Integrated Management of Childhood Illness (IMCI) : Directors Guide

DIRECTOR GUIDE
O RG ANIZE ICATT BASED IMCI TRAINING
DIRECTORGUIDE
GENERALPART
ICATTbasedIMCItraining
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DirectorguideGeneralpart
CONTENTS
GENERALPART..................................................................................................................................................................1 1. 2. Introduction................................................................................................................................................................5 GeneralconsiderationsforplanningandorganizinganICATTbasedIMCItraining..................7 2.1. PlanforICATTbasedtrainingandITsupport....................................................................................7 ComputersandICATTtrainingplayer.........................................................................................7 PhysicalconditionsforICATTbasedtraining...........................................................................8 ITsupport.................................................................................................................................................8 Trainingsites..........................................................................................................................................9 Guideforclinicalpractice...............................................................................................................11 Scheduleofinpatientandoutpatientclinicalpractice.......................................................11 Prepareforclinicalpracticeatoutpatientclinics.................................................................12 Prepareforclinicalpracticeatinpatientward......................................................................14 Facilitators............................................................................................................................................15 Inpatientinstructor...........................................................................................................................19 2.1.1 2.1.2 2.1.3 2.2. 2.2.1 2.2.2 2.2.3 2.2.4 2.2.5 2.3 2.3.1 2.3.2 2.4. 2.5.
Planforclinicalpractice...............................................................................................................................9
Selecttrainersandplanfortheirpreparation.................................................................................15
Selectparticipants.......................................................................................................................................20 Planfordatacollection..............................................................................................................................21 MonitoringtoolsinICATTtrainingset.....................................................................................21 Datacollectionforms........................................................................................................................23 Initialplanning.........................................................................................................................................24 Atthetraininglocation,beforebeginning....................................................................................27 Duringtheclassroombasedtraining ..............................................................................................28 Distancelearningtraining:Duringtheinitialfacilitatorparticipantencounter ........29
2.5.1 2.5.2 3. 3.1 3.2 3.3 3.3
Checklistforplanningandadministrativearrangements...............................................................24
3.4 Distancelearningtraining:Beforetheintermediateandfinalfacilitatorparticipant encounters................................................................................................................................................................29 4. 5. Preparingtheclinicalinstructor.....................................................................................................................30 Trainingfacilitators..............................................................................................................................................31 5.1 5.2 5.3 5.4 5.5 Introduction...................................................................................................................................................31 Generalstructure.........................................................................................................................................31 Dailyschedule...............................................................................................................................................33 Suggestedscheduleforfacilitatortraining.......................................................................................34 Conductingactivities..................................................................................................................................36
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5.5.1 5.5.2 5.5.3
Day1........................................................................................................................................................36 Day2........................................................................................................................................................42 Day3........................................................................................................................................................45
