1. Participatory training techniques WORKSHOP “OST in Developing Countries: A Primer” Atul Ambekar, Alok Agrawal (India)

2. Training for OST staff A multi-disciplinary team of staff is involved in service delivery – Doctor – Counsellor – Nurse – Programme Managers – Outreach workers and peer educators – Programme monitors / evaluators Relative advantages and disadvantages of training them together or training them separately?

3. Induction Training on OST 0 A five day training programme 0 Conducted soon after recruitment of staff 0 Conducted for a mixed group of staff (nodal officers, doctors, nurses, counselors, data managers, programme managers and outreach workers) 0 Class-room type training 0 Highly interactive and participatory 0 Exposure visit – an essential component 0 BASED UPON A MANUAL 0 Outcome: 0 Trained staff who begin service delivery after receiving a certificate

4. Organization of the manual Rajat Ray, Anju Dhawan, Atul Ambekar (2011), Implementing OST : A Training manual for service providers, NACO, Government of India, New Delhi

5. Highlights of the manual 0 Developed as a ‘guide’ for facilitators 0 Not a substitute for practice guidelines or operating procedures 0 Flexibility for facilitators for local adaptation 0 Applicable to a variety of OST settings 0 Entire training programme has been designed to be participatory in nature 0 Strives to address all three components – knowledge, attitudes and skills 0 Manual encourages training programmes for mixed group of participants

6. 0 Organization of the manual 0 Content  0 Format Organization of the manual

7. Content of the manual 0 Initial pages: 0 Acknowledgements 0 Message from DG, NACO 0 Foreword (from NACO) 0 Table of contents 0 Background 0 “About the manual” 0 TOR for facilitators 0 Preparations for the training programme 0 Draft agenda 0 Sessions (arranged chronologically) 0 Annexure 0 Record formats 0 Evaluation and feedback sheets

8. Areas covered in the training 0 Drugs, Drug Dependence, Harm Reduction, Principles of drug treatment, OST: Basic knowledge (and attitude) 0 Assessment and Diagnosis: Clinical skills 0 OST (induction, maintenance, dispensing): Clinical skills 0 Psycho-social interventions: Clinical skills 0 Exposure to a functioning OST centre 0 Programme management: Dispensing, record maintenance, stock keeping, reporting, referral and linkage: knowledge, attitude and skills

9. Content of the manual 0 Initial pages: 0 Acknowledgements 0 Message from DG, NACO 0 Foreword (from NACO) 0 Table of contents 0 Background 0 “About the manual” 0 TOR for facilitators 0 Preparations for the training programme 0 Draft agenda 0 Sessions (arranged chronologically) 0 Annexure 0 Record formats 0 Evaluation and feedback sheets

10. Training sessions DaySessions Day 1 Introduction exercise: meeting strangers and building a rapport Basics of Drugs: Overview of drugs and drug use disorders Drug-related problems and harms Local drug abuse scenario General principles of drug treatment and harm reduction

11. DaySessions Day 2 Opioid substitution therapy – overview Assessment and diagnosis Assessment and diagnosis: role-play and case demonstration / presentation Buprenorphine- pharmacology Training sessions

12. DaySessions Day 3 Implementing OST with buprenorphine: induction, stabilisation, discontinuation Special clinical situations – adolescents; women; HIV; other medical conditions, dual diagnosis Psychosocial interventions Role-play / demonstration of psychosocial interventions Scheme for implementing OST in Government centres: an overview Training sessions

13. DaySessions Day 4 Exposure to the OST clinic, including demonstration Debriefing and experience sharing Programme management–I Procurement and supplies Programme management–II Record maintenance and reporting Training sessions

14. DaySessions Day5 Programme management-III Referral and networking, engaging civil society Programme management-IV Minimum standards of care, reporting Open session Working together: meeting between stakeholders Training sessions

15. Content of each session 0 Objectives 0 Materials and method 0 Steps 0 Highlights (as box items) 0 Contents of the presentation

16. 0 Organization of the manual 0 Content 0 Format  Organization of the manual

17. Format 0 The manual has been designed to be available in two versions: 1. Hard copy: 0 Description of all the sessions 0 Handouts of slides along with ‘notes’ for the facilitator

21. Format 0 The manual has been designed to be available in two versions: 1. Hard copy: 0 Description of all the sessions 0 Handouts of slides along with ‘notes’ for the facilitator 2. Digital version: (available as a CD or online) 0 The manual proper as a pdf file 0 Power point presentations as hyper links

25. Training techniques used in the manual 0 Participatory presentation and discussion 0 Group Work 0 Observations and de-briefing 0 Role Plays

26. Group work 0 Ideal size: 4 – 10 people 0 Shared characteristic: Same place of work / same profession 0 Fosters team building and bonding 0 Provides opportunity for those to be heard who may be silent in front of larger audience 0 Encourages learning from the peers \ 0 Helps assessment of pre-existing knowledge and understanding by the facilitator

27. Role play 0 Best suited for skill-based sessions 0 Ideally at least the first such role play should be almost scripted 0 Based on a pre-decided case vignette 0 Played by two facilitators (one playing client and another playing the staff) 0 Should be followed by feedback and discussion

28. Observation and De-briefing 0 Gives a more ‘real’ and ‘hands-on’ experience 0 Requires logistic arrangements and preparations 0 Should be coupled with de-briefing 0 The facilitator should be well conversant with the 0 Setting observed 0 Setting in which participants are likely to work

29. Refresher Training 0 Ideal time: About 6 months after the initiation into programme and then annually 0 May be smaller in duration than the Induction training 0 Requires more skilled and experienced facilitators 0 The agenda needs to be tailored and customized as per the perceived needs of the participants 0 May have to be coupled with a stock taking exercise or a programme review

30. THANK YOU