http://www.free‐av.com/

2.1.2 PHYSICAL CONDITIONS FOR ICATT BASED TRAINING The room for ICATT based training must be adequate to accommodate all participants and facilitators. There should be also enough space to conduct role plays and set up the necessary equipment and supplies. If this is not the case, find another suitable room nearby. You can also find a suitable room near the inpatient ward or at outpatient clinic and link conducting the role

ng. plays with clinical practice instead of computer traini

Ensure optimal conditions for ICATT based training:

• ts permitting comfortable reading distance Appropriate seating, seating arrangemen screen,

• from the projection

• Proper heating or cooling and ventilation, Adequate lighting,

• tters) or individual computer Outside light not interfering with projection (curtains, shu

• work, Noise not interfering (air‐condition, fans, ambient noise),

• le as li• Best projector available, loudspeakers,

Projection screen if possible (a wall is less preferab ght will be absorbed), • ccess to power supply (enough multiplugs) for all facilitators and/or participants if

hey will use their own computers. At

2.1.3 IT SUPPORT Classroom based training with individual computers: This training is usually conducted in a computer laboratory managed by an IT administrator. He or she should be asked to assist with the installation of the ICATT training player on all computers in the classroom and also on the personal computers of facilitators and participants, if they bring them.

Classroom based training with LCD projector: IT support is usually nor needed as the facilitators frequently use the same equipment that they use routinely.

http://www.free-av.com/





9 | P a g e

Distance learning training: Assistance of a skilled computer user (not necessarily a trained IT speciali n most settings. The responsibilities of this person will be: st) will be very useful i

• BEFORE the training: Assist with identification of suitable computers,

led and/or runs from the DVD/USB flash disk on all o o Ensure that ICATT is instal

• At the Bcomputers that will be used in the facilitator ‐ participant encounters. EGINNING of the training:

tors or participants bring their notebooks, ensure that the ICATT o If some facilita

• DURINGis installed or runs on it from the DVD/USB flash disk. the training:

o Provide assistance to participants who have problems with running ICATT in their he lth facility or at home if a facilitator assigned to communicate with them cannot solve the problems.

a

2.2. PLAN FOR CLINICAL PRACTICE

2.2.1 TRAINING SITES Depending on the training configuration, the participants will have all clinical practice at the training site or they may practice under the supervision of a trained staff member on their work site or the basic part of clinical practice will be conducted at the training site and the participants will do additional practice at their work site.

Basically, the facilities selected for group clinical practice must have a sufficient case load, acceptable quality of care, and a director and staff who are interested in the training and willing and able to cooperate.

The ICATT may replace other training materials in an ongoing IMCI training for which the clinical training sites for in‐patient and out‐patient clinical practice have already been selected and are used. If an existing site is going to be used, check if it is still appropriate. It is important to periodically review whether or not the existing clinical practice sites are meeting the learning objectives of the training. Consider the following:

• t? Is the environment consistent with the skills being taugh

• • Is the staff receptive to supervising participants?

• ? Is there adequate space for the number of participants? re there enough patients and appropriate types of patientsA

• Is the site easily accessible for participants and facilitators?

In case that the clinical practice will be conducted in outpatient clinics and/or an inpatient ward hat have not yet been used for IMCI training, select the training sites according to the criteria in ox 1. tB


10 | P a g e

Box 1 Criteria for selecting clinical practice training sites

Outpatient clinics

• Depending on the number of participants, select several outpatient clinics where many children are seen each day. One of these clinics may be in the same facility as the inpatient ward.

• The clinics should be within a reasonable distance of lodging and classrooms, and close to the inpatient ward as well. Transportation may be needed for small groups from lodging to the clinics, and also from the clinics to the inpatient facility.

• In the clinics there should be an ORT (Oral rehydration therapy) area for treating children with diarrhoea who are dehydrated. The ORT treatment area may be in a corner of a one‐room multipurpose assessment and treatment area, or it may be in a separate room. Some outpatient clinics may also have 1 to 2 beds for giving IV therapy to severely dehydrated children.

• Within or immediately adjacent to the outpatient clinics, there should be a large well‐lit area or two smaller areas (such as exam rooms) where participants can assess patients. These areas should be relatively calm and quiet, so that children who are being assessed will remain calm when their signs are assessed. They must be near enough to the main treatment area of the clinic that children are easily returned to clinic and any emergencies can be managed by the regular clinic staff.

• Ideally the clinic staff should implement IMCI case management approach and use it with confidence. If not, the clinic director and staff should be willing to accommodate use of the assessment, classification, and treatment processes described on the case management charts.

• It is best if the clinic director will permit participants (with supervision of facilitators) to dispense oral drugs to mothers and give the first dose in clinic.

• A staff member such as a nurse should be available at each clinic to participate in the selection of cases. This nurse helps to identify suitable children as they come into the clinic. The nurse arranges for the child and mother to leave the regular clinic line and be seen by the participants. The nurse then takes them to the appropriate station in the clinic for any additional treatment and care, minimizing subsequent waiting time.

• Many supplies are needed at the clinical practice sites, such as scales, thermometers, drugs, and ORS supplies. All of the supplies that may be needed are listed in Annex 7 of this guide. Depending on how the case management charts have been adapted for the local area, you may not need all of the different drugs or different formulations of drugs listed. Be sure that the drugs listed on the adapted charts are available. You may need to bring some of the equipment or supply some of the drugs if the clinic's supply is low.

Inpatient ward

• Select a facility with an inpatient ward that admits children with severe illnesses such as pneumonia, meningitis, and severe malaria. (The facility may have several wards, such as a paediatric, neonatal and malnutrition ward, where infants and children are treated.) This will allow participants to observe certain less common clinical signs, particularly for pneumonia, malnutrition, and signs of serious bacterial infection in young infants.

• The inpatient ward should be within a reasonable distance of lodging and classrooms, as clinical practice will occur almost every day. Transportation may need to be arranged.

• The inpatient ward director should be willing for a group or groups of participants to visit the ward daily during the training duration. The dates of the training should be acceptable to the inpatient ward director.

• A clinical staff member acts as a clinical instructor. Or a clinical staff member should be available starting at 6:00 or 7:00 a.m. each day to assist the inpatient instructor in selecting cases for that day.

• Some supplies are needed in the inpatient ward for assessing and classifying patients, such as scales and thermometers. ORT supplies are also needed. Supplies that may be needed for clinical practice in the inpatient ward are listed in Annex 8 of this guide. You may need to bring some of the supplies if the inpatient ward does not have enough.


11 | P a g e

The training configuration, especially distance learning training, may include clinical practice at participant work site. Consider the following:

• Have some of the staff at participant work sites been trained in IMCI and are they willing dto act as mentors, i.e. supervise the participants’ clinical practice an provide assistance

to the participants with learning IMCI content? • Are all drugs needed for clinical practice available at participant work sites? Plan to

provide small amounts of missing drugs to the participants if possible.

2.2.2 GUIDE FOR CLINICAL PRACTICE As your country most probably already implements IMCI and conducts IMCI training courses, you already use your national or local adaptation of WHO Facilitator guide for outpatient clinical practice and Guide for clinical practice in the inpatient ward in your standard IMCI courses. As the organization and overall content of clinical practice in an ICATT based IMCI training is basically the same as in standard IMCI courses, you may use these guides for clinical practice also for an ICATT based IMCI training.

If you do not already have printed copies of guides for clinical practice in standard IMCI courses, TT training player. you can use the guide or guides for clinical practice printed from the ICA

ICATT support materials in the generic ICATT training player include Guide for clinical practice for conducting both, outpatient and inpatient clinical sessions. Depending on the decision of the ICATT adaptation team, this guide may have been adapted according to your country IMCI guidelines or replaced by the guides used in standard IMCI courses in your country, area or training institution.

In your training, there will be probably fewer sessions than described in the Guide for clinical practice (See Annex 2 of this guide), so you will need to combine the content of some of the sessions described in the guide according to the number of clinical sessions in your training (See example schedules in the specific part of this guide.) and inform the facilitators and the clinical instructor about the content of each clinical session in the training accordingly.

2.2.3 SCHEDULE OF INPATIENT AND OUTPATIENT CLINICAL PRACTICE Classroom based training: Plan the schedule so that participants divided into small groups of 6‐8 persons visit the inpatient ward and an outpatient clinic each day of the training (except for the first day). Each inpatient visit will require one hour, and each outpatient session will require 2½ to 3 hours. Allow for travel time between the inpatient ward and the clinic and a coffee break. The outpatient clinical practice should be scheduled at the time of day when most patients arrive, usually in the morning.

The number of outpatient clinics needed depends on the number of participants, on the patient load, and at the time when patients arrive at each clinic. All participants of a Classroom based training with LCD projector must have clinical practice sessions at the same time, therefore it will only be possible to schedule one group to visit one clinic per day. In a Classroom based training with individual computers, one or more small groups may practice in a clinic or inpatient ward while the rest of the participants work with the ICATT, therefore if a clinic has a continual flow of new patients until lunch break, then 2 groups may be able to visit it, one after


12 | P a g e

the other. It is important to talk with each clinic director about the best time(s) for seeing a variety of new patients.

Below is an example of a schedule for a training in which there are four small groups. Each group will visit the inpatient ward and one of three clinics daily. The City Hospital inpatient ward and outpatient clinic are large enough to accommodate two groups at the same time – the group facilitators will assist the clinical instructor in conducting the inpatient session. The schedule will be the same each day of the training, unless changes are needed. It shows where each group will be until 12:00 p.m. (Remember that your schedule may be very different, depending on the number of groups and the number of clinics used.)

Example clinical practice schedule for a classroom based training with four small groups

City Hospital

Inpatient

City Hospital outpatient

Mains street clinic

Hope clinic

8:00‐9:00

roups A,B G

8:00‐10:45

roup C

G

8:00‐10:4

roup D

5

G

9:15‐12:0

roup A,B G

11:00‐12:00

Groups C,D

In a Distance learning training, the clinical session conducted in the initial facilitator ‐ participant encounter is different from those of the intermediate and final encounters. The objective of the clinical session during the initial facilitator ‐ participant encounter is to demonstrate the assessment and classification of a sick child aged 2 months up to 5 years. The session may be conducted either in an inpatient ward (preferable) or in an outpatient clinic. See specific part on distance learning training, chapter Initial facilitatorparticipant encounter: Suggested objectives and schedule in this guide for possible organization of the session. Clinical sessions during the intermediate and final facilitator – participant encounters are conducted in a similarly to those in classroom based trainings.

Be sure to confirm all dates and times in writing with the director of the inpatient ward and the outpatient clinics.

2.2.4 PREPARE FOR CLINICAL PRACTICE AT OUTPATIENT CLINICS You and the facilitators, if already available, should visit the outpatient clinics where clinical sessions are to be conducted to meet the clinic directors and staff and to discuss/confirm arrangements prior to the training.


13 | P a g e

1. Briefly describe to the clinic director the objectives of the training, the importance of clinical practice in the training, and the types of clinical signs and diseases participants will need to observe.

2. Tour the clinic and check supplies:

• Observe where children arrive and where they are directed. (During outpatient sessions in the training, a staff member will select children as they arrive.)

• Determine if there is an ORT treatment corner or area. If an outpatient clinic chosen as a site for clinical practice does not have an ORT corner for managing diarrhoea patients with dehydration, it is advisable to set one up before the training or during facilitator training.

• Determine what areas or exam rooms are available for participants to use in assessing cases.

• See what supplies are available. Supplies which are essential for outpatient sessions are listed in Annex 7 of this guide. If any necessary supplies are not available, arrange to bring them for clinical practice. Participants will need only a very few drugs and supplies to do the clinical practice activities. The drugs should be in the most common formulation listed on the adapted chart. (A single formulation is adequate even if several are listed on the chart.) If you will

ble in the clinic, you will need any drugs or other supplies in addition to what is availaneed to bring them with you for each session.

• See whether a table or tray is available to use for drug supplies.

3. Discuss and confirm the schedule for clinical practice. If the schedule has not already been arranged, make arrangements as described earlier in section 2.2.3 Schedule inpatient and outpatient clinical practice. Ensure that scheduled times are the best times for participants to see many new patients. Explain how many people will be coming to practice and for how long.

• le from day to day, such as special MCH days, mornings Ask about any changes in scheduwith specialty clinics, etc.

• Confirm the schedule in writing.

4. Plan with the director of the clinic what role the clinic staff will play during the participants' clinical epractic sessions.

• Try to selectio

arrange for a regular clinic staff member such as a nurse to participate in the n of cases for clinical practice sessions. This staff member would:

o identify children and young infants who are appropriate for the clinical session as they come into the outpatient department.

o arrange for the child and mother to leave the regular clinic line and be seen by for the participants and then return them to the appropriate station in the clinic

their treatment and additional care. o return the child to the appropriate station in the clinic for treatment and care.

• Discuss and confirm plans for making sure that patients seen during the outpatient session receive the treatment they need. Discuss whether participants will be permitted to dispense oral drugs to mothers and give the first dose (preferable), or whether patients will be passed to regular clinic staff for treatment. If this must be done by clinic staff, discuss how this will be managed.


14 | P a g e

5. Brief clinic staff so they understand what to expect during the clinical sessions (e.g., how many people will be there, what participants will be doing and learning). Explain that participants will usually assess and classify patients, and then patients will return to the regular staff for treatment. During one or two sessions participants will do some treatment, such as giving oral antibiotics or ORT.

Brief the nurse who will identify suitable children and send them to be seen by participants.

Tell the staff that it is preferable that the child's weight and temperature be taken on arrival at the clinic and recorded for participants to use.

6. Just before the training starts, visit the clinic where you will conduct outpatient sessions. Meet w in advance. ith clinic staff to confirm all administrative and logistical arrangements made

7. Post the following adapted case management wall charts in the clinic: ASSESS AND CLASSIFY THE SICK CHILD, TREAT THE CHILD, COUNSEL THE MOTHER and MANAGEMENT OF THE SICK YOUNG INFANT.

2.2.5 PREPARE FOR CLINICAL PRACTICE AT INPATIENT WARD You and the clinical instructor should visit together the hospital where clinical sessions are to be conducted to meet the director and staff and to discuss/confirm arrangements prior to the training.

1. First meet with the hospital director to obtain permission, then with the ward staff responsible for each ward needed during the training. In each ward, make sure your arrangements include the senior responsible nurse, not just the doctor in charge.

Meet with the director of the paediatric inpatient ward. Explain to the ward director how inpatient sessions work. Describe what the inpatient instructor and the participants would do. Ask permission to conduct sessions in the ward. If there are separate malnutrition, newborn and sick neonate wards, meet with the directors of these wards. Also meet with the director of maternity ward – session on essential care for young infants will take place there.

Ask the ward director for a clinical assistant. This should be someone who works on the ward full time. Ask the director to assign the clinical assistant to come at the time of the early morning preparations (usually at 6:00 or 7:00 am depending on the schedule). Ask for a translator to help interview mothers in the early morning, if needed. (It will often be necessary to provide a stipend to this individual.)

2. Visit the ward. See how the ward is laid out, the schedule of admissions, meals, etc. Find out times patients are available or not available.

3. From this information, plan a possible schedule for the clinical sessions in the inpatient ward during the training.

4. Together with the clinical instructor:


15 | P a g e

• iSet the schedule for inpatient and outpatient sessions, so each group will vis

•

t one outpatient clinic and the inpatient ward each day. Review your responsibilities and plans for conducting the inpatient sessions.

• Plan the content of each inpatient session depending on the training schedule.

5. If a checklist for monitoring inpatient sessions is used, teach the clinical instructor how to se it before the training begins. u

2.3 SELECT TRAINERS AND PLAN FOR THEIR PREPARATION

2.3.1 FACILITATORS Criteria for facilitators

Facilitators must be trained in IMCI. Ideally, facilitators of an ICATT based IMCI training should be trained IMCI facilitators, and therefore have undergone the 5‐day IMCI facilitator training and have conducted at least one IMCI course before they become facilitators for an ICATT based IMCI training.

Facilitators for the computer training also must have computer skills sufficient to learn and teach using the ICATT easily (routine use of MS Windows and Word is adequate).

Facilitators for the computer training must have an easy access to a computer with ICATT during . the whole training

If facilitators are also expected to conduct the follow‐up visit they need to be trained for conducting the follow up visits (WHO Guidelines for conducting the follow up training are available in the ICATT Library). If they are not trained, they should be trained or other solution needs to be identified.

If trained IMCI facilitators are not available, the future facilitators of an ICATT based IMCI training should also meet the criteria listed in Box 2.


16 | P a g e

Box 2 Criteria for selecting facilitators not yet trained in facilitation of IMCI courses

• Facilitators should be currently active in clinical care. They must have the basic clinical skills and ed case management process technical knowledge which will allow them to teach the integrat

• used in the training. They must recently have been participants in the IMCI course.

• They must have good communication skills, including the ability to explain things clearly andsimply to others.

• Facilitators must be confident in an outpatient clinic setting. They must be able to work with clinic staff in selecting patients for participants to see. They must supervise the participants' work in the clinic by ensuring they are given cases to manage and checking their assessments, classifications, treatments, and counselling.

