1. FORGE AHEAD Program Community Facilitator Remote Training
Module 2: Facilitator Role & Readiness Consultation Questionnaires

2. Facilitation – An Introduction
FORGE AHEAD Program
Facilitation – An Introduction

3. A Facilitator is Like:
Architect – to organize, prepare and construct a process to work together
Pilot – has the responsibility to control and steer the group towards its goals and objectives
Guide – to provide leadership and calm in new or difficult territory
If you have worked in teams, on projects, in volunteer organizations, at work, at school, college, or university, you have likely been involved in tasks where you have either had to facilitate others through a task or project, or you have involved in these types of experiences with other people facilitating you through a task or project.
I believe everyone has experiences and skills with facilitation, whether they know it or not. For example, as a parent you may have had to facilitate a number of discussion, to facilitate a discussion about a family trip, about who plays with what toys, and so on. However, not everyone had the tools to be a good facilitator. We are here to help you learn about these tools and practice them whether you already know about them or not, practicing these skills in the context of Forge Ahead will be useful to you and your peers around this table.
Note: there is a video that uses these three roles as a basis for explaining the role of facilitator. This can be used in the training if you like. It is 4 minutes long. At this point it is not included in the timeline.

4. What do Facilitators do? What value do they add?

5. Facilitator Role Evoking participation and creativity
Listening deeply for subtleties
Reading the underlying dynamics of the group (e.g. through observing body language and tone, and statements offered by group)
Adjusting the process when the group is ‘stuck’
Keeping the big picture in mind while working on the nitty-gritty

6. Facilitator Role
Building relationships and recognizing the contributions of others
Paying close attention to others
Asking for other’s ideas and opinions
Listening without interrupting
Looking for opportunities and common ground to move forward
Intervening based on intuition and fact
Demonstrating self-confidence, enthusiasm, and authenticity
Assuming (or sharing) responsibility for the group journey

7. Facilitator Role
Part of facilitation is building a team that works well together. This can be encouraged by being
Friendly and congenial
Encouraging and motivating
Welcoming, inclusive, and respectful
A good sounding board
Good at resolving concerns and issues
Simply reinforce the importance of relationships

8. Facilitation is Not Participation
You are there to guide (not to do the work)
e.g. you help to guide a discussion, but do not have the discussion yourself
You can encourage leadership in the group
A team leader or champion may emerge in the group
You will be there to help guide the champion in the team
A team note-taker is also very helpful to identify to document decisions

9. How to Plan a Meeting as a Facilitator
You can use a Meeting Agenda to help keep your teams on track, and recording any decisions you make. When developing your agenda, important things to consider include:
What is the purpose of the meeting and desired outcomes? The purpose is the reason for holding the meeting (e.g. to identify the main priorities for the community team). The desired outcomes are the tangible results you expect to achieve by the end of the meeting (e.g. A list of key priorities, from highest to lowest priority)
What are the specific agenda items needed to achieve the outcomes? Agenda Design: beginning, middle, end

10. Key Components of a Meeting Agenda
Beginning
Welcome and introductions
Update and document attendees and regrets
Review meeting objectives and team agreement
Warm-up or team building activity (optional)
Middle
Review agenda items (related to meeting objectives)
To help assess the impact of the program we will be asking you to provide copies of your meeting agendas….this will help us better understand what team did or didn’t do, how the program helped or didn’t help, what activities were helpful or not, etc….

11. Key Components of a Meeting Agenda
Summary of Decisions and Actions
Discuss next steps
Schedule next meeting
Do you already know what objectives need to be included?
Did anything not get covered in this meeting?
Thank You and Close

12. How to Plan a Meeting as a Facilitator
How much time should I allot for agenda items? Time dependent on the nature of agenda items: share & discuss information; plan/develop ideas; analyze a problem; decide on actions (Who, What, When)
What is the best process for addressing each agenda item? Determine how to effectively cover the topic, keep participants engaged, and develop shared ownership in the group.