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1. INTRODUCTION
Theaimofthisguideistoprovideyou,thetrainingdirector,anassistancetoplan,organizeand conductanICATTbasedIMCItrainingwiththehelpoftrainingsupportmaterialsappropriately selectedand,ifneeded,adaptedbythelocalICATTadaptationteam. ThisDirectorguideconsistsoftwoparts:ageneralpartdesignedforplanningandorganization all training configurations and a training configuration specific part. Annexes apply to all trainingconfigurations. ThegeneralpartpresentsfirstthegeneralconsiderationsforplanningandorganizinganICATT basedIMCItrainingthenasummarychecklistforplanningandadministrativearrangementsfor the entire training. Next the general part provides instructions how to prepare the clinical instructorandlastlyhowtotrainfacilitatorsforanICATTbasedIMCItraining. The training configuration specific part presents possible training structures and schedules for three different training configurations. Training configuration is the basic type of training andtrainingstructureisadetaileddescriptionofhowaparticulartrainingconfigurationwillbe organized.Suggestionsforclassroombasedtrainingwithindividualcomputers,classroombased trainingwithLCDprojectoranddistancelearningtraining,areprovided. BeforeICATTcanbeused,therelevantbodyresponsibleforintroducingandimplementingIMCI nthecountry,usuallyatMOHlevelmustadaptthegenericICATTtrainingsetcontentaccording to the national IMCI guidelines. Also the training configuration specific part of this guide and trainingsupportmaterialsavailableinthe genericICATTshouldbeadapted,ifneeded.Ideally thisisdonewellbeforethetraining. Ifthetrainingsupport materialshavenot beenadaptedtoreflectthenational IMCIguidelines 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 andmodifythetrainingsupportmaterialsasneeded. You, the training director, should be an experienced IMCI facilitator who has already actedasafacilitatororadirectorinseveralstandardIMCItrainingcourses. IfarenotthoroughlyfamiliarwiththeICATTtrainingplayer,youwillneedtoinviteanoutside ICATT consultant who will help you to conduct facilitator training and assist in supervision of facilitatorsduringthecomputerpartofthetraining. IfyouarenotyetfamiliarwithICATT,youshouldobtainICATTtrainingplayerforyouandyour facilitators before the training starts and work through it in order to get acquainted with its conceptandcontent.Besuretoobtainthelatestversionavailableoneormoretestversions maybecirculating. Yourresponsibilitiesasthetrainingdirectorare: toplanandorganizethetraining, tointroducethetraining, tocoordinatealltrainingactivities, tosupervisethefacilitators, tosupervisetheinpatientinstructor, toconductfacilitatormeetingsduringthetrainingdays,
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tocollectororganizecollectingdataduringthetraining, toorganizetheparticipantevaluation, toorganizetheendoftrainingevaluation,and toclosethetrainingandpresenttrainingcertificates(ifgiven).
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2. GENERALCONSIDERATIONSFOR PLANNINGANDORGANIZING ANICATTBASEDIMCITRAINING

2.1. PLANFORICATTBASEDTRAININGANDITSUPPORT
2.1.1 COMPUTERSANDICATTTRAININGPLAYER
ICATT is a computer program which uses the software on the host computer to display documents,images,videosandanyotherkindofresources.ComputersusedforICATTtraining mustmeettheminimumhardwareandsoftwarerequirements(SeeAnnex1ofthisguide). Approximately4GBoffreespaceisneededforinstallingthegenericICATTtrainingplayerona 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 fromaDVDorUSB. Thetrainingconfigurationandthenumberofparticipantswilldepend,amongotherfactors,on the availabilityofcomputers.Howmanycomputersthatmeettheminimumrequirementsfor ICATTareavailableorcanbelocatedandtheiruseforthetrainingnegotiated. Classroom based training with individual use of computers: One computer per each participantandonecomputerforpresentationareneeded.Ifthenumberofcomputers availableisnotsufficientfortheintendednumberofparticipants,findoutearlyduring theplanningphaseifparticipantshaveandcanbringandusetheirownnotebooks. Classroom based training with LCD projector: One computer (and an LCD projector as forallotherconfigurations)isneeded.Thenumberofparticipantsshouldnotexceed20; ifitislarger,theparticipantsactiveinvolvementinthetrainingdiminishesorthetime neededforfacilitatorparticipantinteractionincreases. Distancelearningtraining: o Each participant needs an access to a computer for approximately 4 hours a weekduringthewhole8weektrainingperiod. o Facilitatorparticipantencounters:Onecomputerper12participantsisneeded duringtheinitialencounterwhentheparticipantslearnandpracticenavigation inICATT.Onecomputerisneededduringtheintermediateandfinalencounters. If the number of computers is not sufficient for the intended number of participants,conducttheinitialencounterforsmallergroupsofparticipantson differentdays. Whenconsideringthenumberofcomputersneededinanytraining,rememberthateach 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 beforethetrainingifeachfacilitatorofICATTbasedtraininghasacomputerandifnot, 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.
Classroombasedtrainingshouldnotbeconductedorapowergeneratorshouldbeprocured if theelectricpowersupplyisnotreliable.