• They must be organized. They must be able to keep the group on schedule and ensure that they arrive for clinical practice on time and with the necessary supplies.

• They must be flexible in order to use time well. For example, if a child with a rarely seen clinical sign appears, they must be able to stop what they are doing and present the sign to the group.

• Facilitators must be available during all of facilitator training and during the entire training. They n attend a must have the energy and motivation to work a long day with participants and the

facilitator meeting to review the day's work and prepare for the next day. • Facilitators should be available to teach several subsequent trainings, if possible.

Facilitator – participant ratio

Facilitator’s tasks are different in different training configurations and are described in Box 2. For this reason the desirable facilitator ‐ participant ratio for ICATT based training is different in different training configurations.


17 | P a g e

Box 3 Tasks of a facilitator in different training configurations Classroom based training with individual computers • Introduce the training, IMCI, and ICATT. • Teach participants how to navigate in ICATT. • Explain how the participants should work through ICATT. • Monitor the progress of participants. The duration of work through each training unit should be approximately

as indicated in the training schedule. • Provide assistance to participants when they ask for help and actively seek participants who may need help but

do not ask for it. • Provide individual feedback on completed printed recording forms for selected exercises. • Conduct demonstrations, drills, and role plays. • Prepare participants for clinical practice sessions and conduct the outpatient sessions. • Summarize each day’s work. • Assist the training director in collecting data during the training.

Classroom based training with LCD projector

• Introduce the training, IMCI, and ICATT. • Work through all ICATT units and sections together with the participants as an interactive activity: • Read and/or summarize all the text screens together with the participants, • Run the videos and flash movies and show the pictures and discuss them as needed, • Work through the PRACTISE part exercises (TEST exercises are optional). • Check participants’ understanding. • Conduct demonstrations, drills, and role plays. • Prepare participants for clinical practice sessions and conduct the outpatient sessions. • Keep the schedule. The duration of work through each training unit should be approximately as indicated in the

training schedule. • Assist the training director in collecting data during the training.

Distance learning training • Conduct the facilitator‐participant encounters according to the agenda.

o Introduce the training, IMCI, and ICATT. o Teach participants how to install ICATT or run it from a DVD/USB flash disk, how to navigate in ICATT,

and how to transfer the Student profile. o Explain how the participants should work during the self‐learning phases. o Check the participant’s progress during the self‐learning phases.

• Provide support to participants during the self‐learning periods as agreed upon with the training director. • Encourage the participants and help them with any individual problems during the facilitator‐participant

encounters, and encourage them to call whenever they have a problem between the encounters. • Assist the training director in collecting data during the training. • Regularly report on progress to the director.

• One facilitator per 10‐15 participants is sufficient for computer training in a classroom • One facilitator per 10‐15 participants is sufficient for computer training in a classroom based training with individual computers because the assistance in ICATT navigation

clarification and of IMCI content if needed is provided to the participants over the whole training period.

• The facilitator participant ratio for computer training should be 1:6‐8 in a classroom based training with LCD projector. One facilitator works through the ICATT content together with the participants, another one or more facilitators help the participants to do the required tasks (e.g. find relevant information in the chart booklet or complete a case recording form correctly). It is NOT recommended to work in a group larger than 20 participants – it would increase the time needed for the interaction of facilitators with participants or decrease the interaction and therefore the quality of training.

• In a distance learning training, the facilitator participant ratio for ICATT based training should be 1: 4‐5 during the facilitator‐participant encounters. During the encounters the facilitators teach participants how to navigate in the ICATT, check participants’ work


18 | P a g e

during the self‐learning phases, provide feedback on it and solve potential problems in a limited time. One facilitator for 10 participants should be designated to provide

assistance to participants during the self‐learning phase by phone, e‐mail or other means of communication.

• The facilitator participant ratio for outpatient clinical practice should be 1:3‐4 as in a standard IMCI course in order to ensure a quality clinical practice. This means that one or more facilitators will be needed for conducting the outpatient clinical sessions in ddition to facilitators responsible for computer training who will also conduct the utpatient clinical practice. ao

Facilitator training

Facilitator training for an ICATT based IMCI training is needed even for facilitators routinely faci rses. They need to: litating standard IMCI cou

• Get familiar with ICATT,

• ning, Learn facilitator techniques used in the ICATT based part of the trai

Obtain information about the organization of the training, and •• Obtain information about their roles and tasks during the training. A 3‐ day facilitator training has been developed for the training of facilitators who have already been trained in facilitating standard IMCI courses (See part Training facilitators in this guide). The training schedule focuses on teaching skills needed for working through the ICATT. Only one half of a day is devoted to the outpatient clinical practice, which consists mainly of refreshing the facilitator techniques used in the outpatient clinical practice and information about the organization of the clinical sessions. The objectives of a facilitator training are the same for all training configurations. In each training configuration however, the tasks of a facilitator are somewhat different (See the Box 3) and this needs to be considered during the facilitator training. After completing the facilitator training, the facilitators will be able to conduct any type of ICATT based IMCI training after a short briefing.

Another s who routinely conduct standard IMCI co

option for the training of experienced IMCI facilitator

• urses can be: An initial 2‐3 hour session on navigation in the ICATT.

• Approximately one month self‐learning phase for working through the ICATT including all exercises. Future facilitators are required to bring printouts of the ICATT progress page displaying that all the TEST exercises have been successfully completed to the training director as a proof of their work through the ICATT.

• Final one day session to learn facilitator techniques that will be used in the training, obtain information about the organization of the training, about the facilitators’ roles and tasks during the training.

his schedule requires a substantial self‐discipline of the facilitators to prepare themselves on Ttheir own. A 4‐day facilitator training that includes three clinical sessions similar to those in WHO standard facilitator training (See WHO generic Course director’s guide in ICATT library, section IMCI Training Course) is recommended for the training of facilitators who have not yet been trained in facilitating IMCI standard courses.


19 | P a g e

Box 4 Responsibilities of the inpatient instructor

• Study thoroughly the parts of Guide for clinical practice related to inpatients. • Discuss his or her responsibilities and any questions with the training director, so that both understand and

agree what he or she will do. • Obtain the necessary permissions and supplies. • Meet and brief the staff in the inpatient ward. • Find out the ward routine and layout, so that he can select children in the morning and conduct the sessions

efficiently and also without disrupting the ward. • Refer to the Guide for clinical practice, part Clinical practice in the inpatient ward for details on how he or she

should prepare himself or herself and the inpatient ward. Go over the list to be sure that everything is ready, and make arrangements for any remaining items.

If the inpatient instructor is expected to collect data on the cases and the performance of participants during the training, the training director should ensure that he or she understands how to complete the Checklist for monitoring inpatient sessions (See Annex 5 of the Guide for clinical practice for instructions how to complete the checklist).

2.3.2 INPATIENT INSTRUCTOR One inpatient instructor is needed for inpatient clinical sessions. The inpatient clinical sessions will be scheduled separately for groups of 6‐8 participants (See section 2.2.3 Schedule of inpatient and outpatient clinical practice).

The responsibilities of the inpatient instructor are the same as in a standard IMCI training. The npatient instructor's tasks are described in detail in the Guide for clinical practice. i

Ideally the inpatient instructor should have been already trained for conducting inpatient clinical practice in IMCI courses before he or she becomes a clinical instructor for an IMCI training using ICATT.

If a trained clinical instructor is not available, use the criteria for his or her selection described in Box 5.


20 | P a g e

Box 5. Criteria for selecting inpatient instructor who has not yet been prepared for conducting IMCI inpatient sessions:

• The inpatient instructor should be currently active in clinical care of children, if possible on the If the inpatient instructor is inpatient ward of the facility where the training is being conducted. (

• not on the staff of the facility, a staff assistant will be needed to help with arrangements.) The inpatient instructor should have proven clinical teaching skills.

• The inpatient instructor should be very familiar with the integrated case management process usly and have experience using it. He or she should have participated in the IMCI training previo

as a participant or facilitator. • He or she should be clinically confident, in order to sort through a ward of children quickly,

identify clinical signs that participants need to observe, and assess and classify children easily according to the ASSESS & CLASSIFY charts. He or she should understand the child's clinical diagnoses and prognosis so as to avoid confusing cases and critically ill children who need urgent care. He or she should be comfortable handling sick children and convey a positive, hands‐on approach.

• He or she must have good organizational ability. It is necessary to be efficient to accomplish all of any the tasks in each clinical session. The individual must be able to stay on the subject, avoiding

extraneous instruction or discussion. • The individual must be outgoing and able to communicate with ward staff, participants, and

mothers. He or she should be a good role model in talking with mothers. • It is helpful if the individual has some training or experience with neonates and in assessing

breastfeeding and teaching mothers to improve positioning and attachment for breastfeeding. • If possible, in preparation for this role, the individual should work as an assistant to an inpatient

instructor at another training to see how to select cases, organize the clinical sessions and the interact with participants. Or another skilled inpatient instructor can join him or her during

first few days of the facilitator training or the training. • The inpatient instructor must be available 1‐2 days prior to facilitator training, during all of

facilitator training, and during the entire training. (If he has previously attended facilitator training, he does not need to repeat this training, but it is important to attend facilitator training at least once to learn facilitation skills.) The inpatient instructor must be willing and motivated to get up early each morning during the training to select cases in the inpatient ward and prepare for the day's clinical sessions.

• The inpatient instructor should be available to teach several other trainings over the next year, if possible.

2.4. SELECT PARTICIPANTS Any health professionals responsible for management sick children age up to 5 years are eligible for the training.

Motivation of participants is very important. The selection of participants for an in‐service training should be ideally done on voluntary basis. This supposes to ensure higher interest and motivation. Developing incentives, such as a certificate and/or incorporating IMCI training, into continuous education for in‐service participants and incorporating IMCI into paediatric examination for pre‐service students are recommended.

Optimally, the in‐service training should promote the idea of team learning – a group of health professionals from a given health facility – doctor, nurse, health assistant – this approach allows to achieve several tasks: i) create a critical mass in a facility, ii) stimulate exchange of knowledge nd skills in a given facility, iii) to help make training more cost effective. a


21 | P a g e

Number of participants in aining

Depending on the training configuration, the number of participants in one training will be limited by the number of computers available (See section Plan for ICATT based training in this chapter), facilitators available (See section Select trainers and plan for their preparation – Facilitators in this chapter), and/or the possibility for adequate clinical practice with sufficient number of patients (See section Plan for clinical practice in this chapter).

tr

Participants’ computer skills e uFuture participants do not need to hav any comp ter skills prior to the training.

When planning your training with individual computer use, you should however obtain information about the participants’ expected computer skills: Do they use a computer? If yes, do they use it a little or frequently? If there are many participants who have no or little computer skills, allocate more time for the session on navigation in ICATT and consider using an optional flash movie How to use a computer that helps the participants to learn the basics about a omputer that can be found in ICATT training player, section Support materials ‐ Training aids. c

2.5. PLAN FOR DATA COLLECTION A number of tools for monitoring participant work, evaluation of participants and evaluation of the training are available either in the training set or in ICATT support materials – Forms for data collection. You need to decide which tools you will use.

2.5.1 MONITORING TOOLS IN ICATT TRAINING SET To monitor the participant’s progress, the Training player displays a progress bar on each screen, includes a sheet for recording clinical practice and a summary sheet of progress in both, training units and clinical practice.

Each screen of the Training player shows the participant’s progress for the TEST exercises done in the form of a progress bar (1). The

progress bar has distinct sections for each training unit. A training unit is either not begun (white,) in progress (yellow), passed (green), or failed (red) – if less than 80% of questions are not answered correctly. The progress within a training unit is not evaluated.

Each participant of a training with individual computer use or the whole group of participants of a training with LCD projector may record cases that they have managed assessed and classified into the clinical practice sheet accessible from the Clinical practice (2) menu item of the Training player.

1

32


22 | P a g e

The Progress (3) menu item in the Training player leads to a summary sheet, which displays the progress in both, the computer learning and the clinical practice. After completing 50 % of training units and clinical cases, the participant is notified there that he or she can print a certificate.

Participants of a distance learning training may be instructed to a) send their Student profile by an e‐mail to the facilitator for checking or b) transfer their Student profile to a USB flash disk and bring it to the facilitator or c) print the Progress summary sheet for checking. The printed Progress summary sheets (also from participants of a classroom based training with individual computers) may be used to determine the proportion of students who completed all training units correctly for the repo. This information will be recorded in the training report (See ICATT support materials – Data collection forms ‐ A. Training report form).

Example of a clinical practice sheet

Example of a summary progress sheet

3

2


23 | P a g e

2.5.2 DATA COLLECTION FORMS ICATT is a new tool for IMCI training with many possible variants of use. When you start using it, you may want to know the feasibility, effort and cost effectiveness of your ICATT based IMCI trainings and also to compare them with the standard IMCI courses conducted in your country, area or institution. In order to achieve this, we suggest that you gather and analyse the informa s: tion in the following area

• Features of the training

•

• Details of work with the ICATT

• Participant evaluation Participants’ views on the training

• ws on the training Facilitators’ vie• Training costs

The ICATT support materials – Data collection forms provide a number of forms for collecting data during the training that will help you in this task. Their description and information about

g their use in different training configurations are in Annexes 4 and 5 of this uide.

The generic forms in the ICATT may have already been adapted by your national ICATT adaptation team. If they have not been adapted, you need to adapt them yourself. Some of the forms are the same as in the generic standard WHO 11 day IMCI clinical training course and you may already be using them in your standard IMCI courses, so you may replace the generic forms in ICATT with your versions.

You may also wish to review and discuss the information provided by the checklists, which are among the data collection forms at the facilitator meetings. The checklists will help facilitators recall common problems that the participants had in the clinical session. It can also be very useful to compare the participant's or group's performance in the outpatient and inpatient setting, to understand better what needs further reinforcement. The checklists can also reveal what groups or individuals still need experience treating dehydration, counselling on feeding, etc.

The monitoring checklists may also be collected at the end of the training, and used to determine the average number of sick children managed by each participant. This information will be recorded in the training report (See ICATT support materials – Data collection forms ‐ A. Training report form).

It is important to ensure that all the facilitators are trained to complete the monitoring checklists and know that they are expected to do so.

Evaluation of participants

The evaluation of participants may consist of knowledge evaluation only (written post test) gement). and/or of skills evaluation (clinical case mana

Conducting a written post test (available in Data collection forms) at the end of the training is suggested. Remember: Participants are allowed to use the chart booklet during the test!

Evaluation of clinical skills (observation and evaluation of clinical case management) is optional. There is no special tool for the evaluation of a clinical performance in the ICATT support


24 | P a g e

materials. The evaluation of clinical skills may be conducted at the end of the training (but NOT before the participants had the opportunity to practice the skills to be evaluated under supervision) or it may be done as a part of the follow‐up visit. If this is the case, the follow‐up visit should be conducted in the morning to increase the probability that a suitable patient for assessment will be available. This means that one facilitator (or other health worker conducting he follow‐up visit) can visit only one health centre per day. t

3. CHECKLIST FOR PLANNING AND ADMINISTRATIVE ARRANGEMENTS Arrangements apply to all training configurations unless otherwise indicated. They may not be listed in the exact order in which they will be made.

Please refer for details about the activities to chapter General considerations for planning and organizing an ICATT based IMCI training of this guide unless otherwise indicated.

3.1 INITIAL PLANNING ensured 1. Appropriate version of adapted and, if needed, translated ICATT training player

(Latest version – one or more test versions may be circulating).

2. Training support materials selected, adapted, if needed translated, and printed. 3. General time‐frame for giving the training identified (preferably during a time of peak

diarrhoea, malaria, and incidence for some of the following illnesses: pneumonia, mea es

4. Traininsl ).

g location(s) selected. Criteria for the training location: a. Availability of a room adequate to accommodate all participants and facilitators.

This room should be located in or near a busy health facility with an outpatient department for clinical practice. Additional nearby outpatient clinics may be

ll visited to assess their adequacy in termneeded. The clinical facilities must be a s

of the training needs (See section Plan for computer training and IT support).

puter training and IT support).b. Availability of computers (See section Plan for coms: c. Classroom based training Adequate lodging for all facilitators and participants.

d. Transportation to and from clinical practice sites. e. Convenient meal service.

Dist can e learning training There are several possibilities how to conduct the facilitator‐part ipic ant encounters:

a. Whole group of participants meet with facilitators at one venue. r ver m nb. Participants f om se al nearby health facilities eet with facilitators i one of the health facilities.

c. A facilitator visits a remotely located health facility with one or several participants and conducts a session “on the spot”.

i. NOTE: Usually one day is needed for one session in one health facility regardless of the number of participants because the clinical practice is an essential part of the encounter and patients come in the morning only.

d. Combination of the above, e.g. initial and final encounters are conducted at the participants’ central venue, intermediate encounter or encounters at several

5. Hea f ill be invited identified. Criteria: health facilities.

lth acilities from which participants wa. A commitment to implement IMCI


25 | P a g e

b. A need to ra train staff in IMCI c. A comm od.

