Using Teen Actors to Teach Using Teen Actors to Teach How to Communicate with How to Communicate with

AdolescentsAdolescents

Anisha Abraham, MD, MPHAnisha Abraham, MD, MPHAssociate Professor, Department of PediatricsAssociate Professor, Department of Pediatrics

Chief, Section of Adolescent MedicineChief, Section of Adolescent MedicineGeorgetown University HospitalGeorgetown University Hospital

Washington, DCWashington, DC

ObjectivesObjectives

To review two programs involving teen actors from local To review two programs involving teen actors from local community organizations: Teens Against the Spread of community organizations: Teens Against the Spread of AIDS (TASA) and Teens and Theater/Duke Ellington AIDS (TASA) and Teens and Theater/Duke Ellington School of ArtsSchool of ArtsTo discuss the benefits of programs using role play with To discuss the benefits of programs using role play with teen actors in teaching trainees how to communicate teen actors in teaching trainees how to communicate with adolescents with adolescents

Teen Actors-TASATeen Actors-TASA

TASA-group of DC high school students who use theater TASA-group of DC high school students who use theater techniques to educate youth/families about health issues techniques to educate youth/families about health issues and based at Children’s National Medical Center and based at Children’s National Medical Center In 1997, workshop developed to improve trainee violence In 1997, workshop developed to improve trainee violence screening skills at CNMCscreening skills at CNMCWorkshop used TASA members as teen actors and Workshop used TASA members as teen actors and educatorseducators

Screening Teens for Violence Risks Workshop

Participants- Medical students & pediatric residents rotating thru the

adolescent clinic at CNMC

Content- Trainees received a brief didactic lecture on violence among

teens including FISTS screening tool (Fights, Injuries, Sexual Violence and Self-Defense Strategies)

- Did one-on-one role play w/ teen actors on violence related scenarios

- Engaged in a panel discussion w/ teens regarding violence risks at home, school and the community

Screening for Teen Violence Risks Workshop

Teen ActorsTeen Actors– TASA members developed their own violence TASA members developed their own violence

scenarios including date rape, domestic violence, etcscenarios including date rape, domestic violence, etc– Performed 20 min role play w/ trainees, then gave Performed 20 min role play w/ trainees, then gave

feedback to trainees on establishing confidentiality, feedback to trainees on establishing confidentiality, use of FISTS screen, identification and management use of FISTS screen, identification and management of problemof problem

– Engaged in an interactive panel discussion Engaged in an interactive panel discussion addressing violence issues at home, school, and addressing violence issues at home, school, and communitycommunity

Screening for Teen Violence Risks Workshop

Led to study assessing impact of workshop on trainee violence screening skills

– Abraham A, Cheng T, Wright J , et al. Assessing an Educational Intervention to Improve Physician Violence Screening Skills Pediatrics 2001; 107: p 63-73

Study: “An Educational Intervention to Improve Physician Violence Screening”

• Purpose- To evaluate a violence prevention program targeted at health care personnel

• Setting- Adolescent clinic of a tertiary care hospital• Participants- Med students and peds residents

assigned to an adolescent rotation • Intervention- On alternate months, trainees

received 3 hr workshop on violence prevention including use of FIST screening tool & role play w/ teen actors

Study: “An Educational Intervention to Improve Physician Violence Screening”

Evaluation MethodsEvaluation Methods– All participants interviewed a standardized patient All participants interviewed a standardized patient

(teen actor) c/o a persistent headache w/ an (teen actor) c/o a persistent headache w/ an underlying violence- related issue during their clinical underlying violence- related issue during their clinical rotationrotation

– Participants were not aware that the standardized Participants were not aware that the standardized patient was an actor and not a real patientpatient was an actor and not a real patient

– Participants completed pre and post rotation Participants completed pre and post rotation questionnaires. Teen actors completed an evaluation questionnaires. Teen actors completed an evaluation of the encounterof the encounter