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AdecisionwhetherUSBflashdiskorDVDwillbeusedforICATTtrainingplayerisneeded. InfavourofDVD: o CheaperthanUSBflashdisk o Cannotbeinfectedwithavirus InfavourofUSBflashdisk o Permits transfer of Student profile; in a Distance learning training the Student profilecanbebroughttoafacilitatorforcheckingparticipantswork. o SomecomputersdonothaveDVDdrive(CDdriveisnotsufficient)
Useofan antiviral programis STRONGLYRECOMMENDEDforallcomputersused,especially if computers of participants, facilitators and/or participants health facilities will be used. A numberoffreeantiviralprogramsareavailableattheinternet,forexample: o o avast!Freeantivirushttp://www.avast.com/freeantivirusdownload FreeantivirusAviraAntivirhttp://www.freeav.com/
2.1.2 PHYSICALCONDITIONSFORICATTBASEDTRAINING
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 equipmentandsupplies.Ifthisisnotthecase,findanothersuitableroomnearby.Youcanalso findasuitableroomneartheinpatientwardoratoutpatientclinicandlinkconductingtherole playswithclinicalpracticeinsteadofcomputertraining. EnsureoptimalconditionsforICATTbasedtraining: Appropriate seating, seating arrangements permitting comfortable reading distance fromtheprojectionscreen, Properheatingorcoolingandventilation, Adequatelighting, Outsidelightnotinterferingwithprojection(curtains,shutters)orindividualcomputer work, Noisenotinterfering(aircondition,fans,ambientnoise), Bestprojectoravailable,loudspeakers, Projectionscreenifpossible(awallislesspreferableaslightwillbeabsorbed), Access to power supply (enough multiplugs) for all facilitators and/or participants if theywillusetheirowncomputers.
2.1.3 ITSUPPORT
Classroom based training with individual computers: This training is usually conducted in a computerlaboratorymanagedbyanITadministrator.Heorsheshouldbeaskedtoassistwith theinstallationoftheICATTtrainingplayeronallcomputersintheclassroomandalsoonthe personalcomputersoffacilitatorsandparticipants,iftheybringthem. ClassroombasedtrainingwithLCDprojector:ITsupportisusuallynorneededasthefacilitators frequentlyusethesameequipmentthattheyuseroutinely.
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Distance learning training: Assistance of a skilled computer user (not necessarily a trained IT specialist)willbeveryusefulinmostsettings.Theresponsibilitiesofthispersonwillbe: BEFOREthetraining: o Assistwithidentificationofsuitablecomputers, o Ensure that ICATT is installed and/or runs from the DVD/USB flash disk on all computersthatwillbeusedinthefacilitatorparticipantencounters. AttheBEGINNINGofthetraining: o Ifsomefacilitatorsorparticipantsbringtheirnotebooks,ensurethattheICATT isinstalledorrunsonitfromtheDVD/USBflashdisk. DURINGthetraining: o Provide assistance to participants who have problems with running ICATT in theirhealthfacilityorathomeifafacilitatorassignedtocommunicatewiththem cannotsolvetheproblems.
2.2. PLANFORCLINICALPRACTICE
2.2.1 TRAININGSITES
Depending on the training configuration, the participants will have all clinical practice at the trainingsiteortheymaypracticeunderthesupervisionofatrainedstaffmemberontheirwork site or the basic part of clinical practice will be conducted at the training site and the participantswilldoadditionalpracticeattheirworksite. Basically, the facilities selected for group clinical practice must have a sufficient case load, acceptablequalityofcare,andadirectorandstaffwhoareinterestedinthetrainingandwilling andabletocooperate. The ICATT may replace other training materials in an ongoing IMCI training for which the clinicaltrainingsitesforinpatientandoutpatientclinicalpracticehavealreadybeenselected andareused.Ifanexistingsiteisgoingtobeused,checkifitisstillappropriate.Itisimportant toperiodicallyreviewwhetherornottheexistingclinicalpracticesitesaremeetingthelearning objectivesofthetraining.Considerthefollowing: Istheenvironmentconsistentwiththeskillsbeingtaught? Isthestaffreceptivetosupervisingparticipants? Isthereadequatespaceforthenumberofparticipants? Arethereenoughpatientsandappropriatetypesofpatients? Isthesiteeasilyaccessibleforparticipantsandfacilitators? Incasethattheclinicalpracticewillbeconductedinoutpatientclinicsand/oraninpatientward thathavenotyetbeenusedforIMCItraining,selectthetrainingsitesaccordingtothecriteriain Box1.