(staff never trained or needing refresher t ining) itment t allow each participant to participate in the training.

n e learning training:Dista c i. At least one computer with correct specifications (See Annex 1 of this

guide) and, if possible, a head set per computer in the health facility and a commitment to allow each participant to use the computer for approximately 4 hours per week during the training.

ii. Future participants have their own computers or an access to a computer elsewhere than in their health facility (e.g. internet cafe).

NOTE: The specification of computers available, including the availability of DVD/USB drives, and the access of the future participants to them need to be specifically clarified. Antiviral protection of all computers that will be used is strongly recommended. Assistance of an IT support person may be needed at this stage. (See section Plan for computer training and IT support).

6. Selection of participants discussed and agreed upon with the management of the health facilities from which the participants will be invited and, for a training with individual computer use, information about current computer skills of future part

he m writing.

icipants’ obtained (See section Select participants).

7. Consent of t anagement of the health facilities obtained in ect trainers and plan for 8. The format of facilitator training decided upon (See section Sel

9. their preparation). Specific dates of the facilitator and participant training selected. When selecting the dates, makes sure that there are no holidays or other events that would disrupt the training. For distance learning training, in which sufficient number of patients for clinical practice on the days of facilitator – participant encounters is crucial, enquire if the patient load is different in different days of the week (e.g. more patients on

immunization days) and plan the dates market days; no sick children on the clinic

accordingly.

10. Participants selected and invited (See section Select participant). availability (See 11. IT support person identified and arrangements made for his or hersection Plan for computer training and IT support).

and12. Facilitators and inpatient instructor selected and invited (See section Select trainers plan for their preparation).

13. Availability of one computer for each facilitator during the facilitator training and the raining whole duration of the participant t ensured (See section Plan for computer

training and IT support). 14. Dist can e learning training: Decision on partic pant support during the self learning

se made: a. Communication between facilitators and participants (telephone, e‐mail,

personal; plan for allowances for facilitators and/or participants for telephone calls). O ill the p rt

i pha s

ne facilitator per 10 participants w be appointed to communicate with a icipants during the self‐learning phases. Possible approaches: i. Active approach: A facilitator will contact participants once a week to

enquire about the work progress. The participants will be encouraged to contact the facilitator if they have any problem. The facilitator(s) will communicate with the director as needed.


26 | P a g e

Ac t t ethtive support to participants con ribu es to th ir motivation to complete e training.

ii. Passive approach: Participants will contact the designated facilitator question. Facilitators themselves will not when they need help or have a

b. Poss lecontact the participants.

ib (optional) additional support: i. If there are regular supervisory visits in the area, it might be useful to

“ have an informational session” for the regular supervisors, who might provide additional support to the participants.

ii. Mentors are another possibility of participant support. A mentor is a health worker trained in IMCI working in the same health facility as the

gparticipant(s) who e.g. helps the participant to mana e cases correctly according to IMCI guidelines or clarifies IMCI content if needed.

15. Distance learning training: Information about supplies/drugs at the participants’ worksites obtained. Missing IMCI supplies/drugs needed for clinical practice identified

and a plan to provide supplies/drugs for the participants made. 16. Distance learning training: Decision on whether the participants will or will not be

required to manage a specified number of patients according to the IMCI guidelines during the self‐learning phases at their health facility. If yes, the number of patients to manage decided upon.

17. Persons identified to conduct follow‐up visits 4 ‐6 weeks after the training. (These may include training facilitators, supervisors in the district, or others with IMCI and facilitation skills.) Plans made for preparing these individuals to conduct follow‐up visits after training. (WHO Guidelines for followup after training are available in the ICATT library).

itoring 18. Decision on collection of mon and evaluation information made. Forms selected and adapted if needed (See section Plan for data collection)

19. Decision on the evaluation of participants made. Evaluation may consist of knowledge n Plan for data evaluation only (written post test) and/or of skills evaluation (See sectio

collection).

20. Materials and supplies needed identified (See annexes 6‐9 of this guide). 21. Decision whether ICATT training player used will be on USB or DVD made (See section Plan for computer training and IT support).

n DVD or USB flash disk will be provided to all 22. Decision whether ICATT training player ofaci at

23. Bud t lit ors and participants taken. ge prepared. Budget should include:

a. Training personnel cost (per diem or remunerations, travel costs) b. Training personnel cost (travel costs, per diem)

inted materials, photocopies, DVDs or USBs, c. Materials and supplies cost (prstationery)

d. Supplies for clinical practice cost e. Costs of room, equipment rental, and miscellaneous such as refreshments.

(24. Arrangements made with one local inpatient facility and outpatient clinic s) to conduct clinical practice sessions (See section Plan for clinical practice).

25. Precise schedules for the facilitator and participant training prepared including the content of each clinical practice session (See the specific part and section Plan for clinical


27 | P a g e

practice in chapter General considerat

ions for planning and organizing an ICATT based IMCI training in this guide).

26. Venue for computer training reserved. be available to ensure that

oo27. Arrangements made for a support staff (secretary) to

necessary administrative tasks are done and to ensure that things go sm thly.

28. Travel authorizations sent to facilitators and participants. 29. Arrangements made for providing adequate numbers of copies of the training support

materials (chart booklets, recording forms, monitoring checklists), necessary supplies for role plays (if conducted), and drugs and other supplies for clinical practice.

(Necessary materials and supplies are listed in the annexes 6‐9 of this guide.) 30. Plans for the opening session made. It may be useful to invite policy makers or senior

officials of the Ministry of Health, representatives from international or bilateral agencies (e.g. WHO or UNICEF) or representatives of bilateral organizations such as from

the national medical and/or nursing association or the national paediatric society. 31. Plans for press release made. Visibility becomes more and more important; therefore

consideration should be given to issuing a press release.

3.2 AT THE TRAINING LOCATION, BEFORE BEGINNING 1‐2 days before the training: Training director (with clinical instructors/s if feasible) visits the sites for clinical practice and discuss/confirm arrangements. (See items on this checklist.)

s1. Classroom based training : Adequate lodging arrangements confirmed for all facilitators and participants.

ants at the hotel, airport 2. Arrangements made for welcoming facilitators and particip

and/or train station (if applicable).

3. Arrangements confirmed for the room and computers. 4. ICATT i

use einstalled on all computers that will be used. If facilitators and/or participants will

th r notebooks:

ha. ICATT installed on their computers as soon as they arrive to the training location,

e.g. in the evening before t e training begins or during the registration. b. Access to electric power for the notebooks (sufficient number of multiplugs)

ensured. 5. LCD projector available. For the best quality of the projected image, adjust the computer

tdesktop resolution to he native LCD projector resolution (usually 1024 x 768 pixels). If you cannot do that, try which of the computers available gives the best projection result.

cipants n6. Arrangements made for registering facilitators and parti for the trai ing including registration forms.

7. Arrangements made for typing and copying of materials during the training (for participants, training evaluation example, registration forms, schedules, lists of

questionnaires). 8. Arrangements made for meals and coffee/tea service. 9. Arrangements made for paying per diem to participants and facilitators. 10. Inpatient ward for clinical practice visited and confirmed to be suitable for clinical

practice. Director and staff informed about the practice sessions to be held during the training. (See section Plan for clinical practice).


28 | P a g e

a. Daily schedule (or dates and times in a distance learning training) discussed and dules confirmed in agreed upon with inpatient ward director. Dates and sche

writing.

b. Drugs and supplies checked and supplemented as necessary. c. Role of inpatient staff during practice sessions discussed with inpatient ward

director. 11. Outpatient clinic(s) for clinical practice visited (during morning, at the time outpatient

sess n o ir taff informe n b c i

io s will be held) and c nf med to be suitable for clinical practice. Director and sd about practice sessio s to e held. (See section Plan for lin cal practice).

tually available at planned time for a. Adequate number of sick children ac

outpatient session.

b. ORT treatment corner or area available.

c. Quiet area or exam rooms available where participants can assess patients. supplemented as necessary.

. d Drugs and supplies checked and e. Role of clinic staff during practice sessions discussed with clinic director. f. Clinic staff briefed on their role. g. Schedule for clinical practice sessions discussed and confirmed in writing. The

patients are likely to .

clinical practice should be conducted at times when many be seen, usually in the morning (See section Schedule clinical practice sessions)

h. Charts hung at sites to be used during the training (if used).

12. Arrangements made for transportation to and from clinical practice sites (if needed). 13. Sufficient copies made of training support materials (Facilitator guide, registration form,

training schedule, case recording forms, Mother's card, and monitoring checklists for use in clinical practice sessions (if used).

3.3 D URING THE CLASSROOM BASED TRAINING1. Training participants registered using registration form.

a d r a o

2. ICATT inst lle o runs from the DVD/USB fl sh disk n participants’ own notebooks (if used).

3. Groups of up to 8 participants assigned to pairs of facilitators for outpatient clinical practice.

nd addresses of all participants, facilitators, and 4. Training directory (including names a

instructors) provided to everyone.

5. Training photograph, if desired, made. 6. Training evaluation questionnaires modified as needed and reproduced in sufficient quantity to give a copy to each participant and facilitator.

7. Post –test adapted according to the national IMCI guidelines and reproduced in sufficient quantity to give a copy to each participant.

(s) provided with the post –test key and scoring 8. Scoring of post test assigned to facilitatorinstructions.

s9. Arrangements made for closing ses10. Training completion certificate pre11. Plans for follow‐up visits finalized.

ion. pared for each participant (if used).


29 | P a g e

3.3 DISTANCE LEARNING TRAINING: DURING THE INITIAL FACILITATOR PARTICIPANT ENC UNO TER

1. Training participants registered using registration form.

2. ICATT installed or runs from the DVD/USB flash disk on participants’ own notebooks (if used).

s, 3. Training directory (including names and addresses of all participants, facilitator provided to everyone.

communicate with during self‐learning phases. instructors, and the IT support person)

4. Participants assigned to a facilitator to 5. Training photograph, if desired, made.

3.4 DISTANCE LEARNING TRAINING: BEFORE THE INTERMEDIATE AND FINAL FACILITATOR PA IRT CIPANT ENCOUNTERS

1. Participants reminded of the encounter.

2. Arrangements confirmed for the room, computers, and LCD projector.

ice. .

3. Arrangements confirmed for the sites for clinical pract

4. Arrangements made for transportation to and from clinical practice sites5. Arrangements made for meals and coffee/tea service. 6. Arrangements made for paying per diem to participants and facilitators.

Before the final encounter also:

7. Training evaluation questionnaires modified as needed and reproduced in sufficient quantity to give a copy to each participant and facilitator.

8. Post –test adapted according to the national IMCI guidelines and reproduced in sufficient quantity to give a copy to each participant.

r(s) provided with the post –test key and scoring 9. Scoring of post test assigned to facilitato

instructions.

si10. Arrangements made for closing ses11. Training completion certificate pre12. Plans for follow‐up visits finalized.

on. pared for each participant (if used).


30 | P a g e

4. PREPARING THE CLINICAL INSTRUCTOR An inpatient instructor who has not yet been prepared for conducted inpatient clinical practice and meets the criteria in Box 1 in General considerations for planning and organizing an ICATT based IMCI training of this guide chapter will not require extensive training. He has already conducted inpatient sessions in a previous IMCI course or has been a participant or facilitator in a previous IMCI course, and he is experienced in assessing and classifying children using the integrated case management process, and so does not require clinical training. He is familiar with the role of an inpatient instructor. However, if he has not yet acted as a clinical instructor, he must adapt to the method of selecting and reviewing cases presented in the Guide for clinical

. practice

As the training director, you are responsible for supervision of the inpatient instructor. Prepara ati ing steps: tion of the inp ent instructor should include the follow

• The inpatient instructor should study thoroughly the Guide for Clinical Practice in the Inpatient Ward. (Note: Explain to the inpatient instructor that inpatient sessions will not be conducted during facilitator training, only during the course.)

• The inpatient instructor should discuss his responsibilities and any questions with you, so that you both understand and agree what he will do.

• ctor should obtain the necessary With assistance from you as needed, the inpatient instrupermissions and supplies.

• He should meet and brief the staff in the inpatient ward. • He should find out the ward routine and layout, so that he can select children in the

morning and conduct the sessions efficiently and also without disrupting the ward. • He should begin working with the clinical assistant needed if the inpatient instructor is

not on the staff of the facility, to prepare the assistant for his tasks. • At some time before the training begins, he should go early in the morning to practice

working with the clinical assistant to select at least 6 children and prepare recording forms for a clinical session. He should then show you, the selected cases and recording forms and work out any problems encountered during the practice. The inpatient

ould also do a practice instructor sh demonstration for you using one of the selected children.

• Refer to the Guide for clinical practice for details on how the inpatient instructor should prepare himself and the inpatient ward. Go over the list with the inpatient instructor to be sure that everything is ready, and make arrangements for any remaining items.

• If you expect the inpatient instructor to collect data on the cases and the performance of participants during the training, discuss that with him. Ensure that he understands how to complete the checklist for monitoring inpatient sessions (See Annex 5 of the Guide for

cklist. clinical practice for instructions for completing the che


31 | P a g e

5. RAINING FACILITATORS T

5.1 INTRODUCTION This 3‐day ICATT facilitator training was designed for facilitators who have already been trained in the facilitation of standard IMCI courses with printed modules who are not yet familiar with ICATT.

ICATT facilitator trainees must have reasonable computer skills to learn and teach using ICATT easily – routine use of MS Word is sufficient.

The objectives of ICATT facilitator training are:

• Learning how to use ICATT and getting familiar with the way how IMCI is presented in ICATT.

• Learning facilitator techniques used in an ICATT based IMCI training and practicing f te e e d C u techniques

io . relevant acilitator chniqu s us d in a standar IM I co rse (including used in clinical practice sess ns)

tting informed ab ut the organization of the training and facilitator • Ge oresponsibilities.

G5.2 ENERAL STRUCTURE This 3‐day ICATT facilitator training is recommended before the participant training. As the training director, you are responsible for conducting the facilitator training. For a small group of ICATT facilitator trainees (up to 4‐5) you can conduct the training yourself. For a larger group, you should be assisted by an experienced facilitator familiar with ICATT. As the training is intensive, it is very helpful to have two people work together. By working together, you can also

demonstrate how co‐facilitators share the work during the actual ICATT training.

The agenda of the ICATT facilitator training is suitable for all training configurations. The objectives of the ICATT facilitator training and the schedule remain the same in preparation for facilitating all training configurations. In each training configuration, however, the role of a facilitator is somewhat different (See Box 3. Tasks of a facilitator in different training configurations in chapter General considerations for planning and organizing an ICATT based IMCI training of this guide), therefore different facilitator techniques need to be emphasised in preparation of facilitators for different training configurations. After completing the 3‐day facilitator training, the ICATT facilitators will be able to conduct any type of ICATT based training only after a short briefing.

One computer with ICATT training player must be available for each facilitator trainee during the whole facilitator training (except for the clinical session). Also each facilitator must have an unrestricted access to a computer with ICATT training player during the whole training.

Facilitator training for conducting ICATT based IMCI trainings is extremely important. During the ICATT facilitator training the facilitators must learn how to work with ICATT, how the IMCI materials are organized in ICATT and how to conduct the training. Well‐trained and supportive facilitators using ICATT with confidence are necessary for the success of the ICATT based IMCI training.

ICATT facilitator trainees will work quickly through ICATT; take turns in presenting the content of ICATT training units and in practicing the teaching activities described in the Facilitator guide for the particular training configuration that they will conduct.


32 | P a g e

The ICATT facilitator trainees will also practice leading outpatient clinical practice within the frame of an ICATT based IMCI training. As the ICATT facilitator trainees have already been trained in facilitating IMCI courses and therefore in conducting clinical practice sessions, the preparation of ICATT facilitators to conduct clinical practice sessions is limited to one half of the third day of training and focuses on refreshing the techniques used for conducting clinical sessions and obtaining information on the organization of clinical sessions in the ICATT based IMCI training that will follow.

Four methods will be used in the ICATT facilitator training:

• You (the training director) act as a facilitator. ICATT facilitator trainees observe appropriate behaviours as you teach the navigation in ICATT, deliver interactive presentation, present the content of ICATT training unit READ and SEE parts, conduct RACTISE and TEST part exercises, provide assistance with ICATT software and respond Pto questions concerning the ICATT IMCI content.

• An ICATT facilitator trainee acts as a facilitator speaking to a group of participants. The trainee is practicing teaching the navigation in ICATT, delivering interactive presentation, presenting the content of ICATT training unit READ and SEE parts, conduct PRACTISE and TEST part exercises, coordinating a role play, leading an oral drill, and summarizing daily work. While practicing, the trainee is also demonstrating these teaching activities for the others in the group. NOTE: Most of the time will be spent on presenting overviews of ICATT training units. This is because the ICATT facilitator trainees need to learn how the IMCI content is arranged in ICATT. Only classroom based training with LCD projector will be conducted in a similar way. This is NOT how trainings with individual computer use (either classroom based or istance learning) will be conducted in these trainings the ICATT content will not be dpresented by a facilitator except for chapters in the ICATT component INTRODUCTION).