Study Design

Beginning of rotation End of rotation

Intervention Group-Violence Workshop--Standardized patient Pre-rotation questionnaire Post-rotation questionnaire

Standardized patient evaluation

Control Group-----------------------------------------Standardized patientPre-rotation questionnaire Post-rotation questionnaire

Standardized patient evaluation

Study: “An Educational Intervention to Improve Physician Violence Screening”

ResultsResults-- Post-rotation intervention subjects Post-rotation intervention subjects reported: reported: – More screening of fighting history (p < .003)More screening of fighting history (p < .003)– Perceived importance in asking about access/ use of Perceived importance in asking about access/ use of

weapons (p< .02)weapons (p< .02)– More screening of violence in school/neighborhood More screening of violence in school/neighborhood

(p< .01) (p< .01)

Standardized Patient EvaluationStandardized Patient Evaluation

0

5

10

15

20

25

FISTS use(p<.02) Identification and Management of

violencescenario(p<.0004)

Interpersonal Skills(p<.04)

Mean score Intervention(n=26)Control(n=30)

Study: “An Educational Intervention to Improve Physician Violence Screening”

Conclusion – A violence prevention education program using teen A violence prevention education program using teen

actors improved participants’ violence questioning actors improved participants’ violence questioning and perceived comfort and importance in violence and perceived comfort and importance in violence screening screening

– Improved identification and management of a Improved identification and management of a standardized violence-related scenariostandardized violence-related scenario

Screening for Teen Violence Risks Workshop

Taking it on the road Taking it on the road – Conducted workshops with TASA at the National AAP Conducted workshops with TASA at the National AAP

conference in DC (1999), National ER conference in conference in DC (1999), National ER conference in DC, the International Adolescent Health Conference DC, the International Adolescent Health Conference in Lisbon, Portugal (2005), Georgetown University in Lisbon, Portugal (2005), Georgetown University Hospital, National Naval Medical Center, etc. Hospital, National Naval Medical Center, etc.

Duke Ellington/Teens Duke Ellington/Teens and Theaterand Theater

“ “Communicating with Teens Workshop” at GUH Communicating with Teens Workshop” at GUH started in 2006 & involves teen actors from:started in 2006 & involves teen actors from:The Improvisation Group/Theater Program at the The Improvisation Group/Theater Program at the Duke Ellington School of the Arts Duke Ellington School of the Arts – The only DC public high school providing professional The only DC public high school providing professional

arts training & college preparationarts training & college preparationTeens and Theater Teens and Theater – A group of home-schooled high school students from A group of home-schooled high school students from

the DC area that are involved in improvisational the DC area that are involved in improvisational theatertheater

Communicating with Teens Workshop Communicating with Teens Workshop at GUHat GUH

ParticipantsParticipants– 33rdrd yr med students in pediatric clerkship & peds yr med students in pediatric clerkship & peds

residents in adolescent rotation residents in adolescent rotation Workshop ContentWorkshop Content– Overview of SSHADESS assessment (Strengths, Overview of SSHADESS assessment (Strengths,

School, Home, Activities, Diet, Drugs, Emotions, School, Home, Activities, Diet, Drugs, Emotions, Sexuality, Suicidality and Safety)Sexuality, Suicidality and Safety)

– Tips on talking to teens & establishing confidentialityTips on talking to teens & establishing confidentiality– Interactive role play w/ teen actorsInteractive role play w/ teen actors

Communicating with Teens WorkshopCommunicating with Teens Workshop

Teen ActorsTeen Actors– Create scenarios/perform 20 min role plays with Create scenarios/perform 20 min role plays with

groups of med students & residents groups of med students & residents – Scenarios topics involve drug use, depression, Scenarios topics involve drug use, depression,

gender identity, eating disorders,etcgender identity, eating disorders,etc– Give feedback on use of confidentiality,body Give feedback on use of confidentiality,body

language, SSHADESS screen, ability to identify chief language, SSHADESS screen, ability to identify chief complaint & manage issuecomplaint & manage issue