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Box1 Criteriaforselectingclinicalpracticetrainingsites
Outpatientclinics Dependingonthenumberofparticipants,selectseveraloutpatientclinicswheremanychildrenareseeneach day.Oneoftheseclinicsmaybeinthesamefacilityastheinpatientward. Theclinicsshouldbewithinareasonabledistanceoflodgingandclassrooms,andclosetotheinpatientwardas well.Transportationmaybeneededforsmallgroupsfromlodgingtotheclinics,andalsofromtheclinicstothe inpatientfacility. IntheclinicsthereshouldbeanORT(Oralrehydrationtherapy)areafortreatingchildrenwithdiarrhoeawhoare dehydrated.TheORTtreatmentareamaybeinacornerofaoneroommultipurposeassessmentandtreatment area,oritmaybeinaseparateroom.Someoutpatientclinicsmayalsohave1to2bedsforgivingIVtherapyto severelydehydratedchildren. Withinorimmediatelyadjacenttotheoutpatientclinics,thereshouldbealargewelllitareaortwosmaller areas(suchasexamrooms)whereparticipantscanassesspatients.Theseareasshouldberelativelycalmand quiet,sothatchildrenwhoarebeingassessedwillremaincalmwhentheirsignsareassessed.Theymustbe nearenoughtothemaintreatmentareaoftheclinicthatchildrenareeasilyreturnedtoclinicandany emergenciescanbemanagedbytheregularclinicstaff. IdeallytheclinicstaffshouldimplementIMCIcasemanagementapproachanduseitwithconfidence.Ifnot,the clinicdirectorandstaffshouldbewillingtoaccommodateuseoftheassessment,classification,andtreatment processesdescribedonthecasemanagementcharts. Itisbestiftheclinicdirectorwillpermitparticipants(withsupervisionoffacilitators)todispenseoraldrugsto mothersandgivethefirstdoseinclinic. Astaffmembersuchasanurseshouldbeavailableateachclinictoparticipateintheselectionofcases.This nursehelpstoidentifysuitablechildrenastheycomeintotheclinic.Thenursearrangesforthechildand mothertoleavetheregularcliniclineandbeseenbytheparticipants.Thenursethentakesthemtothe appropriatestationintheclinicforanyadditionaltreatmentandcare,minimizingsubsequentwaitingtime. Manysuppliesareneededattheclinicalpracticesites,suchasscales,thermometers,drugs,andORSsupplies. AllofthesuppliesthatmaybeneededarelistedinAnnex7ofthisguide.Dependingonhowthecase managementchartshavebeenadaptedforthelocalarea,youmaynotneedallofthedifferentdrugsor differentformulationsofdrugslisted.Besurethatthedrugslistedontheadaptedchartsareavailable.Youmay needtobringsomeoftheequipmentorsupplysomeofthedrugsiftheclinic'ssupplyislow.
Inpatientward Selectafacilitywithaninpatientwardthatadmitschildrenwithsevereillnessessuchaspneumonia,meningitis, andseveremalaria.(Thefacilitymayhaveseveralwards,suchasapaediatric,neonatalandmalnutritionward, whereinfantsandchildrenaretreated.)Thiswillallowparticipantstoobservecertainlesscommonclinical signs,particularlyforpneumonia,malnutrition,andsignsofseriousbacterialinfectioninyounginfants. Theinpatientwardshouldbewithinareasonabledistanceoflodgingandclassrooms,asclinicalpracticewill occuralmosteveryday.Transportationmayneedtobearranged. Theinpatientwarddirectorshouldbewillingforagrouporgroupsofparticipantstovisitthewarddailyduring thetrainingduration.Thedatesofthetrainingshouldbeacceptabletotheinpatientwarddirector. Aclinicalstaffmemberactsasaclinicalinstructor.Oraclinicalstaffmembershouldbeavailablestartingat6:00 or7:00a.m.eachdaytoassisttheinpatientinstructorinselectingcasesforthatday. Somesuppliesareneededintheinpatientwardforassessingandclassifyingpatients,suchasscalesand thermometers.ORTsuppliesarealsoneeded.Suppliesthatmaybeneededforclinicalpracticeintheinpatient wardarelistedinAnnex8ofthisguide.Youmayneedtobringsomeofthesuppliesiftheinpatientwarddoes nothaveenough.