• One trainee acts as a training participant and another one acts as a facilitator providing assistance and responding to questions. The ICATT facilitator trainee is both practicing nd demonstrating these activities. He or she asks questions to ensure that the a"participant" understands the item.

• A trainee acts as a facilitator who is supervising clinical practice. He identifies patients who have relevant signs for the day's objectives, demonstrates a clinical skill to other facilitator trainees, assigns patients, observes other trainees as they manage the patients, ives feedback as necessary, completes a Checklist for monitoring outpatient sessions, or ummarizes the session in a discussion. gs

At appropriate points during facilitator training, you will introduce the facilitator techniques described in Facilitator guide either in chapter Facilitator techniques or in the instructions for a specific activity. Once a technique has been introduced, you will assign facilitator trainees to practice the technique in front of the group. After every practice activity, it is useful and important to discuss the trainees’ performance and give feedback. By the end of the training, every trainee should have practiced each teaching technique.


33 | P a g e

5.3 DAILY SCHEDULE The 3‐day facilitator training schedule will focus on getting familiar with ICATT software and content and on teaching skills to be used in the classroom. The first two days will be spent in the classroom learning how to work with the ICATT software, reviewing the ICATT component Care of child aged 2 months up to 5 years, and learning techniques for conducting the training. The last day will be divided between clinical practice and classroom work. In the morning, the ICATT facilitator trainees will visit outpatient clinic, where they will refresh their skills how to conduct clinical practice. In the afternoon, they will review the Care of young infant aged up to 2 months.

A suggested schedule for facilitator training is provided in the next section. This schedule can be used to make more precise schedule including specific dates and times once you know them.

From time to time you will need to remind ICATT facilitator trainees from time to time that the participant training will not be conducted the way facilitator training is conducted. The training will be conducted as described in part of the Facilitator guide for the relevant training configuration. Refer to the facilitator guides and the actual training schedule frequently, so

everyone understands how the actual training will differ.

The schedule for facilitator training is highly compressed and will require efficient and concentrated work. The approximate duration of work through ICATT is 26 hours for participants without prior knowledge of IMCI. It is not possible to work through the full ICATT content during the facilitator training. The training units will be reviewed very quickly; the ICATT facilitator trainees will work only through selected exercises to understand how to complete various types of exercises. For this reason a short period (about 1 week) between the facilitator and participant trainings is recommended. Facilitators should use this period for

Agetting more comfortable with the IC TT software and content.

The schedule should be flexible. It suggests assigning tasks for homework (if trainees have access to computers in the evening) and it also provides time to prepare the tasks during the day (if trainees do NOT have access to computers in the evening). Also the configuration of the training that will follow needs to be taken in consideration, e.g. techniques of checking the participant progress and solving issues in a limited period of time and ways of communications between facilitator‐participant encounters need to be given sufficient time for distance learning training; presenting ICATT and working through exercises in a group needs to be emphasized for a training with LCD projector. If work is completed ahead of schedule on a certain day, facilitator trainees can begin work on the next scheduled item or be given more time to work individually through ICATT (do the exercises, run videos etc.)

ICATT ba IMsed CI training

34 | P a g e

5.4 SUGGESTED SCHEDULE FOR FACILITATOR TRAINING

DAY 1

Activity Time inutes)(m

Opening, welcome, introductions 30

Presentation: IMCI –strategy to improve health and overview of IMCI implementation in the country

30

Presentation: ICATT as a training tool 20

Objectives and organization of the facilitator training 10

Description of the training structure and introduction to training support materials 30

Interactive presentation: ICATT – How to start and individual practice in ICATT navigation

90

Presentation from ICATT: IMCI case management process 10

Interactive presentation from ICATT and demonstration: IMCI case management charts (chart booklet) and recording forms

30

Review of ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS, Part 1: ssess and classify the sick child (Continue Day 2) A

180

Assign tasks for the next day 10

Total 7:20 hrs


35 | P a g e

DAY 2

Activity Time inutes)(m

Review of ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS, Part 1: Assess and classify the sick child (Finish)

60

Individual work in ICATT ‐ preparation of tasks assigned on Day 1 (if not done as homework)

60

Practicing facilitator technique: Delivering interactive presentation: ICATT ‐ How to start, part: Run ICATT, ICATT menu, READ, SEE, PRACTISE and TEST parts

15

Demonstration and individual practice: Progress monitoring tools in ICATT, transfer of Student profile, run or install ICATT from a DVD

60

Practicing facilitator techniques: Interactive presentation from ICATT and demonstration: IMCI case management charts (chart booklet) and recording forms. Working with a co‐facilitator

30

Review of ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS Part 2 – 5

180

Practicing facilitator techniques: Lead a drill 20

Practicing facilitator techniques: Conduct a role play 30

Assign tasks for the next day 10

Total 7:45 hrs

DAY 3

Introduction to clinical practice 30

Outpatient clinical session: Clinical demonstrations 90

Outpatient clinical session: Assigning patients and monitoring clinical practice 90

Review of the ICATT Component CARE OF YOUNG INFANT AGED UP TO 2 MONTHS 180

Practical arrangements for the training and closing remarks 60

Total 7:30 hrs

ICATT ba IMsed CI training

36 | P a g e

5.5 CONDUCTING ACTIVITIES

5.5.1 DAY 1 g session

eOpenin

Welcome the ICATT facilitator train es.

Introduce yourself as the training director and write your name in large letters on a blackboard or flipchart. Ask the ICATT facilitator trainees to introduce themselves and write their names under yours on the flipchart. They may also wish to tell other information about themselves.

Make any necessary announcements regarding meals, transportation, payments, hotel regulations, etc.

Presenthe cou

tation: IMCI –strategy to improve health and overview of IMCI implementation in ntry Give the presentation “IMCI –strategy to improve health” that can be found in Training player ‐ Support materials – Training aids. It substitutes the ICATT chapter “What is IMCI”.

Complement this presentation by adding an overview of IMCI implementation in your country.

Presentation: ICATT as a training tool Open the ICATT training player and introduce briefly its content. Show an example of each item as you describe it. Mention the following:

The content of ICATT training player is based on building blocks organized in a very similar way as the printed IMCI training course modules. ICATT has 3 components (INTRODUCTION, CARE OF CHILD AGED 2 MONTHS UP TO 5 YEARS and CARE OF YOUNG INFANT AGED UP TO 2 MONTHS). The component CARE OF CHILD AGED 2 MONTHS UP TO 5 YEARS includes parts: Assess and classify, Identify treatment, Treat, Counsel the mother, and Follow‐up. The component CARE OF YOUNG INFANT AGED UP TO 2 MONTHS includes parts: Essential care for every young infant, Assess and classify young infant, Identify treatment for young infant, treat and counsel, and Follow‐up. Each part includes one or more training units similar to chapters of the printed modules. Each training unit includes READ, SEE, PRACTISE and TEST parts. In the READ part, there is a text, again based on the printed modules. In addition, in section Further reading, there are links to many technical materials that are not a part of the training. The SEE part includes many photographs and all videos from the standard IMCI course and additional audiovisual materials. The PRACTISE and TEST parts include exercises. Many of the exercises are the same as in the printed modules but usually organized in somewhat different way.

IMPORTANT: Assure the facilitator trainees, that as they are familiar with the standard IMCI course, they will get familiar with the ICATT training player very quickly even if here is no time to work through it in detail during this facilitator training. t


37 | P a g e

Objectives and organization of the facilitator training

All ICATT facilitator trainees should have already been trained as IMCI facilitators. They should have already learned the IMCI training content, developed clinical skills in managing children using the integrated case management process, and developed

facilitating skills to teach a standard IMCI course.

The objectives of the ICATT facilitator training are to learn how to use the ICATT software, to learn how the IMCI materials are organized in ICATT, to learn facilitator techniques used in the training, how the training will be organized, and what will be the facilitators’ responsibilities.

Describe the organization of the facilitator training using the information in sections eneral structure and Daily schedule of chapter Training of facilitators in this guide. G

tion of the training structure and introduction to training support materials Describe the structure of the training according to the training configuration that will be

Descrip

conducted after the ICATT facilitator training referring to the Director guide.

Distribute and briefly describe printed materials for facilitators that will be used during the ICATT based training:

• l iQuick reference for ICATT training p ayer or ICATT navigation min mum (optional) • Facilitator guide adapted for the training configuration that will follow the

facilitator training • IMCI chart booklet • Participant workbook (for Distance learning training only) • Case recording form Management of the sick child aged 2 months up to 5 years • Case recording form Management of the sick young infant aged up to 2 months • Other training aids if they will be used (A decision is needed during the planning

phase).

Facilitator guid and review the General part. Ask the trainees to open the e

Review the specific part of Facilitator guide:

Individual computer use and LCD projected trainings – tasks of a facilitator, facilitator techniques, and guidelines for each ICATT component: list of activities, notes for conducting the activities. Explain to the trainees that, as the ICATT provides instructions on how to work through its content, the notes for conducting the activities in the Facilitator guide describe only those activities that need emphasizing or that are not described in the ICATT.

DL training – training calendar, schedules and notes for conducting activities during the encounters.

Interac H r dividual practice n Ative presentation: ICATT ow to sta t and in i IC TT navigation Conduct the activity as described in the Facilitator guide in Guidelines for INTRODUCTION.


38 | P a g e

At the end of this activity assure the trainees that by the end of the facilitator training they will be able to navigate through ICATT with confidence.

Presentation from ICATT component INTRODUCTION: IMCI case management process Explain to the trainees that you will conduct this activity in the same way as it will be

.done during the training

Conduct the activity as described in the Facilitator guide in Guidelines for INTRODUCTION.

Ask the facilitator trainees if they have any questions about what they read or heard. Answer their questions.

Interac C p e INTRODUCTION an dIMCI ca s cording forms

tive presentation from I ATT com on nt d emonstration: se management chart (chart booklet) and reConduct the activity as described in the Facilitator guide in Guidelines for INTRODUCTION.

Explain to the trainees that you will conduct this activity in the same way as it will be done during the training.

Ask the facilitator trainees if they have any questions about what they read or heard. Answer their questions.

Review of ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS, Part 1: Assess and cla

ssify the sick child Show trainees the menu of the ICATT component INTRODUCTION. Tell them that in the form of presentations you have worked with them through all chapters of this component except chapter Additional information on major causes of childhood illness and death, and on the IMCI strategy. This chapter is optional and it is not a part of the training. They may return to the component Introduction individually later.

Now they are ready to start with ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS, Part 1: Assess and classify the sick child.

Explain that during the facilitator training there will not be enough time to work through the complete ICATT content.

• For training with individual computers: You will work together with the trainees nthrough the training u its very quickly to show how the IMCI content is

organized in ICATT and how to work with the software. • For training with LCD projector: You will work together with the trainees

through several training units in the same way as it should be done in the participant training. The trainees will first observe, then practice teaching the ICATT content. Then you will go with the trainees through the remaining training units very quickly just to show them how the IMCI content is organized in ICATT.

• For any training configuration: There is no need to run all videos or enlarge all pictures – the ICATT facilitator trainees already know those that are included in the standard IMCI training. Just make sure that the trainees know how to run a


39 | P a g e

video or enlarge a picture. It is useful to run all flash movies as they are a new IMCI teaching material.

You will now demonstrate the first two training units, and then the trainees will take turns to demonstrate to the group the following training units.

Present training unit Ask the mother about child’s problem:

• Briefly summarize the introductory page, open and read the Learning objectives. • READ part: Summarize very briefly the Key information. Show and talk through

the Example recording form screen. Show the Further reading screen and explain that there is no need to read the annotation of materials linked to the Further

m only if reading screen. These materials are optional – participants may read the

• they wish to do so and have time for it. SEE part: only show – do not run‐ the videos and pictures that are there.

• PRACTISE and TEST part: only show the screens and tell participants that you will do some exercises in the next training unit.

Present training unit Check for general danger signs:

For training with individual computers: Present the unit very briefly.

For training with LCD projector: Work through the training unit as you want the facilitator trainees to do it in the participant training.

When presenting the training unit, follow these steps:

• Briefly summarize the introductory page. Open the link to chart booklet and point out that the link “See IMCI chart” leads to the relevant part of each training unit. Show and read the Learning objectives.

• ing form READ part: Summarize the Key information. Show the Example record

• screen. Show the Further reading screen. SEE part: Show only– do not run‐ the videos and pictures that are there.

• PRACTISE part: Do Exercise 2 as an example of dual question exercise. Point out that the participant get feedback (correct answer) for PRACTISE exercises immediately.

• TEST part: Do the exercise (dual questions). Point out that the participant does not get aanswers

the feedback (correct nswer) immediately. Demonstrate how the of TEST exercises are evaluated in the Progress bar:

o There is one square for each training unit. Only TEST exercises are evaluated in the Progress bar. A white square means that the exercise has not been begun; a green square means “passed” (at least 80% of correct answers); a yellow square shows when the exercise has been begun AND that particular training unit is open; a red square means “failed”.

Tell the participants that now they will present the READ and SEE parts of the following training units and do one exercise in the same way as you presented the training unit General danger signs.


Assign the remaining training units in Part 1: Assess and classify child listed below to the participants and give them one hour to prepare individually to present the assigned training units. Provide assistance as needed.

When the participants are ready, ask them to present the training units one by one in the same or ning playder as they appear in the Trai er.

• For training with individual computers: Tell trainees that the presentation of each training unit should take at most 20 minutes – they should just show the content of all parts of the training unit and do one exercise. In addition to getting familiar with the IMCI content organization in ICATT, this will provide the trainee presenting the unit a practice in navigation in ICATT while other trainees will benefit from going through the navigation steps repeatedly. Do not focus on how the trainee summarizes the training unit content – he or she will not do this during the training. NOTE: As the trainees are familiar with IMCI, they tend to talk too long about the IMCI content. If this happens, interrupt the trainee and remind him or her that he or she should only SHOW the content of the unit.

• For training with LCD projector: The trainees should practice working through the training units in the same way as they will do it in the participant training. Ask the trainees to read facilitator techniques Teaching the information in ICATT, Demonstrating audiovisual materials, and Conducting exercises in Facilitator guide and follow the instructions when presenting their assigned training unit. NOTE: As the trainees are familiar with IMCI, they tend to give long presentations. If this happens, interrupt the trainee and remind him or her that he or she should summarize the content of READ part where possible.

Lead a short discussion about the trainee’s performance after the presentation. Focus on how the content was presented. More time to present each training unit is needed than for training with individual computers.

Assign and work through the following training units:

_______________Assess cough or difficulty breathing, PRATISE part Exercise 6 (number, one of many, dual questions)

_______________Assess diarrhoea, PRATISE part Exercise 5 – video.

NOTE: When the trainee who is presenting this unit gets to the exercise, give trainees one recording form and ask them to complete the form as they observe the video. Tell them that several exercises in ICATT instruct the participant to complete a printed recording form (Information about which exercises these are can be found in the Facilitator guide). The facilitators will check that the participants have completed the forms correctly. This is important preparation for the clinical practice during which the printed recording forms will be used. After the exercise is done, check if the trainees have completed the forms correctly.

fever (one of many, several of many)

g e

_______________ Assess fever, TEST exercise Classify

_______________ Assess ear problem, TEST exercise

40 | P a


41 | P a g e

_______________ Check for malnutrition and anaemia, PRACTISE Exercise 5 – use growth chart

______________ Check immunization, vitamin A and deworming status, TEST exercise _

Present very briefly training unit Assess other problems & review of assess and classify yourself (As described above for training unit Ask the mother about child’s problem). Tell the trainees that in this training unit, there are a large number of exercises. In a classroom based training, there may not be enough time to work through these exercises.

Assign tasks for the next day

Assign ICATT facilitator trainees:

_______________ Interactive presentation: ICATT How to start, part: Run ICATT, ICATT ISE and TEST parts menu, READ, SEE, PRACT

_______________ Interactive presentation IMCI case management charts and recording forms: agement charts part about IMCI case man

_______________ Interactive presentation IMCI case management charts and recording forms part about recording forms

Ask for one volunteer to serve as a co‐facilitator for each facilitator.

This will be repetitive, because you delivered the presentations during the first day of training but it is important to practice teaching techniques and also the ICATT facilitator trainees will benefit from going through these activities again.

Also assign demonstrating training units in ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS Pa t 2 – 5 r

Part 2: Identify treatment

_______________ Identify treatment, PRACTISE Exercise 2

Part 3: Treat

_______________ Selection of oral drug PRACTISE Exercise 1

NOTE: Make sure that all trainees know how to insert numbers in the answers.

_______________ Teaching mother to give oral drugs and treat local infections at home, TEST exercise

_______________ Give treatments and immunize the child at the clinic, TEST exercise


_______________ Give extra fluid for diarrhoea and continue feeding PRACTISE exercises 1 2 and

NOTE: Make sure that trainees know how to insert the amounts of fluids.

Part 4: Counsel the mother

ST exercise _______________ Assess feeding and make recommendations. TE

_______________ Use good communication skills, TEST exercise

Part: 5 Followup

_______________ Follow‐up

Coordinating role play: Teaching a mother to give oral drugs – Dasar (Annex 4 of the Facilitator guide).

