1. Using Teen Actors to Teach How to Communicate with Adolescents Anisha Abraham, MD, MPH Associate Professor, Department of Pediatrics Chief, Section of Adolescent Medicine Georgetown University Hospital Washington, DC

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

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

4. 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

5. Screening for Teen Violence Risks Workshop Teen Actors –TASA members developed their own violence scenarios including date rape, domestic violence, etc –Performed 20 min role play w/ trainees, then gave feedback to trainees on establishing confidentiality, use of FISTS screen, identification and management of problem –Engaged in an interactive panel discussion addressing violence issues at home, school, and community

6. 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

7. 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

8. Study: “An Educational Intervention to Improve Physician Violence Screening” Evaluation Methods –All participants interviewed a standardized patient (teen actor) c/o a persistent headache w/ an underlying violence- related issue during their clinical rotation –Participants were not aware that the standardized patient was an actor and not a real patient –Participants completed pre and post rotation questionnaires. Teen actors completed an evaluation of the encounter

9. 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 patient Pre-rotation questionnaire Post-rotation questionnaire Standardized patient evaluation

10. Study: “An Educational Intervention to Improve Physician Violence Screening” Results- Post-rotation intervention subjects reported: –More screening of fighting history (p <.003) –Perceived importance in asking about access/ use of weapons (p<.02) –More screening of violence in school/neighborhood (p<.01)

11. Standardized Patient Evaluation

12. Study: “An Educational Intervention to Improve Physician Violence Screening” Conclusion –A violence prevention education program using teen actors improved participants’ violence questioning and perceived comfort and importance in violence screening –Improved identification and management of a standardized violence-related scenario

13. Screening for Teen Violence Risks Workshop Taking it on the road –Conducted workshops with TASA at the National AAP conference in DC (1999), National ER conference in DC, the International Adolescent Health Conference in Lisbon, Portugal (2005), Georgetown University Hospital, National Naval Medical Center, etc.

14. Duke Ellington/Teens and Theater “Communicating with Teens Workshop” at GUH started in 2006 & involves teen actors from: “Communicating with Teens Workshop” at GUH started in 2006 & involves teen actors from: The Improvisation Group/Theater Program at the Duke Ellington School of the Arts –The only DC public high school providing professional arts training & college preparation Teens and Theater –A group of home-schooled high school students from the DC area that are involved in improvisational theater

15. Communicating with Teens Workshop at GUH Participants – 3 rd yr med students in pediatric clerkship & peds residents in adolescent rotation Workshop Content –Overview of SSHADESS assessment (Strengths, School, Home, Activities, Diet, Drugs, Emotions, Sexuality, Suicidality and Safety) –Tips on talking to teens & establishing confidentiality –Interactive role play w/ teen actors

16. Communicating with Teens Workshop Teen Actors –Create scenarios/perform 20 min role plays with groups of med students & residents –Scenarios topics involve drug use, depression, gender identity, eating disorders,etc –Give feedback on use of confidentiality,body language, SSHADESS screen, ability to identify chief complaint & manage issue Facilitators –Attending and pediatric residents give feedback regarding communication techniques and management of issue

17. Communicating with Teens Workshop (Video clip)

18. Communicating 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: –Students report increased confidence & skills in communicating w/ teens when participating in interactive workshop as compared to lecture alone Workshop as curriculum –As a result of positive evaluations by trainees and results of study showing benefit, workshop has become regular part of pediatric medical student curriculum; conducted every 6 weeks

19. Communicating with Teens Workshop Reaching larger audiences –Conducted workshop at 2009 American Academy of Pediatrics National Conference (DC) –Created sexual history-taking pod cast with teen actor available at AAP website –Received invitations to take workshop to area hospitals & organizations

20. Costs Teen and Theater/Duke Ellington Funding –Initially from $25,000 hospital education grant to enhance medical student teaching –Under grant, $600/workshop for coordinator/school –Currently $150/ workshop for approx 8 teens/ coordinator- paid by Pediatric Department –At National conference-teen actors received $50/ workshop from AAP TASA Funding –Received primary funding from grants including Washington AIDS Partnership, GEICO, CNMC’s Child Health Center and Board of Visitors

21. Using Teen Actors: Lessons Learned Scheduling student actors can be challenging – to avoid missing classes, tests, performances Initial development of scenarios requires time and extensive training Workshops can be dependent on scenarios and actors and experience of facilitator Funding necessary but costs are reasonable

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