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Thetrainingconfiguration,especiallydistancelearningtraining,mayincludeclinicalpracticeat participantworksite.Considerthefollowing: HavesomeofthestaffatparticipantworksitesbeentrainedinIMCIandaretheywilling toactasmentors,i.e.supervisetheparticipantsclinicalpracticeandprovideassistance totheparticipantswithlearningIMCIcontent? Are all drugs needed for clinical practice available at participant work sites? Plan to providesmallamountsofmissingdrugstotheparticipantsifpossible.
2.2.2 GUIDEFORCLINICALPRACTICE
As your country most probably already implements IMCI and conducts IMCI training courses, youalreadyuseyournationalorlocaladaptationofWHO Facilitatorguideforoutpatientclinical 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 alsoforanICATTbasedIMCItraining. IfyoudonotalreadyhaveprintedcopiesofguidesforclinicalpracticeinstandardIMCIcourses, youcanusetheguideorguidesforclinicalpracticeprintedfromtheICATTtrainingplayer. ICATTsupportmaterialsinthegenericICATTtrainingplayerinclude Guideforclinicalpractice forconductingboth,outpatientandinpatientclinicalsessions.Dependingonthedecisionofthe 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 traininginstitution. 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 sessionsdescribedintheguideaccordingtothenumberofclinicalsessionsinyourtraining(See exampleschedulesinthespecificpartofthisguide.)andinformthefacilitatorsandtheclinical instructoraboutthecontentofeachclinicalsessioninthetrainingaccordingly.
2.2.3 SCHEDULEOFINPATIENTANDOUTPATIENTCLINICALPRACTICE
Classroombasedtraining:Plantheschedulesothatparticipantsdividedintosmallgroupsof68 personsvisittheinpatientwardandanoutpatientcliniceachdayofthetraining(exceptforthe firstday).Eachinpatientvisitwillrequireonehour,andeachoutpatientsessionwillrequire2 to3hours.Allowfortraveltimebetweentheinpatientwardandtheclinicandacoffeebreak. The outpatient clinical practice should be scheduled at the time of day when most patients arrive,usuallyinthemorning. Thenumberofoutpatientclinicsneededdependsonthenumberofparticipants,onthepatient load,and at thetimewhenpatients arrive at eachclinic.Allparticipants 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 inpatientwardwhiletherestoftheparticipantsworkwiththeICATT,thereforeifaclinichasa continualflowofnewpatientsuntillunchbreak,then2groupsmaybeabletovisitit,oneafter
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the other. It is important to talk with each clinic director about the best time(s) for seeing a varietyofnewpatients. Belowisanexampleofascheduleforatraininginwhichtherearefoursmallgroups.Eachgroup willvisittheinpatientwardandoneofthreeclinicsdaily.TheCityHospitalinpatientwardand 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 willbethesameeachdayofthetraining,unlesschangesareneeded.Itshowswhereeachgroup willbeuntil12:00p.m.(Rememberthatyourschedulemaybeverydifferent,dependingonthe numberofgroupsandthenumberofclinicsused.) Exampleclinicalpracticescheduleforaclassroombasedtrainingwithfoursmallgroups CityHospital Inpatient 8:009:00 GroupsA,B 9:1512:0 GroupA,B 11:0012:00 GroupsC,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 demonstratetheassessmentandclassificationofasickchildaged2monthsupto5years.The sessionmaybeconductedeitherinaninpatientward(preferable)orinanoutpatientclinic.See specific part on distance learning training, chapter Initial facilitatorparticipant encounter: Suggestedobjectivesandschedule in this guide for possible organization of the session. Clinical sessionsduringtheintermediateandfinalfacilitatorparticipantencountersareconductedina similarlytothoseinclassroombasedtrainings. Besuretoconfirmalldatesandtimesinwritingwiththedirectoroftheinpatientwardandthe outpatientclinics. CityHospital outpatient Mainsstreet clinic 8:0010:45 GroupC Hopeclinic
8:0010:45 GroupD
2.2.4 PREPAREFORCLINICALPRACTICEATOUTPATIENTCLINICS
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 arrangementspriortothetraining.