_______________ Facilitator

orker _______________ Health w

_______________ Mother

5.5.2 DAY 2

Review of ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS, Part 1 Assess and classify the sick child (Finish)

Ask participants to present remaining training units in ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS, Part 1 Assess and classify the sick child

Individual work in ICATT preparation of tasks assigned on Day 1

Trainees work individually in ICATT. If they have not had the possibility to prepare the tasks assigned yesterday in the evening (no computers), they prepare them now. Provide assistance as needed.

Practicing facilitator techniques: Interactive presentation: ICATT How to start, part: Run ICATT, ICATT menu, READ, SEE, PRACTISE and TEST parts; working with a cofacilitator

Ask the trainees to deliver the presentations assigned to them on Day 1. Ask the assigned facilitator trainees to serve as co‐facilitators. Provide constructive feedback after the presentation.

Answer any questions that the trainees may have.

Demonstration and individual practice: Progress monitoring tools in ICATT, transfer of Studen

g e

t profile, installing ICATT and running it from DVD

Trainees have already learned about the Progress bar.

42 | P a


43 | P a g e

Now demonstrate checking the answers to the TEST exercises in the Check progress sheet accessible from the Student profile screen and make sure that all trainees know how to open it.

Demonstrate the Clinical practice sheet – recording of cases seen. Discuss whether the participants will use this form for recording cases seen.

Demonstrate the transfer of Student profile. For DL training: Ask trainees to practice transferring the Student profile. For other trainings: Do not spend too much time on practising the transfer of Student profile – it may be very time consuming and the participants will not do it.

For DL training: Explain how to check the participant’s progress and provide feedback during Facilitator – participant encounters (see Facilitator guide).

Demonstrate and practice installing ICATT and running it from DVD.

Practicing facilitator techniques: Delivering interactive presentation from ICATT and demonstration: IMCI case management charts (chart booklet) and recording forms; workin g with a cofacilitator

Ask the trainees to deliver the presentations assigned to them on day One. Ask the assigned facilitator trainees to serve as co‐facilitators. Provide constructive feedback after each presentation.

Review of ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS Part 2 5

Ask participants to present the assigned training units one by one using LCD projection: technical content and ICATT features. Provide constructive feedback after the presentation.

Answer any questions that the trainees may have.

Practising facilitator techniques: Lead a drill

Practise leading a drill any time during the day ‐before or after a break or when trainees need a break from work with ICATT.

Tell trainees that now they will practice leading an oral drill. Remind them that certain ral drills help to hese skills. skills need a lot of practice. O develop t

Ask trainees to open their Facilitator guide at page Facilitator techniques: Lead a drill. Referring to it remind trainees how to lead an oral drill.

Ask trainees to find the drill Review information on the ASSESS and CLASSIFY chart in the Annex 2 of the Facilitator guide. Begin the drill. Then, after the pace of the drill is set, let several trainees to take turns being the “facilitator” while other act as “participants”. Afterwards discuss how the drill went. Did the facilitators make the participants comfortable with the process? Were there ways that the drill could have been improved?

Remind trainees that they have some flexibility in when to lead a drill during the training. They may lead a drill when it is mentioned in the schedule, or they may lead it


44 | P a g e

when participants need a break from work in ICATT. They may do a drill after a tea break or lunch, as a way to focus the group's attention. However, they should not forget to do the drill sometime during the day.

Practising facilitator techniques: Coordinate a role play

Practise coordinating a role play any time during the day ‐ before or after a break or when trainees need a break from work with ICATT.

Tell trainees that now they will practice coordinating a role play. Remind them that role plays are especially useful for practising communication skills, and so are used often to practise instructing the mother on continuing treatment at home, and to practice counselling the mother.

Ask trainees to open their Facilitator guide at page with Facilitator techniques: Coordinate a role play. Discuss each point of the facilitator technique and answer any questio s ens. Al o revi w the following points:

• Role plays will not (and should not) be perfectly prepared and rehearsed performances. The point of role plays is to practice dealing with newly acquired information about the child, or unexpected but realistic characteristics of the mother.

• The person playing the role of the health worker should not be told in advance any more information than is provided in the Facilitator guide; however, this person should be encouraged to review the relevant sections of the management charts, or the communication skills to be used. The facilitator should be sure that

o d a t the the health w rker un erst nds he purpose of the role play and steps or points to cover.

• The person playing the role of the mother should behave realistically, incorporating any background information given to her about her role. She may

necessary, as make up additional information if long as it is realistic and consistent with the background information.

• It is important to look ahead in the Facilitator guide to see when role plays will occur and prepare for them. Some role plays require supplies such as drugs or a baby doll. These supplies will be listed in the instructions for the role play. Explain where these supplies are located now and that most of the supplies will

e he training. be furnished in th training room during t

Have facilitator trainees practice the role play Teaching a mother to give oral drugs – Dasar (Annex 4 of the Facilitator guide) for which the roles were assigned yesterday.

Assign tasks for the next day

Assign demonstrating training units in ICATT Component CARE OF YOUNG INFANT AGED UP TO 2 MONTHS to trainees

Part 1: Essential care for every young infant

_______________ Essential care for every young infant


45 | P a g e

Part 2: Assess and classify young infant

re disease and local bacterial infection _______________Check young infant for very seve

_______________ Check young infant for jaundice

_______________ Assess young infant for diarrhoea

_______________ Check young infant for feeding problem or low weight

_______________ Check immunization and assess other problems of the young infant

Part 3: Identify treatment for young infant, treat and counsel

_______________ Identify treatment for young infant, treat and counsel

Part 4: Follow up the young infant

_______________ Follow up the young infant

5.5.3 DAY 3 Introduction to clinical practice

This ICATT based facilitator training was designed for facilitators who have been already trained in facilitating standard IMCI courses; therefore they already know how to conduct clinical sessions. The objectives of the clinical practice session in ICATT facilitator training are to:

• TT based IMCI training, Learn how the clinical sessions will be organized in the ICAand

the techniques used for c• Refresh onducting clinical sessions.

Distribute the Guide for clinical practice (This may be the ICATT guide adapted according to the national IMCI guidelines or the guide for the outpatient clinical practice used for standard IMCI courses in your country, area or training institution ‐ See section Plan for clinical practice in chapter General considerations for planning and organizing an ICATT based IMCI training of this guide.). These instructions refer to the ICATT Guide for clinical practice. If you will use your own guide, you need to adjust the instructions accordingly.

Review the guide and explain to the facilitator trainees how the clinical practice will be conducted during the participant training.

NOTE: There will be probably fewer clinical sessions in the ICATT based IMCI training than described in the guide. A decision which sessions need to be combined needs to be taken before the training and facilitator trainees informed accordingly (See section Plan for clinical practice in chapter General considerations for planning and organizing an ICATT based IMCI training of this guide).

Explain to the participants how the clinical practice will be conducted in this facilitator training.

Outpatient clinical session: Clinical demonstrations


On arrival at the clinic, make the proper introductions and become oriented to the clinic's routine. Discuss with the clinic staff the types of children you will want to see throughout the morning.

l ationsFaci itator Techniques: Clinical demonstr

Ask the facilitator trainees to open the Guide for clinical practice to the Outpatient session Child‐1: Check for danger signs assess and classify cough and difficult breathing (or its equivalent in your national guide). Select children with cough or difficult breathing and any child with a general danger sign. Let the group see how you select the children. Remind them that selecting the children for demonstrations and for practice will be an important part of their job as a facilitator.

Following the guidelines in the Guide for clinical practice, do the demonstration of checking for danger signs and assessing and classifying for cough and difficult breathing, identify treatment and counsel the mother as appropriate. Act as though you are a facilitator doing the demonstration for participants in the training.

After your demonstration, review the following guidelines with facilitators before they do their assigned demonstrations:

• Use the instructions in the Guide for clinical practice. • cribe what you are going to do

to use. State the objectives of the demonstration; that is, desand the sections of the IMCI charts that you are going

• Stand where everyone can see the proced

•

ure clearly. • Demonstrate the entire correct procedure (no short cuts).

Describe the steps aloud as you do them. • to check their Encourage observers to ask questions; ask them questions

• understanding. Project your voice so all can hear; make eye contact when speaking.

uch as sections of the chart), ensure that all can see. • When showing visual aids (s

Practice of clinical demonstrations

Assign each trainee (or a pair of trainees) one of the demonstrations listed below. Tell them that they should select children for demonstrations who are likely to have relevant signs. For example, if they will demonstrate how to assess and classify diarrhoea, they should find a child with diarrhoea.

One by one, have each trainee (or a pair of trainees) select a suitable child and do the assigned demonstration in front of the group. (Remind them to start at the beginning of the Assess and classify chart and go through the assigned step.)

It will not be possible conduct all demonstrations in the time allocated to this session and also there may not be patients suitable for all demonstrations – do as many demonstrations

46 | P a g e

as time allows with those patients that are available.

As in the training, if any child presents with infrequently seen signs (such as stiff neck, measles rash, or corneal clouding or others listed in the Guide for clinical practice) you should take time to show those signs.


47 | P a g e

_______________ Demonstrate how to assess and classify diarrhoea, identify treatment and counsel the mother as appropriate.

_______________ Demonstrate how to assess and classify fever, identify treatment and counsel the mother as appropriate.

_______________ Demonstrate how to assess and classify ear problem, identify treatment and counsel the mother as appropriate.

_______________ Demonstrate how to check for malnutrition and anaemia, use the weight for mother as appropriate. age chart, identify treatment and counsel the

_______________ Assess breastfeeding and counsel the mother.

For this demonstration, select an infant age 1 week up to 2 months. Look for a breastfeeding mother who may need help. Have the assigned facilitator trainees do the demonstration of assessing breastfeeding and counselling the mother about correct positioning and attachment according to the YOUNG INFANT chart.

During each clinical demonstration, the group should observe and use their recording forms. After each demonstration, have the group give feedback. If the child needs treatment, wait and give feedback to the trainees after the child is returned to the clinic's care, so that you do not delay the child's receiving treatment.

Ask trainees to keep their recording forms to use when they return to the classroom. When they return, show them the enlarged Group checklist of clinical signs. Have them write their own initials in the box for each sign that they have seen. Explain that, during the training, participants will fill in this chart in the same way after every clinical session. During the training, facilitators should notice which participants have not seen certain signs and take special care to point out those signs when an appropriate child presents.

Outpat Assigningient clinical session: patients and monitoring clinical practice

After completing the clinical demonstrations, this session will be devoted to learning how to assign patients to participants and monitor their work using the Monitoring checklist.

Facilitator techniques: Assigning patients to participants

Tell facilitator trainees that an important part of their job will be to select suitable patients for participants to assess, classify, treat, and counsel. Each day they will need patients with different characteristics depending on where the participants are in the ICATT.

During the participant training, facilitators will need to work with clinic staff to identify appropriate children. Sometimes there may not be enough suitable patients. In such

vailacases, participants may have to group together to work with the a ble patients.

Facilitators should ensure that each training participant sees as many signs on the ASSESS & CLASSIFY chart as possible. By looking at the Group checklist of clinical signs


48 | P a g e

each day, facilitators can see which participants have not seen certain signs and try to assign them patients with those signs.

Whenever a participant has finished with a patient, a facilitator should give feedback and quickly find him another patient to see. It is important to keep participants busy. If there are few patients to see, facilitators can conduct a drill or a demonstration until more patients arrive.

Facilitator techniques: Monitoring clinical practice

Review the following ways to monitor clinical practice:

Whenever possible, directly observe participants working with patients to ensure that clinical skills are done correctly. Use the Checklist for monitoring clinical outpatient sessions to record the participant's assessments and any errors. If you see the participant make a mistake, ask him to look or try again. If the participant cannot correct his own mistake, provide an explanation or assistance. Also check the participant's recording form to see that information is correctly recorded. Provide feedback as needed. Comment on things done well and on things that need improvement.

When you are not able to directly observe the participant's work, take note of the patient's condition yourself. Then ask the participant to present the case to you. He or she should refer to his or her recording form and tell you the child's main symptoms, signs, and classifications (and, later in the training, the treatment plan). Discuss the case and verify the assessment and classification. If treatment has been specified, verify that it is correct.

If time is very limited, at least look at the participant's recording form. Compare your observation of the child's condition with the participant's findings. Ask questions to be sure the participant understands how to identify particular signs and classify them correctly.

Emphasize the following points:

• Teaching has priority over completion of the monitoring checklist. If you are very busy, put the checklist aside during the outpatient session and concentrate on teaching. Then fill out the checklist at the end of the session, or after several cases, referring to the participants' recording forms as needed. Cases managed by each participant will be counted at the end of the training, so be sure to record each case managed, even if you do not observe the entire process.

• Since participants are learning this process, some errors are expected. If you find no errors on the checklists, you may not be paying close attention, or you may be dismissing all problems as minor. On the other hand, do not be overly critical,

ork on every step of every case. finding fault with the participant's w

Practice assigning patients and monitoring

Select one facilitator trainee to help assign patients to the others. This person should select patients who may have fast breathing, fever, an ear problem, or diarrhoea.


49 | P a g e

Divide the remaining trainees into groups of two or three. One person in each group will act as the "facilitator" by monitoring another person who will assess and classify the child, identify treatment, advise when to return, and (if appropriate) teach the mother how to give an oral drug at home. The "facilitator" should use the Monitoring Checklist and give feedback. If there is a third person in the group, that person will also use the Monitoring Checklist and compare results.

After awhile, ask a different trainee to help with assigning patients. Try to let each trainee have a turn with this task.

Remind trainees to keep their recording forms so that they may complete the Group checklist of clinical signs when they return to the classroom.

Review of the ICATT Component CARE OF YOUNG INFANT AGED UP TO 2 MONTHS

Ask participants to present the training units one by one using LCD projection: technical content and ICATT features.

Practical arrangements for the training

Inform the ICATT facilitator trainees about the practical arrangements for the training. These will depend on the training configuration. In general, the following should be included:

• Discuss how the facilitators will divide the work for the first sessions. • Announce the clinic where each small group will do outpatient clinical practice.

Provide facilitators with any needed information about the site (e.g., location, director's name, staff nurse who will be assisting them). Ask facilitators to visit their assigned clinics themselves and make any necessary arrangements. For example, they need to find out what supplies or drugs they may need to bring with them.

• Give facilitators the written schedule for the training and the schedule for visits tto the inpatient ward and the ou patient clinics. Explain when and where

participants will meet for transportation to the clinical sessions. • Inform facilitators that lists of the participants will be prepared on the first

morning as soon as participants have registered. Facilitators will be given a copy of the registration form for each participant.

• Tell facilitators when and where they can obtain the training materials, or when the materials will be delivered to the classroom/computer laboratory where the participant training will be conducted and whom to contact if they need extra supplies or materials during the training.

• Ask faci o go to the classroom/computer laborato

litators to plan time before the training t

o ry and: arrange the tables, chairs, and materials,

o make sure that ICATT is installed and runs on all computers that will be used,

o r works, that there is a screen to project well (curtains may be needed), and

make sure that the LCD projectoon and the projection can be seen

o put charts on the walls (if used).


50 | P a g e

• Tell facilitators whom to contact if they need help with computers.

Closing remarks to facilitators

Briefly review the major tasks of a facilitator as described in the Facilitator guide.

Tell facilitators when the facilitator meetings will be held (at the end of each training day in classroom trainings, after each facilitator – participant encounter in a distance learning training). Explain the objectives of these brief meetings, which are:

• To assess progress made and identify any problems. To agree on actions to solve deach problem. The checklists for monitoring outpatient sessions can be use to

help report progress and problems in clinical practice. • To provide opportunity to meet with the inpatient instructor, who also has

feedback on your participants. • To discuss techniques which some facilitators found useful and can recommend

to others, • To prepare for the next day (for example, to review points to be emphasized, plan

which may be needed in activities for clinical sessions, discuss any modificationsthe schedule or locations for clinical practice), and

• To make any necessary administrative announcements.

Encourage informal discussions to be held after class hours (for example, to discuss practical use of what they are learning, potential problems such as unreliable drug supply, or other ideas related to the training). Ask facilitators to suggest ways, times, and places that such informal discussions could take place.

If a written post test or training evaluation questionnaire will be used, tell facilitators that they will be given the test and/or questionnaire at the end of the training to distribute to participants.

Thank the facilitators for their hard work.

ORGANIZE ICATT BASED IMCI TRAINING

DIRECTOR GUIDE SPECIFIC PART:

CLASSROOM BASED TRAINING WITH INDIVIDUAL COMPUTERS

ICA trainingTT based IMCI

2 | P a g e

CONTENTS CL SR AS OOM BASED TRAINING WITH INDIVIDUAL COMPUTERS ............................................................... 1

1. Example training structure ............................................................................................................................. 3

2. Example schedule for 6 day training ........................................................................................................... 5

guide Classroom based training with individual computers

3 | P a g e

Director

1. EXAMPLE TRAINING STRUCTURE Training objective

Train health professional responsible for management of sick children aged up to 5 years in IMCI.