FacilitatorsFacilitators– Attending and pediatric residents give feedback Attending and pediatric residents give feedback

regarding communication techniques and regarding communication techniques and management of issuemanagement of issue

Communicating with Teens WorkshopCommunicating with Teens Workshop

(Video clip)(Video clip)

Communicating with Teens WorkshopCommunicating with Teens Workshop

2007-2008 Study– “An Educational Intervention to Improve Physician Interviewing

Skills of Adolescent Patients during the Pediatric Clerkship” involving 150 medical students

Study conclusion: Study conclusion: – Students report increased confidence & skills in communicating Students report increased confidence & skills in communicating

w/ teens when participating in interactive workshop as compared w/ teens when participating in interactive workshop as compared to lecture aloneto lecture alone

Workshop as curriculumWorkshop as curriculum– As a result of positive evaluations by trainees and results of As a result of positive evaluations by trainees and results of

study showing benefit, workshop has become regular part of study showing benefit, workshop has become regular part of pediatric medical student curriculum; conducted every 6 weekspediatric medical student curriculum; conducted every 6 weeks

Communicating with Teens WorkshopCommunicating with Teens Workshop

Reaching larger audiencesReaching larger audiences– Conducted workshop at 2009 American Academy of Conducted workshop at 2009 American Academy of

Pediatrics National Conference (DC) Pediatrics National Conference (DC) – Created sexual history-taking pod cast with teen actor Created sexual history-taking pod cast with teen actor

available at AAP websiteavailable at AAP website– Received invitations to take workshop to area Received invitations to take workshop to area

hospitals & organizationshospitals & organizations

CostsTeen and Theater/Duke Ellington FundingTeen and Theater/Duke Ellington Funding– Initially from $25,000 hospital education grant to Initially from $25,000 hospital education grant to

enhance medical student teachingenhance medical student teaching– Under grant, $600/workshop for coordinator/schoolUnder grant, $600/workshop for coordinator/school– Currently $150/ workshop for approx 8 teens/ Currently $150/ workshop for approx 8 teens/

coordinator- paid by Pediatric Departmentcoordinator- paid by Pediatric Department– At National conference-teen actors received $50/ At National conference-teen actors received $50/

workshop from AAPworkshop from AAPTASA Funding– Received primary funding from grants including Received primary funding from grants including

Washington AIDS Partnership , GEICO, CNMC’s Washington AIDS Partnership , GEICO, CNMC’s Child Health Center and Board of Visitors Child Health Center and Board of Visitors

Using Teen Actors: Lessons LearnedUsing Teen Actors: Lessons Learned

Scheduling student actors can be challengingScheduling student actors can be challenging– to avoid missing classes, tests, performancesto avoid missing classes, tests, performances

Initial development of scenarios requires time and Initial development of scenarios requires time and extensive training extensive training Workshops can be dependent on scenarios and actors Workshops can be dependent on scenarios and actors and experience of facilitatorand experience of facilitatorFunding necessary but costs are reasonableFunding necessary but costs are reasonable

Using Teen Actors: Lessons LearnedUsing Teen Actors: Lessons Learned

Using teen actors from the community can be a very Using teen actors from the community can be a very rewarding experience for actors, facilitators and trainees! rewarding experience for actors, facilitators and trainees! Model is easily adaptableModel is easily adaptablePilot studies show interactive role play improves Pilot studies show interactive role play improves trainees’ educational experiencetrainees’ educational experienceTeen actors can also train medical faculty, non medical Teen actors can also train medical faculty, non medical personnelpersonnelActors once trained can be used for many other Actors once trained can be used for many other adolescent health topics i.e. substance use, pregnancy adolescent health topics i.e. substance use, pregnancy prevention, etc.prevention, etc.