13. Here is an example of a meeting agenda template
Here is an example of a meeting agenda template. We will provide you with a blank template to help you plan your team meetings

14. Community and Clinical Readiness Consultation Questionnaires
FORGE AHEAD Program
Community and Clinical Readiness Consultation Questionnaires

15. Readiness
There are two readiness questionnaires in THE FORGE AHEAD program:
Community Readiness Questionnaire – Community Team
Clinical Readiness Questionnaire – Clinical Team
First, you will receive training to understand the questionnaires
Second, we will train you on how to administer the questionnaires to team members

16. Training for the Readiness Questionnaire Will Involve:
Learning about the idea of readiness so you know what it means
Becoming familiar with the questionnaire so that you understand it.
Reading and learning about the reports (what is in the report, what the readiness scores mean, etc.)
Learning to explain the questionnaire’s instructions and cover letter to the team

17. Community Readiness

18. Community Readiness
Community Readiness is the degree to which your community is willing and able to make improvements in programming for people with diabetes
The goal of the readiness questionnaire is for teams to reflect on their level of readiness so that the team can plan to make improvements to programming for people with diabetes
The community team will have 3-5 people
1 to 3 community primary prevention leaders, administrators, managers, workers/volunteers of existing community programs or services
at least one traditional health leader,
at least one community member living with diabetes,
at least one elder, and
at least one clinical care program leader.

19. Community Readiness Questionnaire
20 pages in length, takes approx mins.
Each community team member will be asked to complete the questionnaire
Questions focus on both the community members’ and leaders’ perspective
Team members are asked to score each question, along with a written statement for why they believe that number reflects the state of the community.

20. Knowledge & Action Readiness Scores
The readiness of the community will be calculated using two separate scores
Knowledge Readiness Score: how much a community understands diabetes and how much of a concern and priority it is for the community.
Score will be between 1 (low readiness) and 5 (high readiness)
Action Readiness Score: what is being done about diabetes, how involved the community is in improving diabetes, and actions that have been taken.
Score will be between 0 (low readiness) and 5 (high readiness)

21. KNOWLEDGE READINESS SCORE ACTION READINESS SCORE
NO ACTION - nothing is being done about diabetes. 1
NO AWARENESS - Not recognised as an issue, no awareness of the issue.
PREPARATION – community members and leaders are active in terms of planning efforts, or trying to get efforts started. This includes involvement in getting resources for efforts. No efforts are operating yet. 2
APATHY/RESISTENCE – has minimal knowledge and/or wrong information. There is some basic awareness of the issue, but not important enough to do anything.
INITIATION – activities are underway with some community member and leader involvement. And some resources are used and assigned to efforts. 3
AWARNESS – there is some knowledge and awareness of the issue, and as a result people would like something to be done. However other community priorities stop diabetes from being an important issue.
STABILIZATION – activities are actively supported by leaders and community members in key roles, including some work to find and secure resources. 4
SUPORT–Diabetes is a priority. There is enough knowledge to act with likelihood of good success. Solid understanding of diabetes and its local impact
CONFIRMATION/EXAPANSION - efforts are in place and may have expanded, and community members and community leaders play key roles in efforts. Resources have been increased, some resources are secure, and some evaluation of resources takes place. 5
DETAILED AWARENESS –Diabetes is a significant and ongoing priority. Know the effects of disease and how to evaluate knowledge about diabetes.
OWNERSHIP – diabetes efforts are now ongoing, with community leaders and community members highly involved. Some resources are secure, and efforts will likely continue into the future. The success of diabetes efforts can be used as an example to help other community issues.
Just flash this slide to show how there is a specific definition for each of the stages on the scale

22. Example of a Community’s Readiness Scores
KNOWLEDGE READINESS SCORE
ACTION READINESS SCORE 3
AWARNESS – there is some knowledge and awareness of the issue, and as a result people would like something to be done. However other community priorities stop diabetes from being an important issue. 2
INITIATION – activities are underway with some community member and leader involvement. And some resources are used and assigned to efforts.

23. Sample Item Score

24. Clinical Readiness

25. Clinical Readiness
Clinical Readiness is the degree to which your clinic is willing and able to make improvements in programming for people with diabetes
The goal of the readiness questionnaire is for teams to reflect on their level of readiness so that the team can plan to make improvements to clinical care for peoples with diabetes
The community team will have 3-5 people
1 to 3 community primary prevention leaders, administrators, managers, workers/volunteers of existing community programs or services
at least one traditional health leader,
at least one community member living with diabetes,
at least one elder, and
at least one clinical care program leader.