Participants

Any health professionals responsible for management sick children aged up to 5 years at primary health care level.

General timeframe

The training will be conducted for 6 full consecutive days.

Computer training

Each participant will work with ICATT individually (one computer will be available for one participant) in a group in a computer laboratory, supervised and assisted by a facilitator as needed.

Each ICATT facilitator needs to have an unlimited access to a computer during the whole duration of the training.

A complete ICATT training set adapted according to the national IMCI guidelines will be used for the training.

Participants will be expected to work through the whole ICATT training set except the parts marked in the ICATT as optional (Additional information in the ICATT component INTRODUCTION and Further reading pages in the READ section of each training unit).

Clinical practice

Five inpatient and four outpatient clinical practice sessions will be conducted (No outpatient session on Saturday).

Clinical practice sessions will be conducted in groups of up to 8 participants in an outpatient clinic and inpatient ward. More outpatient clinics may be needed for the clinical practice.

Interactive group activities

Two drills (Review information on the ASSESS & CLASSIFY chart and Practise asking checking questions) and two role plays “Teaching a mother to give oral drugs – Dasar” and “Using good communication skills and the entire COUNSEL chart and Mother’s card – Felice” will be included into the training.

Human resources needed

One training director is needed to plan, organize, and coordinate the training activities and to train facilitators. The director may also act as one of the facilitators.


4 | P a g e

An additional outside training director is needed if the local training director has not yet been trained in facilitation of an IMCI training using ICATT.

One facilitator per 10 participants is needed for ICATT work, drills and role plays.

One facilitator per 3‐4 participants is needed for the outpatient clinical practice (two for each group of 6‐8 participants).

One clinical instructor is needed for inpatient clinical practice sessions. (He or she will conduct the clinical sessions with groups of up to 8 participants).

IT support: IT administrator in charge of the computers that will be used in the training is needed to assist with the installation of ICATT training player on all computers used and to provide assistance during the training if needed.

Administrative staff: One person is needed to assists the director with administrative tasks, logistics and to ensure sufficient quantity of printed and other materials.


A 3‐day facilitator training will be conducted one week before the participant training. There will be one week period between the facilitator training and the participant training to provide the future facilitators an opportunity to get more comfortable with the ICATT software and the organization of its IMCI content.


Participants will take a standard ICATT written post test adapted according to the national IMCI guidelines on the last day of training.

Followup after the training

Follow‐up visit will be conducted 4‐6 weeks after the training according to the standard WHO guidelines available in the ICATT library.

Director guide Classroom based training with individual computers

5 | P a g e

2. EXAMPLE SCHEDULE FOR 6 DAY TRAINING An example schedule is provided on the next pages. This schedule can be used to make more precise schedule including specific dates and times once you know the times for clinical sessions, transport to clinical sessions, and the arrangements for lunch, tea breaks, etc. (Note: If clinic visits will not be held in the morning, the schedule will need to be adjusted.)

Since participants will work at different pace, the schedule should be flexible. Approximate times required for completing each training unit should serve as guidance to facilitators in assisting the participants to complete work through ICATT in time limited by the course duration.

Every day, with the exception of the first and last day, should include 4 hours of clinical practice. Clinical practice should be scheduled at the time of day when most patients arrive, usually in the morning. The schedule provided assumes that the course will run Monday through Saturday. As there usually are no outpatients on Saturday, only 2 hours of inpatient clinical practice are scheduled for Saturday.


6 | P a g e

Activity type

Activities Time (min)

Day 1

Registration Registration and administrative tasks 30

Introducgroup session

tory

Opening ceremony, welcome and introductions of participants 15 Presentation: IMCI –strategy to improve health and overview of IMCI in the country 25

Objectives of the training, brief overview of the training organization, introduction of ICATT training player 15

Presentation from ICATT: IMCI case management process 15 Demonstration IMCI case management chartsrecording forms

(chart booklet) and 20

Interactive presentation: ICATT how to start 90

Individual work with ICATT

Care of child aged 2 months up to 5 yearsPart 1: Assess and classify the sick child aged 2 months up to 5 years

Ask the mother about the child’s problems 40 Check for general danger signs 45 Assess cough or difficulty breathing 100 Assess diarrhoea 85

Day 2

Clinical practice

Check for general danger signsAssess and classify cough or difficult breathing Assess and classify diarrhoea

240

Individual work with CATT I

Assess fever 100 Assess ear problem 25 Check for malnutrition and anaemia 80 Check immunization, vitamin A and deworming status 35

Day 3

Clinical practice

Assess and classify feverAssess and classify ear problem Check for malnutrition and anaemia

240


Assess other problems and review of assess and classify 55 Part 2: Identify treatment for child

Start: Identify treatment for child 90 Part 3:Treat the child

Select and give oral drug 80 Drill Drill: Reviewing information on the ASSESS and CLASSIFY chart 15


7 | P a g e

Activity type


Day 4

Clinical practice

Identify treatment for childTeach the mother to give oral drugs Advise mother when to return immediately

240


Part 3:Treat the child

Teach the mother to give treatment at home 70 Give treatment and immunize the child at the clinic 45 Give extra fluid for diarrhoea and continue feeding 50 Part 4: Counsel the mother

Assess feeding and make recommendations 55

Role play Demonstration role play ‐‐ Teaching a other to give oral drugs at home using good communication skills, Dasar

m 20

Day 5

Clinical practice

Plan A: Treat diarrhoea at homePlan B: Treat some dehydration with ORS Plan C: Treat severe dehydration quickly Counsel the mother about feeding problems

240


Use good communication skills 35 Part :5 Follow up the child Follow up the child 60 Care of young aged up to 2 moninfant thsPart 1: Essential care for every young infant

Essential care for every young infant 50 Part 2: Assess and classify young infant Check for very severe disease and local bacterial infection 60

Drill Drill: Practise asking checking questions 15

Role play Role play: Using good communication skills and the entire COUNSEL chart (Mother’s card if used) – Felice 20

Day 6

Clinical practice

Inpatient session only (No outpatients on Saturday)Essential care for all young infants Assess and classify young infants for bacterial infection, diarrhoea, and jaundice Assess breastfeeding attachment and suckling Correct positioning and attachment

120


Check young infant for jaundice 25 Assess young infant for diarrhoea 40 Check young infant for feeding problem or low weight 30 Check immunization and assess other problems of the young infant 35 Part 3: Identify treatment for young infant, treat and counsel Identify treatment for young infant, treat and counsel 100 Part 4: Follow up the young infant Follow up the young infant 40

Closing session Written post test, training evaluation closing of the training 90


8 | P a g e


DIRECTOR GUIDE SPECIFIC PART:

H LCD PROJECTOR CLASSROOM BASED TRAINING WIT


2 | P a g e

CONTENTS CL SR AS OOM BASED TRAINING WITH LCD PROJECTOR .................................................................................. 1


2. Example training schedule for 6 day training .......................................................................................... 5


3 | P a g e

1. EXAMPLE TRAINING STRUCTURE

Training objective


Participants


General timeframe

The training will be conducted for 6 full consecutive days.

Computer training

One computer and one projector are needed for the group of participants.

Each ICATT facilitator needs to have an unlimited access to a computer during the whole duration of the training.

A facilitator will work through the ICATT projected on a screen together with the group of participants.


The facilitator will work, together with the participants, through the whole ICATT training set EXCEPT:

• Sections marked in the ICATT as optional (Additional information in the ICATT rther reading pa ection of component INTRODUCTION and Fu ges in the READ s

• marked in the Facilitator guide as optional, and each training unit), PRACTISE exercises

• All TEST exercises.

The number of PRACTISE exercises worked through may be further reduced depending on the time available.

Clinical practice

Five inpatient and four outpatient clinical practice sessions will be conducted (No outpatient session on Saturday).

Clinical practice sessions will be conducted in groups of up to 8 participants in an outpatient clinic and inpatient ward. More outpatient clinics may be needed for the linical practice. c


4 | P a g e

Interac tive group activities

Two drills (Review information on the ASSESS & CLASSIFY chart and Practise asking checking questions) and two role plays “Teaching a mother to give oral drugs – Dasar” and “Using good communication skills and the entire COUNSEL chart and Mother’s card – Felice” will be included into the training.




The facilitator participant ratio for computer training should be 1: 6‐8. One facilitator works through the ICATT content together with the participants, another one or more facilitators help the participants to do the required tasks (e.g. find relevant information in the chart booklet or complete a case recording form correctly). It is NOT recommended to work in a group larger than 20 participants – it would increase the time needed for the interaction of facilitators with participants or decrease the interaction and therefore the quality of training.


One clinical instructor is needed for inpatient clinical practice sessions. (He or she will conduct the clinical sessions with groups of up to 8 participants).

IT support is usually not needed if the director/facilitators routinely use the available equipment (computer and projector) for teaching.



A 3‐day facilitator training will be conducted one week before the participant training. There will be one week period between the facilitator training and the participant training to provide the future facilitators an opportunity to get more comfortable with the ICATT software and the organization of its IMCI content.




Follow‐up visit will be conducted 4‐6 weeks after the training according to the standard WHO guidelines available in the ICATT library.


5 | P a g e

.2 EXAMPLE TRAINING SCHEDULE FOR 6 DAY TRAINING

An example schedule is provided on the next pages. This schedule can be used to make more precise schedule including specific dates and times once you know the times for clinical sessions, transport to clinical sessions, and the arrangements for lunch, tea breaks, etc.

l(Note: If clinic visits wil not be held in the morning, the schedule will need to be adjusted.)

The progress through the schedule is set by facilitators. Approximate times required for completing each training unit should serve as guidance to the facilitators in their preparations for conducting the activities and conducting them. If a training unit is completed ahead of schedule, the facilitator can begin work on the next training unit. If the work is behind schedule, the facilitator should adjust the duration of teaching the next unit (e.g. omit some exercises).

Every day, with the exception of the first and last day, should include 4 hours of clinical practice. Clinical practice should be scheduled at the time of day when most patients arrive, usually in the morning. The schedule provided assumes that the course will run Monday through Saturday. As there usually are no outpatients on Saturday, only 2 hours of inpatient linical practice are scheduled for Saturday. c


6 | P a g e

Activity type


Day 1

Registration Registration and administrative tasks 30

Introducgroup session

tory

Opening ceremony, welcome and introductions of participants 15 Presentation: IMCI –strategy to improve health and overview of IMCI in the country 25

Objectives of the training, brief overview of the training organization, introduction of ICATT training player 15

Presentation from ICATT: IMCI case management process 15 Demonstration IMCI case management charts (chart booklet) and recording forms 20


Care of child aged 2 months up to 5 yearsPart 1: Assess and classify the sick child aged 2 months up to 5 years

Ask the mother about the child’s problems 40 Check for general danger signs 45 Assess cough or difficulty breathing 100 Assess diarrhoea 85 Assess fever (Total time 100’) 60

Day 2

Clinical practice

Check for general danger signsAssess and classify cough or difficult breathing Assess and classify diarrhoea 240


Assess fever ‐ finish (Total 100’) 40 Assess ear problem 25 Check for malnutrition and anaemia 80 Check immunization, vitamin A and deworming status 35 Assess other problems and review of assess and classify (Total 55’) 30

Day 3

Clinical practice

Assess and classify feverAssess and classify ear problem Check for malnutrition and anaemia

240


Assess other problems and review of assess and classify ‐ finish (Total 55’) 25

Part 2: Identify treatment for child

Start: Identify treatment for child 90 Part 3:Treat the child

Select and give oral drug 80 Drill Drill: Reviewing information on the ASSESS and CLASSIFY chart 15


7 | P a g e

Activity type


Day 4

Clinical practice

Identify treatment for childTeach the mother to give oral drugs Advise mother when to return immediately

240


Part 3:Treat the child

Teach the mother to give treatment at home 70 Give treatment and immunize the child at the clinic 45 Give extra fluid for diarrhoea and continue feeding 50 Part 4: Counsel the mother

Assess feeding and make recommendations 55

Role play Demonstration role play ‐‐ Teaching a other to give oral drugs at home using good communication skills, Dasar

m 20

Day 5

Clinical practice

Plan A: Treat diarrhoea at homePlan B: Treat some dehydration with ORS Plan C: Treat severe dehydration quickly Counsel the mother about feeding problems

240


Use good communication skills 35 Part :5 Follow up the child Follow up the child 60 Care of young aged up to 2 moninfant thsPart 1: Essential care for every young infant

Essential care for every young infant 50 Part 2: Assess and classify young infant Check for very severe disease and local bacterial infection 60

Drill Drill: Practise asking checking questions 15

Role play Role play: Using good communication skills and the entire COUNSEL chart (Mother’s card if used) – Felice 20

Day 6

Clinical practice

Inpatient session only (No outpatients on Saturday)Essential care for all young infants Assess and classify young infants for bacterial infection, diarrhoea, and jaundice Assess breastfeeding attachment and suckling Correct positioning and attachment

120


Check young infant for jaundice 25 Assess young infant for diarrhoea 40 Check young infant for feeding problem or low weight 30 Check immunization and assess other problems of the young infant 35 Part 3: Identify treatment for young infant, treat and counsel Identify treatment for young infant, treat and counsel 100 Part 4: Follow up the young infant Follow up the young infant 40

Closing session Written post test, training evaluation closing of the training 90


8 | P a g e


PDIRECTOR GUIDE SPECIFIC ART:

RNING TRAINING ICATT BASED IMCI DISTANCE LEA


2 | P a g e

CONTENTS ICATT BASED IMCI DISTANCE LEARNING TRAINING ....................................................................................... 1


2. Example training calendar –Sequence, objectives, and location of training events ................ 6

3. Initial facilitator‐participant encounter: Suggested objectives and schedule ............................ 7

4. First self‐learning phase: Suggested objectives and participant ‘s tasks ..................................... 9

5. Intermediate facilitator‐participant encounter: Suggested objectives and schedule .......... 10

6. Second self‐learning phase: Suggested objectives and participant ‘s tasks ............................. 11

tives and schedule ........................... 12 7. Final facilitator‐participant encounter: Suggested objec

Director guide ICATT based IMCI distance learning training

3 | P a g e

1. EXAMPLE TRAINING STRUCTURE Training objective


Participants


General timeframe

The total training duration will be 2 months. The training will consist of three one‐day facilitator‐participant encounters and two self‐learning phases of approximately 3.5 and 4.5 weeks in‐between. All facilitator – participant encounters will be conducted at central level.

A facilitator will communicate each week with the participants (one facilitator per 10 participants) during the self‐learning phases in order to monitor participant progress, provide assistance and solve problems as needed.

Computer training

Initial encounter: One computer for a maximum of two participants is needed as the participants need to learn and practice navigation in ICATT.

Intermediate and final encounters: One computer is needed for the group feedback and problem solving sessions.

NOTE: If the number of computers available for the initial facilitatorparticipant encounter is not sufficient for the planned number of participants, the encounter may be organized for

ssmaller group on different days.

Self‐learning phases: Each participant must have an access to a computer for approximately 4 hours per week during the 8 week training.

Each ICATT facilitator must to have an unlimited access to a computer during the whole duration of the training.


Participants will be expected to work through the whole ICATT training set except the parts marked in the ICATT as optional (Additional information in the ICATT component INTRODUCTION and Further reading pages in the READ section of each training unit).

Clinica cl pra tice

One clinical demonstration session will be conducted during the initial facilitator – participant encounter. One outpatient and one inpatient clinical practice session will be conducted during each subsequent encounter.


4 | P a g e

Clinical practice sessions during the encounters will be conducted in groups of up to 8 participants in an outpatient clinic and inpatient ward. More outpatient clinics may be needed for the outpatient clinical practice.

Participants will practice IMCI case management individually in their health facilities with as many patients as possible but not less than 20.

Interac tive group activities

Two drills (Review information on the ASSESS & CLASSIFY chart and Practise asking checking questions) will be included into the training.




One facilitator per 4‐5 participants is needed for ICATT work, drills and role plays during the encounters.


One facilitator per 10 participants will be assigned to communicate with participants during the self‐learning phases.

One clinical instructor is needed to assists the facilitators to select patients for demonstration during the initial facilitator‐participant encounter and to conducts the inpatient clinical sessions during the subsequent encounters. (He or she will conduct the clinical sessions with groups of up to 8 participants).

IT support: One skilled computer user is needed to assist the training director with identification of suitable computers to be used in the training, installation/running of ICATT from DVD or USB flash disk, and to solve participants’ IT related problems during the training.



A 3‐day facilitator training will be conducted one week before the initial facilitator ‐ participant encounter. There will be one week period between the facilitator training and the initial encounter to provide the future facilitators an opportunity to get more omfortable with the ICATT software and the organization of its IMCI content. c


5 | P a g e




Follow‐up visit will be conducted 4‐6 weeks after the training according to standard WHO guidelines available in the ICATT library.


6 | P a g e

2. EXAMPLE TRAINING CALENDAR –SEQUENCE, OBJECTIVES, AND LOCATION OF RAINING EVENTS T

Duration/

date(s) Teaching/learning objectives Location

Initial facilitator – participant encounter 1 day

Facilitator• t is Explain how the training will be organized and wha

expected from the participant • Teach the principles of the IMCI case management

booklet and recording process and the use of the chart

• forms Clinical practice: Demonstrate ASSESS & CLASSIFY

• Teach how to run/install ICATT and navigate in it

Central

1st self learning phase

NOTE: Working through Assess and classify child aged 2 months up to 5 years takes approximately 10 hrs; 42% of the total ICATT work time

Approx. 3.5 weeks

Participant •

ars Learn Part 1: Assess and classify child of ICATT component Care of child aged 2 months up to 5 ye

• Practice the assessment and classification of sick children aged 2 months up to 5 years

Participant HF

Intermediate facilitator – participant encounter

1 day

Facilitator

• • Assess participant progress in ICATT

Solve possible problems • Clinical practice outpatients: Demonstrate identifying

treatment, treating the child and counselling the mother; conduct participants’ individual practice in the assessment and classification of children aged 2 months up to 5 years

• Clinical practice inpatients: Conduct participants’ individual practice in the assessment and classification of children aged 2 months up to 5 years

Central

2nd self learning phaseNOTE: Working through Part 2‐5 Care of child aged 2 months up to 5 years takes

of

approximately 8 hrs; 33%the total ICATT work time.Working through Care of young infant aged up to 2 months takes approximately 6.5 hrs; 25% of the total ICATT work time.

Approx. 4.5 weeks

Participant • Learn parts Identify treatment, Treat, Counsel the

mother and Follow‐up of ICATT component Care of child aged 2 months up to 5 years

• up Learn ICATT component Care of young infant aged to 2 months

• Practice managing sick children aged up to 5 years

Participant HF

Final facilitator – participant encounter

Facilitator

• • Check if participants have finalized the ICATT

Solve possible problems • Clinical practice outpatients: Conduct participants’

individual practice in complete case management of children aged 2 months up to 5 years

• Clinical practice inpatients: Demonstrate assessment and classification of a young infant; demonstrate breastfeeding assessment and counselling

• Evaluate participant knowledge: Written post‐test

Central

Followup visit 4‐6 weeks after the training

Facil ted person itator or another designa• Conduct follow‐up visits

Participant HF


7 | P a g e

3. INITIAL FACILITATOR‐PARTICIPANT ENCOUNTER: SUGGESTED OBJECTIVES AND SCHEDULE Objectives At the end of the session each participant should:

• d from him or her, Know how the training will be organized and what is expect

•

e• Be familiar with installing of and navigating through ICATT,

Know principles of the case management process, and • Know principles of the use of the chart booklet and recording forms.

Possible schedule An example schedule is provided below. This schedule can be used to make more precise schedule including specific dates and times once you know the time for clinical session and the arrangements for lunch, tea breaks, etc. When setting the time of the beginning and of the end of the encounter, take into account the time when participants can arrive for the encounter and

ey need to depart. when th

Activity Time

nutes)(mi

Registration and administrative tasks 30

Opening ceremony 20

Presentation: IMCI –strategy to improve health and overview of IMCI in the country

30

Objectives of the training, brief overview of the training organization, agenda of this encounter, and your role as a facilitator

15

Presentation from ICATT: IMCI case management process 15

Presentation from ICATT and demonstration: IMCI case management charts and recording forms

25

Clinical practice: Demonstration of assessment and classification of a sick child aged 2 months up to 5 years

90

Interactive presentation: ICATT ‐ How to start followed by individual practice of ICATT navigation

160

Review of Participant workbook and announcement of practical arrangements for the training.

30

Total duration 7 hrs


8 | P a g e

Possible organization of the clinical demonstration session

The objective of the clinical session during the initial facilitator ‐ participant encounter is to demonstrate the assessment and classification of a sick child aged 2 months up to 5 years. The demonstration is scheduled for the afternoon of the initial encounter because the participants need to learn about the IMCI, IMCI case management process, and IMCI charts, and recording form before the clinical demonstration. As the patients usually come to the clinics in the morning, conducting this session in an inpatient ward is preferable to conducting it in outpatient clinics in most settings. Two variants of a possible organization of the clinical demonstration are des bcri ed below:

a) Clinical demonstration in an inpatient ward:

The demonstration session takes place in an inpatient ward. Participants are divided into as many small groups (up to 4‐5 people each) as there are facilitators. Ask one of the facilitators or a clinical instructor to select with the assistance of the inpatient ward’s staff 4‐5 children

orwith one or more IMCI symptoms for the demonstration in the m ning.

Assign each facilitator to one patient. For the first group of participants, the facilitator demonstrates the assessment and classification process, how to use the chart booklet and the recording form, and assists the participants in finding the relevant places in the chart booklet and in entering the findings into the recording form.

After the demonstration, the groups of participants rotate. For the next group, the facilitator tells the participants the patients’ history and symptoms that the patient DOES NOT have; the facilitator demonstrates and classifies the symptoms and signs that the patient DOES

f iHAVE. This way each group o participants will see several pat ents with various IMCI signs.

The participants should see 4‐5 patients. If there are fewer facilitators/small groups, one facilitator can demonstrate two patients.

b) Clinical demonstration in outpatient clinics:

Each small group of 6‐8 people with two facilitators visits one outpatient clinic, where c tthe fa ilita ors demonstrate the assessment and classification process on as many

patients as time allows. While one facilitator demonstrates on one patient the assessment and classification process, how to use the chart booklet and the recording form, the other facilitator assists the participants in finding the relevant places in the chart booklet and entering the findings into the recording form. Then, for the next patient, the facilitators change their roles.


9 | P a g e

4 . FIRST SELF‐LEARNING PHASE: SUGGESTED OBJECTIVES AND PARTICIPANT ‘S TASKS

Objectives

At the end of this phase the participant should know and have the skills to assess and classify sick children aged 2 months up to 5 years.

Tasks

ICATT:

• Review the ICATT component INTRODUCTION presented during the initial facilitator‐participant encounter.

• Work through and learn Part 1 of the ICATT component CARE OF CHILD AGED 2 MONTHS UP TO 5 YEARS.

• Complete printed recording forms for those PRACTISE exercises in ICATT that require keep the forms for the facilitator. them and

Clinical practice:

• Assess and classify sick children aged 2 months up to 5 years of age (Optional: specify the number of patients to assess and classify – needs to be decided upon before the training begins).

• t a k Comple e a printed recording form for each p tient seen and eep them for the facilitator.

• Record each individual clinical practice session into the Record of clinical practice sessions (Item 5 in Participant workbook).

• Record the classification(s) of each child seen into the Record of classifications seen (Items 6 and 7 in Participant workbook).


10 | P a g e

5. INTERMEDIATE FACILITATOR‐PARTICIPANT ENCOUNTER: SUGGESTED OBJECTIVES AND SCHEDULE

• Objectives

• Assess participant progress I ICATT. Solve possible problems.

• tion of a sick child aged 2 Conduct individual clinical practice in assessment and classificaonths up to 5 years.

• emonstrate identify treatment, treat, and counsel the mother. mD

Possible schedule An example schedule is provided below. This schedule can be used to make more precise schedule including specific dates and times once you know the time for clinical session and the arrangements for lunch, tea breaks, etc. (Note: If clinic visits will not be held in the morning, the schedule will need to be adjusted.)

Activity Time

(minutes)

Registration and administrative tasks. Collection of participants’ ICATT Student profiles and completed recording forms for checking

20

Objectives and organization of the intermediate facilitator – participant encounter 10

Group overview of participant progress in ICATT and individual clinical practice during the self‐learning phase

40

Clinical practice outpatients: Demonstration of identifying treatment, treating the child and counselling the mother; individual practice in assessment and classification of children aged 2 months up to 5 years

Clinical practice inpatients: Individual practice in assessment and classification of children aged 2 months up to 5 years

180

Drill: Reviewing information on the ASSESS & CLASSIFY chart 20

Group feedback and problem solving session 90

Individual feedback conducted in small groups 30

Summarize the work and review tasks for the 2nd self‐learning phase. 30


D

irector guide ICATT based IMCI distance learning training

11 | P a g e

6. SECOND SELF‐LEARNING PHASE: SUGGESTED OBJECTIVES AND PARTICIPANT ‘S ASKS T

Objectives

At the end of this phase the participant should know and have the skills to manage sick children up to 5 years according to the IMCI guidelines.

Tasks

ICATT:

• Work through parts 2‐5 of the ICATT component CARE OF CHILD AGED 2 MONTHS UPTO 5 YEARS.

ugh the ICATT component CARE OF YOUNG INFANT AGED UP TO 2 MONTHS. • Work thro

Clinical practice:

• Practise a complete case management of as many sick children up to 5 years as possible manage – needs to be decided upon before (Optional: specify the number of patients to

• the training begins). Practise case management of young infants.

• aComplete printed recording form for each patient seen and keep them for the facilitator.

• r a in l s t e cContinue ecording e ch dividual clinica practice ession into he R cord of clini al practice sessions (Item 5 in Participant workbook).

• Continue recording the classification(s) of each child seen into the Record of classifications seen (Items 6 and 7 in Participant workbook).


12 | P a g e

7. FINAL FACILITATOR‐PARTICIPANT ENCOUNTER: SUGGESTED OBJECTIVES AND SCHEDULE Objectives

Check if participants finalized working through ICATT. • •

Conduct individual clinical practice in complete case management of sick children aged 2 months up to 5 years.

• ement of the young infant including feeding assessment Demonstrate a complete case managand breastfeeding counselling.

• Evaluate knowledge of participants.

Possible schedule An example schedule is provided below. This schedule can be used to make more precise schedule including specific dates and times once you know the time for clinical session and the arrangements for lunch, tea breaks, etc. (Note: If clinic visits will not be held in the morning, the schedule will need to be adjusted.)

As the ICATT sessions are shorter than in the intermediate encounter, you can schedule a specified time apart from the encounter regular hours when at least one facilitator is available to

ny problems or questions. discuss a

Activity Time nutes) (mi

Registration and administrative tasks. Collection of participants’ ICATT Student profiles and completed recording forms for checking.

20

Objectives and organization of the final facilitator – participant encounter 10

Group overview of participant progress in ICATT and individual clinical practice during the self‐learning phase

20

Clinical practice outpatients: Individual practice in complete case management of children aged 2 months up to 5 years

Clinical practice inpatients: Demonstration of assessment and classification of a young infant; demonstration of breastfeeding assessment and counselling

180

Drill: Practise asking checking questions 20

Group feedback and problem solving session 80

Written post test, training evaluation closing of the training 90


ANNEX 1: HARDWARE AND SOFTWARE REQUIREMENTS FOR IMCI ADAPTATION AND TRAINING TOOL (ICATT )

Minimum hardware and software requirements

MS Windows 2000™ or higher

MS Internet Explorer 5.5™ or higher

rk 1.1 (included with MS Windows 2000 and higher) Microsoft .Net Framewo

ayer Windows Media pl

DVD or USB drive

ace for installation (not required for running the ICATT from USB or DVD) About 4 Gb free sp

mplifier system A

In addition, to improve the usability of ICATT, some additional viewer applications will be are not already available: installed from the ICATT DVD/USB if they

Adobe Acrobat Viewer™ to display PDF files

vies Adobe Flash Player to enable viewing flash mo

MS Word viewer to display Word documents

S PowerPoint viewer to display PowerPoint presentations. M

ANNEX 2: LIST OF CLINICAL PRACTICE SESSIONS IN GENERIC GUIDE FOR CLINICAL PRACTICE

Outpatient Sessions

Inpatient Sessions

Care of sick child age 2 m up to 5 yearsonths Outpatient session Child‐1: Check for general danger signs

cough or difficult Assess and classify reathinb g

Inpatient session Child‐1 Check for general danger signs

y cough or difficult Assess and classif reathinb g

Outpatient session Child‐2: Assess and classify diarrhoea

Inpatient session Child‐2: Assess and classify diarrhoea

Outpatient session Child‐3: Assess and classify fever

Inpatient Session Childs3: Assess and classify fever

Outpatient session Child‐4: ear problem ion and anaemia

Assess and classify t Check for malnutri

Inpatient session Child‐4: Assess and classify ear problem Check for malnutrition and anaemia

Outpatient session Child‐5:

rugs Identify treatment Teach the mother to give oral d

n to r turn Advise mother whe eimmediately Outpatient session Child‐6: Plan A: Treat diarrhoea at home

dehydration with ORS Plan B: Treat some

Inpatient session Child‐5:

ly P Treat some dehydration with ORS Plan C: Treat severe dehydration quick Assess and classify additional children

lan B:

Outpatient session Child‐7: Counsel the mother about feeding problems

Care of young infant up to 2 months

Inpatient session Infant‐1: Essential care for all young infants

Outpatient session Infant‐1: oung infants for Assess and classify y

bacterial infection and diarrhoea

Inpatient Session Infant‐2: young infants for Assess and classify

acteriab l infection and diarrhoea Outpatient session Infant‐2:

Assess breastfeeding attachment andsuckling Correct positioning and attachment

Inpatient Session Infant‐3: nd

uckling Assess breastfeeding attachment as Assess and classify young infants

1

ANNEX 3: LIST OF TRAINING GUIDES AND AIDS

This annex provides a list of guides and other training aids developed for organizing and . conducting ICATT based IMCI training

The documents are located in ICATT training player, section Support materials, guides folders nd Training aids. a

Facilitator guide (Document)

This document consists of general and training configuration specific parts. The general part provides suggestions how to prepare for facilitating an ICATT based training and describes facilitator techniques that are used in any type of training. In the training configuration specific parts, there are three sections. Each section provides guidelines for one of the following training configurations: classroom based training with individual computers, classroom based training with LCD projector, and distance learning training. Each section describes first the tasks of a facilitator, then facilitating techniques specific for the training configuration and then it provides guidelines for conducting the training.

Adaptation needed: According to national guidelines. Pedagogical adaptation is needed if the training structure will be different from the generic one. To prepare for facilitating an ICATT based IMCI training, print the General part, Training specific part for the training configuration hat you will conduct and the annexes. t

Guide for clinical practice (Document)

This document consists of two parts: Clinical practice in the inpatient ward and Clinical practice in the outpatient clinic. Each part describes the role of the tutor, general procedures and specific instructions for conducting the clinical sessions.

Adaptation needed: This guide may be substituted by local clinical guides used in standard IMCI trainings or adapted according to national guidelines.

Quick reference for ICATT training player (Document)

This document provides detailed instructions about navigation in ICATT. It is accessible from Student profile screen – Help in ICATT training player. Use of its printed version is optional and usually not needed.

Adaptation needed: None.

2

How to use a computer (Flash movie)

This flash movie explains the main components of a computer for participants with no or very limited computer skills.


ICATT – How to start (PowerPoint presentation)

step‐by step explanations how to navigate in ICATT training player. This presentation provides


ICATT navigation minimum (Document)

This aid is intended for participants of distance learning training. It provides information how to start working with ICATT training player, how to transfer the Student profile, and how to open

I player that provides detailed instructions about navigation in ICATT. Quick reference for the IMC


IMCI – strategy to improve child health (PowerPoint presentation)

This presentation describes the rationale for WHO/UNICEF strategy for Integrated Management of Childhood Illness (IMCI). It substitutes ICATT chapter “What is IMCI”.

Adaptation needed: Including an overview of IMCI implementation in the country is desirable.

ICATT exercises and answers (Document)

The generic document is located in Adaptation and translation aids – Generic ICATT content Word files. It includes all ICATT exercises with correct answers. It is an essential document for the ICATT adaptation team during the adaptation of ICATT content. In addition it may be used a) for adjustment of the training content for a particular target audience either in ICATT or in the instructions of Facilitator guide and b) for quick orientation of facilitators in exercises and decisions which exercises must be worked through and which may be omitted during classroom based trainings if time is short.

Adaptation needed: Adaptation according to national IMCI guidelines should be done during the national adaptation of ICATT training player.

3

Coordinate role plays (Document)

This document provides instructions for coordinating 8 role plays included in the Facilitator guide for WHO generic 11 day training adapted according to IMCI guidelines used in ICATT; Two of the role plays have also been included into the ICATT Facilitator guide.

This document is useful for facilitators or ICATT adaptation team if they wish to use more or other role plays in the training.

Adaptation needed: If the role plays are in your national adaptation of WHO IMCI modules, your ational adaptation/translation may be used instead of adapting/translating this document. n

Lead drills (Document)

This document provides instructions for leading drills included in the Facilitator guide for WHO generic 11 day training adapted according to IMCI guidelines used in ICATT; Two of the drills

alsohave been included into the ICATT Facilitator guide.

This document is useful for facilitators or ICATT adaptation team if they wish to use more or other drills in the training.

Adaptation needed: If the role plays are in your national adaptation of WHO IMCI modules, your national adaptation/translation may be used instead of adapting/translating this document.

Participant workbook (Document)

This document for participants of a distance learning training provides the training calendar, tasks for self-learning phases, suggestions how to work and several forms for self-monitoring.