26. Clinical Readiness Questionnaire
27 pages in length, takes approx. 1 hour
Each clinical team member will be asked to complete the questionnaire
The questions are linked to 5 key components (see the next slide)
Team members are asked to score each question on a scale from 0 to 11, along with a written statement for why they believe that number reflects the state of their health clinic

27. Clinical Readiness Was Developed Using the Chronic Care Model
The literature tells us that important features include:
ongoing care, ideally from a team of care providers including a family physician, nurse, diabetes educator, etc.
Proactive healthcare - keeping individuals with diabetes healthy (not reactive and responding only when an individual is sick)
The Chronic Care Model was first developed to highlight the basic elements of a proactive healthcare system including the community, organization, practice and patient level. The Chronic Care Model was expanded to include the concepts of population health promotion and the importance in chronic illness care.
Wagner et al., 2001
Barr et al., 2003

28. Expanded Chronic Illness Model
Jann – not sure if you want the background to the chronic care model or extended chronic care model
Barr et al., 2003

29. 5 Key Components of Health Systems
Delivery System Design
Each of the questions are based on the Five key components of health systems
Local health center organizational influence and integration
Information Systems & Decision Support
Linkages with Community Resources and Other Health Services
Self-management Support

30. Example Question Circle Response (0-11) Write Justification
Component 3 – Self-management Support
Self-management support refers to health center structures and processes that support patients and their families to play a major role in maintaining their health, managing their health, and achieving safe and healthy environments. Effective self-management support strategies include assessing and documenting self-management needs and activities, providing education and support and behavior change interventions, and promoting peer support.
3.1 Self-management support, assessment and documentation
Elements for Discussion
Participant Score
Self-management for patients with diabetes is a central, strategic part of diabetes care.
For example: The patient’s role in maintaining their health, managing their health problems, and promoting a safe and healthy environment, is a central tenet of self-management support and routinely discussed during patient visits. The goal is for patients to be actively engaged in the management of their diabetes 
No or minimal support for self- management.
Fair support for self- management. Self- management is part of ad hoc care.
Good support for self- management. Self-management is becoming part of routine care.
Very good support for self- management. Self-management is routinely part of care. 1 2 3 4 5 6 7 8 9 10 11
Justification:
Circle Response (0-11)
Write Justification

31. How to Administer the Questionnaires

32. Program Consent Overall program letter of information
Prior to completing the first readiness questionnaire, each team member must review the program letter of information and sign the consent form. This is done prior to the start of the program in your community.
Jann to do this!

33. Community Readiness Process Involves
The community facilitator explaining the readiness questionnaire to the team
The team then fills in the readiness questionnaire
The Western university team creates a report that summarizes the answers to the readiness questionnaire
The team then reviews the report and uses it to promote discussion about how improvements can be made to community diabetes programs

34. Master List
You will receive a master list, which is a list of all team members and their ID numbers
This information is confidential, and you will receive training on how to keep it confidential
Both questionnaires will only contain ID numbers
Facilitators will write the ID#’s on the questionnaires prior to providing the them to team members
You will receive a master list that contains the names of each member on both the community and clinical teams, along with the ID number that is assigned to them. Both questionnaires will only contain ID numbers and NOT names of team members. This is an important security measure to protect their identity. Make sure at all times the correct id number goes to the correct team member. Using the list provided, contact the community and clinical team members to schedule meetings; these meetings will be an information session for the team members and will take place in October 2014.
The research team will be provide you with a master list that contains the names of each member of the clinical team along with a survey ID number that is assigned to them
The questionnaires will only be identified by survey ID number to ensure confidentiality
Store the master list
You need to keep the master list in a separate place from where the rest of the community data is kept. This will mean a different locked filling cabinet and office from the rest of the community data (completed questionnaires, etc.), or a different and password protected computer for electronic documents. Only you have authorization to view this list and you should be the only one with access to it.

35. Key Steps Organize the first meeting with your team
Hand out the questionnaires
Collect the questionnaires
Sending the questionnaires to Western
Storing information securely
You will hand out this questionnaire to the identified team members and will organize a meeting for each team to help explain the questionnaire.
You will follow-up with each team member to collect completed questionnaires and answer any questions that they may have.
You will send completed questionnaires from each team member to the research team at Western University.
The research team at Western University will calculate the Community and Clinical Readiness scores from the answers of each of the team members and develop summary reports for each community and clinical team in each community.
The average scores for each team will be presented to the group at the first workshop.