Adaptation needed: According to national IMCI guidelines. Pedagogical adaptation is needed if the training structure will be different from the generic one.

Case recording forms Management of the sick child aged 2 months up to 5 years (Document)

Recording form used for clinical practice can be printed from chart booklet in ICATT but it usually prints better as Word document. The generic recording form is located in Adaptation and translation aids.

daptation needed:A According to national IMCI guidelines.

4

Case recording forms Management of the sick young infant aged up to 2 months (Document)

Recording form used for clinical practice can be printed from chart booklet in ICATT but it usually prints better as Word document. The generic recording form is located in Adaptation and translation aids.

daptation needed:A According to national IMCI guidelines.

1

G. Group checklists of clinical signs (Word document)

The checklists are completed by participants, day by day. By the end of the training, it is a cumulative record of the clinical signs the participants have seen. See Annex 6 in Guide for clinical practice for instructions for completing this checklist.

ANNEX 4: LIST OF DATA COLLECTION FORMS

The forms listed below will help you in monitoring and evaluation of the ICATT based IMCI training. A number of the forms are the same as in the generic WHO/UNICEF IMCI clinical training course and you may be already using their nationally adapted version in your standard IMCI courses.

The forms are located in ICATT training player, section Support materials, Data collection forms.

A. Training report form (Word document)

The Training report form is completed by the training director at the end of training. It includes information on the total numbers of participants and facilitators, results of participants’ progress, hours devoted to clinical sessions, etc. All of this information is useful for monitoring numbers of participants trained, selecting future training sites (based on adequacy of case load), and ensuring that the training is being given as planned and not altered or shortened unacceptably.

B. Participant training registration form (Word document)

The form is completed by participants at registration on the first morning of the training.

C. Summary participant list (Excel sheet)

The list summarizes the data of the registration forms. This information can be useful for the training report and in planning for follow‐up visits.

D. Individual record of distance learning training participant progress (Word document)

The participant progress form is completed by facilitators of distance learning trainings. It is used for recording communication between the participant and facilitator and it summarizes participant’s progress in ICATT and the extent of his or her clinical practice. It is useful for monitoring the participant progress during self‐learning periods.

E. Summary record of distance learnin progress (Excel sheet)

The list summarizes the data in Individual records of distance learning training participant progress. This information can be useful for the training report and in planning future trainings.

g training participant

F. Time sheet for classroom based training (Word document)

You may wish to record the time it takes to work through ICATT training units for a better time organization in future trainings. This document provides an example how this can be done.

2

H. Checklists for monitoring clinical sessions and summary of clinical practice experience (Excel sheet)

Checklists for monitoring outpatient sessions are completed by facilitators to record the performance of their participants in each outpatient session. See Annex 5 in Guide for clinical practice for instructions for completing this checklist, which has two versions: one for sick children aged 2 months up to 5 years, and one for young infants aged up to 2 months.

Checklists for monitoring inpatient sessions are completed by the inpatient instructor at the end of each inpatient session. See Annex 6 in Guide for clinical practice for instructions for completing this checklist, which has two versions: one for sick children aged 2 months up to 5 years, and one for young infants aged up to 2 months. These checklists are primarily for the use of the inpatient instructor for use in keeping track of signs seen by each participant.

The summary of clinical practice experience is completed by the training director at the end of training on the basis of checklists for monitoring inpatient and outpatient sessions. This information can be useful in planning for future trainings.

I. IMCI knowledge post test and answer key (Word document)

The test comprises of 33 questions. The document includes an answer key and suggested scoring of results.

J. Evaluation questionnaire participant (Word document)

You may wish to use this questionnaire to determine participants' opinions at the conclusion of the training. Review and revise this questionnaire as necessary to ensure that it is appropriate for evaluating the training as it has been conducted.

You may wish to add or delete specific questions. If you make such revisions, remember: 1) keep the questionnaire as short as possible, and 2) only include questions if you will use the responses to the questions for a specific purpose, for example, to plan future trainings, or to evaluate helpfulness of a particular activity.

K. Evaluation questionnaire facilitator (Word document)

You may wish to this questionnaire to determine facilitators' opinions at the conclusion of the training. Review and revise this questionnaire as necessary to ensure that it is appropriate for evaluating the training as it has been conducted.

You may wish to add or delete specific questions. If you make such revisions, remember: 1) keep the questionnaire as short as possible, and 2) only include questions if you will use the responses to the questions for a specific purpose, for example, to plan future trainings, or to evaluate helpfulness of a particular activity.

L. Costing sheet (Word document)

The document provides suggestions how to calculate a training costs and compare the costs of an ICATT based IMCI training with costs of a standard IMCI training course.

ANNEX 5: CHECKLIST OF MATERIALS NEEDED AT THE TRAINING

Facilitator materials

Extent

Num

ber of copies

needed

Classroom based –

individual computers

Classroom based ‐LCD

projector

Distance learning

training

Quick reference for ICATT training player 14 pages One per facilitator

± (1) ±

ICATT navigation minimum 6 pages One per f acilitator ±

Facilitator guide Depends

on co infigurat

on

One per f acilitator

Guide for clinical practice (2) Approx. 20 pages1

One per f acilitator

Printed copy of IMCI chart booklet (3) Depends

on national adaptation

One per facilitator

ICATT exercises and answers 120 pages One per facilitator

± ± ±

Coordinate role plays 26 pages One per facilitator

± ± ±

Lead drills 45 pages One per facilitator

± ± ±

Participant workbook 8 pages One per facilitator

Case recording forms Management of the sick child aged 2 months up to 5 years

1 page

10 per facilitator

Case recording forms Management of the sick young infant aged up to 2 months

1 page

5 per facilitator

PowerPoint presentation: IMCI – strategy to improve child health Electronic

PowerPoint presentation ICATT – How to start Electronic

Fla w to use a computer Electronic ± ± sh movie: Ho

(1) Optional (2) Nationally adapted ICA T Guidelines for clinical(3) National printed copies or printed from ICATT

T

practice or standard national guide(s)

1

Participant materials Ex

tent

Num

ber of copies

needed

Classroom based –

individual

computers

Classroom based ‐

LCD projector

Distance learning

training

Printed copy of IMCI chart booklet

Depends on

n adaptationational

One per participant

Participant workbook 8 pages One per

participant

ICATT minimum navigation 6 pages One per

participant

Case recording forms Management of the sick child aged 2 months up to 5 years

1 page

30 per participant

Case recording forms Management of the sick young infant aged up to 2 months

1 page 10 per participant

Mother’s card – if used in the country 1 page 10 per

participant

2

Data collection forms

Extent

Num

ber needed

Classroom based –

individual

computers

Classroom based ‐

LCD projector

Distance training

A. Training report form One per training

B. Participant training registration form 1 page One per

participant

C. Summary participant list Electrexcel s

onic heet

One per training

D. Individual record of distance learningtraining participant progress

1 page One per participant

E. Summary record of distance leartraining participant progress

ning Electronic eetexcel sh One per

training

F. Time sheet for classroom based trainings

2 pages One per training

G. Group checklists of clinical signs (1)

Poster One per training group

H. Checklist for monitoring outpatient sessions – child aged 2 months up to 5 years (1)

1 pageOne per

session per 4participants

H. Checklist for monitoring outpatient sessions – young infant aged up to 2 months (1)

1 pageOne per

se r 4

ssion peparticipants

H. Checklist for monitoring inpatient sessions– child aged 2 months up to 5

years (1)

1 page One per session per

participantsgroup of

H. Checklist for monitoring inpatient sessions – young infant aged up to 2 months (1)

1 page One per session per

participantsgroup of

H. Summary of clinical practice experienceElectronic

eetexcel shOne per training

L. IMCI knowledge post test 5 pages One per

participant

L. Answer key for the post test 2 pages 1‐2 per

training

M. Evaluation questionnaire – participant 4 pages One per

participant

N. Evaluation questionnaire – facilitator 4 pages One per

facilitator

O. Costing sheet 8 pages 1‐2 per

training

(1) The form is the same as in the generic WHO/UNICEF IMCI clinical training course adapted according to IMCI clinical guidelines in the ICATT; you may have your nationally adapted version for your standard IMCI courses.

3

1

ANNEX 6: CHECKLIST OF EQUIPMENT AND SUPPLIES NEEDED AT THE TRAINING

Facilitator equipment and supplies

Item needed Number needed for any training configuration unless otherwise indicated

Computer to which the facilitator has a n or constant access (preferably his or her ow

in his or her office) One per facilitator

ICATT training player on DVD or USB or installed at the facilitator’s computer Each facilitator

Red pencils tom mark errors on completed s recording for One per facilitator

Pen or pencil One per facilitator Writing‐pad One per facilitator Folders or bags to hold the materials One per facilitator

Equipment and supplies for classroom sessions


USB flash disk or DVD with ICATT training player Optional one per participant

Head set One per each computer in Classroom basetraining with individual computers

d

Computers

Classroom based training with individual computers: One per participant

ector:Classroom based training with LCD proj One Distance learning training: One per 1‐2 articipants during Initial encounter; one

g other encounters pdurin

LCD projector One

Flipchart One

Markers for flip chart ‐ one set One set

Set of highlighters if chart booklets need to be colored

Several sets ‐ depending on the number of participants

IMCI wall charts (if used in the country): one set for the classroom, one set for each venue of

clinical sessions

One set for the classroom, one set for each f clinical sessions venue o

Loudspeakers One set

Paper Several reams for copying of forms etc.

2

Participant equipment and supplies


ICATT training player DVD or USB flash disk One per participant of Distance learning training, Optional for other training configurations

Labels for USB flash disks to put names on them if Student profile will be checked

One per participant of Distance learning training,

Name tag and/or name card for table One per participant Pen or pencil One per participant Writing‐pad One per participant Head set – one per each computer a(optional)

t HC One per computer at participant HF in Distance learning training

Folder for printed recording forms One per participant

1

ANNEX 7: LIST OF MATERIALS, DRUGS, AND SUPPLIES NEEDED FOR CLINICAL PRACTICE IN OUTPATIENT SESSIONS

Th ne actice sessions. e following instructional materials will be

TEM NEEDED FOR CLINICAL PRACTICE

eded for clinical pr

NUMBER NEEDED I

Set of wall‐size Case management charts to hang at clinical practice sites

1 set for each outpatient clinic and the inpatient ward

Copies of Mother's card to distribute to mothers

2 per counselling session per participant

Sick child recording forms 8 per participant per session

Young infant recording forms 8 per participant per session

Drug envelopes and labels 5 per participant, if sites will use them

Clipboard 1 per participant

Bag or box of drugs and other clinical supplies (such as cups) for a facilitator from each group to carry to outpatient clinics*

1 for each small group

2

Essential rugs and supplies fod

Drugs:

r outpatient sessions

)1 ‐ at least 8 per ORS packets (low osmolarity if available

participant First‐line oral antibiotic for pneumonia

alarial otic for dysentery

First‐line antimFirst‐line oral antibi

MebendazoleVitamin A capsules aracetamol PIron (tablet and syrup if possible)

Supplies: Plastic cups (one for each participant – to offer drinks to child with diarrhoea) Clean water supply (for mixing ORS, offering fluid to child

ed when assessing signs of dehydration; and making crushdrugs)

timing devices (participants will Enough watches or otherusually use their own watches) Mother's cards (if used)

food to use when mixing crushed ortable and children like it.

Banana or other acceptable Banana is handy, ptablets.

Other essential

supplies for ORT Corner

Containers for mixing ORS Spoons

on salts premixed packets1 Oral rehydrati

Other essentia l

clinic supplies

Thermometer

urately Wash basin, towel, soap

gFunctional scale for weighin children and accTape for the measuring of MUAC

Desirable for use in clinical practice:

Tetracycline eye ointment2 ‐ 1 tube per group Gentian violet2 ‐ small bottle of 0.5%

ing eyes with Soft cloths for applying gentian violet and washpus

Desirable for ORT corner if IV fluids to be given:

Ringer's lactate solution for IV administration Beds or tables with wires above for hanging bottles of IV fluid IV supplies such as scalp vein (butterfly) needles

1If pre-mixed packets of either standard or low osmolarity ORS are not available, use the following ingredients with amounts specified for mixing with 1 litre of water (low osmolarity ORS): Glucose (13.5 g) -- (or 27 g s otassium ucrose), Sodium chloride (2.6 g), Trisodium citrate, dihydrate (2.9 g) - (or 2.5 g sodium bicarbonate), Pchloride (1.5 g) 2These are unlikely to be used during the session. However, instructors can keep a small supply to use when demonstrating treatments of local infections.

It would be an ideal situation if clinics where outpatient sessions are held are stocked with all the drugs listed on the nationally adapted case management charts and with the necessary equipment for administering them. The drugs which are needed for doing all the steps as described on all of the case management charts include the following (less would be required after charts are adapted):

3

To provide care as taugh Integrated Management of Childhood Illness: t in the course

• CotrimAntibiotics: oxazole o Adult tablet (80 mg trimethoprim + 400 mg sulpho

amethoxazole) Paediatric tablet (20 mg trimethoprim + 100 mg

xazole) ethoprim + 200 mg sulphamethoxazole)

sulphamethoo

• AmSyrup (40 mg trimoxycillin

o Tablet (250 mg) )

• vial) o Syrup (125 mg per 5 mlAm

• Genpicillin intramuscular (250 mgtamicin intramuscular

o 2 ml vial containing 20 mg OR

• R 500 mg) o 2 ml vial containing 80 mg

• Ciprofloxacine tablets (250 mg O

• Tetracycline tablets (250 mg)

50 mg) Erythromycin tablets (2Antimalarials: • efantrine) Co‐a

• Quinrtemether tablets (20 mg artemether and 120 mg lum

OR ine Intramuscular

sing quinine salt) quinine salt)

o 300 mg/ml (in 2 ml ampoules uo 150 mg/ml (in 2 ml ampoules using

Antipyretic: Paracetamol tablets 500 mg OR 100 mgOther drugs: Sma les of safe, soothing cough remedy (optional) ll bottVaccines: Ade , HIB, Hep B, and Measles vaccinesquate supplies of BCG, OPV, DPTOther supplies: • Sugar

Cloth for wicking draining ears • e) with cover and side tap for holding

orner

• Large drum (5, 10, or 15 litre siz

f ORS in ORT c•

large quantities o

• Food to give patients on Plan B Naso

• Sterilgastric tube e syringes and sterile needles:

o 5 cc sterile syringes and sterile needles e needles

• o 10 cc sterile syringes and steril

• Sterile water for diluting IM antibiotics and IM antimalarials Cotton swabs and alcohol or spirits

• All appropriate cold chain supplies such as a reliable refrigerator or cold box, sterilizers, sterile syringes and sterile needles, immunization cards.

1

ANNEX 8: LIST OF SUPPLIES NEEDED FOR CLINICAL PRACTICE IN INPATIENT SESSIONS Supplies necessary for instruction

gement charts One set of wall‐size Case manaSick child recording forms Young infant recording forms

ee in one group clipboards to foot or head of bed

One clipboard per train fastenString or tape to

Highlighter pens, pens Thermometers Tapes for measuring of MUAC Scales for weighing children and infants ups, spoons and clean water (for offering fluid to assess thirst) upplies for treating dehydration according to Plan B and Plan C CS

Essential paediatric inpatienon:

t supplies • For IM/IV administrati Quinine Gentamicin Ampicillin

or injection) Diazepam

xtrose, f For : D50 (50% de• oral administration

ol tablets

Paracetam Iron syrup/ Vitamin A

d dysentery ORS

First and second line oral antimalarials and antibiotics for pneumonia an

• stration equipment Mebendazole

• Oxygen by cylinder or concentrator plus oxygen admini

sed NG tubes, oxygen tubing, etc. Nasogastric tubes Disi ash u• nfectant to w

• ORT corner supplies: Clean water ORS packets

Cups and spoons Containers for mixing ORS solution

• of IV and beds or tables with wires IV equipment including ways to regulate infusion rate

• olution and D5W above for hanging bottles of IV fluid

ing Ringer's lactate s•

IV fluids includ

• Cotton swabs and alcohol or spirits

• Thermometer Scale which can be zeroed and weighs accurately

• severely malnourished children, and children not Appropriate food for tube feeding (for

• able to feed)

use •

KCl solution ‐ for IV and oral

• Availability of safe blood transfusion Sterile needles and syringes

needles • Food to give to patients on Plan B and other patients • Reasonable HIV precautions including safe disposal of

1

ANNEX 9: LIST OF SUPPLIES FOR ROLE PLAYS INCLUDED IN FACILITATOR GUIDE

Role play: Teaching a mother to give oral drugs Dasar

Doll or other "baby"

Drug labels and a pen

Co‐artemether tablets

rup at your clinic) Iron syrup (or tablets, if there is no sy

Common spoon for measuring syrup

mall bottles (or drug envelopes) for mother to take drugs home S

Role play: Using good communication skills and the entire COUNSEL chart and Mother's card – Felice

No additional supplies are needed

Integrated Management of Childhood illness (IMCI): Directors Guide

Documents

Transcript of Integrated Management of Childhood illness (IMCI): Directors Guide