36. Organize the First Meeting
You will need to organize a meeting with the community team, and another meeting with the clinical team
Introduce the team members to each other
Introduce the FA program to the team
Explain the issue (the importance of diabetes) of FORGE AHEAD
Explain the idea of readiness, and why it is important for the community or clinic
Explain how the questionnaire is used to develop readiness
Explain the importance of the team’s role
Be available to answer any questions by the team members.
Make sure the team members knows how valuable their time and answers will be
At these meeting you can explain why the questionnaire is important, what the questionnaire is about, provide instructions to the teams, answer any questions, and create a plan or timeline to complete the questionnaire. You will need to have a good understanding of this process for both questionnaires to answer any questions from the members of the teams. If there is anything you cannot answer or do not know what to do, feel free to contact the FORGE AHEAD program to help you through this process.
Introductions: Introduce yourself and provide your contact details (a phone number, or an address) if the team has any questions for you about FORGE AHEAD.
Introductory Activity: Start with an introductory activity where everybody introduces themselves, and gets to know one another if they do not know each other, and to focus them on the need to work together (a group that feels comfortable with each other is more likely to provide a helpful and safe place for discussion and work).

37. Organize a Second Meeting: Hand Out the Questionnaire
Explain the cover letter and instructions section.
Briefly go over the questionnaire
Create a timeline or due date for the questionnaire
Explain how you will collect the questionnaires
Make a time for you to call or meet the team to answer any questions and remind the team of when the questionnaire is due.
Explain the cover letter and instructions section.
Briefly go over the questionnaire so the team members can better understand the questionnaire and what they will need to do.
Create a timeline or due date for the questionnaire (this could be a few days, a week, or two weeks, depending on the needs of the team).
Explain how you will collect the questionnaires (e.g., establish a time and place for the team to drop them off to you, or where you will pick them up, etc.).
Make a time for you to call or meet the team to answer any questions and remind the team of when the questionnaire is due. This could be a week after providing the team with the questionnaire.

38. Collect the Questionnaires
Collect the questionnaires on the timeline that was created for each team.
Follow up procedure:
Contact the person to arrange another time to collect the questionnaire
If the questionnaire is not finished, offer support to assist the person, and then arrange for another time to collect the questionnaire
Part of your responsibility is to keep the team moving forward through the program.
You could also contact the team members with friendly reminders of the due date and provide an opportunity to answer any questions.
Collect the questionnaires on the timeline that was created for each team. You will need to collect the questionnaires and or fax the questionnaires back to the research team in London by early November (details provided below).
If a team member has not returned the questionnaire on time, we recommend that you follow-up with that person by phone and/or within a couple of days of the due date to set up a new date and time to collect the questionnaire. If there is no response then please leave a message and try to contact them within the next 2-3 days. If you continue to attempt to contact this person and there is no response after 2 weeks, contact the FORGE AHEAD team for additional assistance.
Part of your responsibility is to keep the team moving forward through the program. Collecting the questionnaires on time is part of this role. You could also contact the team members with friendly reminders of the due date and provide an opportunity to answer any questions.

39. Community Readiness Questionnaire
There are no right or wrong answers
The more honest and realistic the answers, the better the results will contribute to the clinic and your community of patients with diabetes
High or low score does NOT mean one community’s activities or services are better or worse

40. Community Readiness Questionnaire
The questionnaires will be completed 3 times:
Before the first QI workshop,
During the second QI workshop, and
After the last workshop.
By completing it three times, we can capture changes in readiness over time.
First QI session for wave 1 is in January (see slide 36ish)

41. Readiness Reports
Readiness scores were calculated by averaging everyone’s responses on the community/clinical team.
The report includes a summary of the description team members provided to explain their answers (open box)
Provides snap shot of how ready the community/clinic is to address diabetes

42. What to do with the Results?
Important to understand what the scores mean and their value and limitations
The point is to recognize how everyone interprets the scores
It is crucial to build upon the results by using LOCAL KNOWLEDGE. There are particular needs, desires and history that the readiness questionnaire does not capture.
After the scoring is final, there should be a focus on how to use the scores and information to guide the development of an action plan

43. Question-Answers
Come prepared to your next meeting to discuss any areas that need further explanation (if you don’t have a meeting booked, please contact us to make schedule a meeting).
At your next meeting, all of the slides will be discussed
Should Alex run this session
Summarize what we covered today
Preview tomorrow work
Ask if anything content needs to be explained/ re-examined
Ask if anything about how the training is run and organized can be changed for tomorrow
Ask if the CF have any concerns about their role, about troubles they may encounter, about parts of the program they are unsure about or do not know what to expect, if they expect any troubles/issues to arise.
Ask what they are confident about, and as a team write on the board a list of things they are confident about. Then ask what they are not confident about in fulfilling their role in the program, and write this on the board. (use this information to guide what we cover in workshop and/or future training).

44. Thank you
Start time tomorrow is 8:00am, the building doors open at 7:30am
Shuttle pick up time is 7:30am
Remember to bring your binders