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1. Brieflydescribetotheclinicdirectortheobjectivesofthetraining,theimportanceofclinical practice in the training, and the types of clinical signs and diseases participants will need to observe. 2. Tourtheclinicandchecksupplies: Observewherechildrenarriveandwheretheyaredirected.(Duringoutpatientsessions inthetraining,astaffmemberwillselectchildrenastheyarrive.) DetermineifthereisanORTtreatmentcornerorarea.Ifanoutpatientclinicchosenasa siteforclinicalpracticedoesnothaveanORTcornerformanagingdiarrhoeapatientswith dehydration,itisadvisabletosetoneupbeforethetrainingorduringfacilitatortraining. Determine what areas orexamroomsare availableforparticipantstouseinassessing cases. Seewhatsuppliesareavailable.Supplieswhichareessentialforoutpatientsessionsare listed in Annex 7 of this guide. If any necessary supplies are not available, arrange to bringthemforclinicalpractice. 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.(Asingleformulationisadequateevenifseveralarelistedonthechart.)Ifyouwill need any drugs or other supplies in addition to what is available in the clinic, you will needtobringthemwithyouforeachsession. Seewhetheratableortrayisavailabletousefordrugsupplies.
3. Discussandconfirmthescheduleforclinicalpractice.Iftheschedulehasnotalreadybeen arranged, make arrangements as described earlier in section 2.2.3 Schedule inpatient and outpatientclinicalpractice.Ensurethatscheduledtimesarethebesttimesforparticipantstosee manynewpatients.Explainhowmanypeoplewillbecomingtopracticeandforhowlong. Askaboutanychangesinschedulefromdaytoday,suchasspecialMCHdays,mornings withspecialtyclinics,etc. Confirmthescheduleinwriting.
4. Planwiththedirectoroftheclinicwhatroletheclinicstaffwillplayduringtheparticipants' clinicalpracticesessions. Try to arrange for a regular clinic staff member such as a nurse to participate in the selectionofcasesforclinicalpracticesessions.Thisstaffmemberwould: o identifychildrenand younginfants whoareappropriatefor theclinicalsession astheycomeintotheoutpatientdepartment. o arrange forthechildandmothertoleavetheregularcliniclineandbeseenby theparticipantsandthenreturnthemtotheappropriatestationintheclinic for theirtreatmentandadditionalcare. o returnthechildtotheappropriatestationintheclinicfortreatmentandcare. Discuss and confirm plans for making sure that patients seen during the outpatient sessionreceivethetreatmenttheyneed.Discusswhetherparticipantswillbepermitted to dispense oral drugs to mothers and give the first dose (preferable), or whether patientswillbepassedtoregularclinicstafffortreatment.Ifthismustbedonebyclinic staff,discusshowthiswillbemanaged.
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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 participantswillusuallyassessandclassifypatients,andthenpatientswillreturntotheregular staff for treatment. During one or two sessions participants will do some treatment, such as givingoralantibioticsorORT. Briefthenursewhowillidentifysuitablechildrenandsendthemtobeseenbyparticipants. Tellthestaffthatitispreferablethatthechild'sweightandtemperaturebetakenonarrivalat theclinicandrecordedforparticipantstouse. 6. Justbeforethetrainingstarts,visittheclinicwhereyouwillconductoutpatientsessions. Meetwithclinicstafftoconfirmalladministrativeandlogisticalarrangementsmadeinadvance. 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 THESICKYOUNGINFANT.
2.2.5 PREPAREFORCLINICALPRACTICEATINPATIENTWARD
Youandtheclinicalinstructorshouldvisittogetherthehospitalwhereclinicalsessionsaretobe 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 arrangementsincludetheseniorresponsiblenurse,notjustthedoctorincharge. Meetwiththedirectorofthepaediatricinpatientward.Explaintothewarddirectorhow inpatientsessionswork.Describewhattheinpatientinstructorandtheparticipantswould do. Ask permission to conduct sessions in the ward. If there are separate malnutrition, newbornandsickneonatewards,meetwiththedirectorsofthesewards.Alsomeetwith thedirectorofmaternitywardsessiononessentialcareforyounginfantswilltakeplace there. Askthewarddirectorforaclinicalassistant.Thisshouldbesomeonewhoworksonthe wardfulltime.Askthedirectortoassigntheclinicalassistanttocomeatthetimeofthe earlymorningpreparations(usuallyat6:00or7:00amdependingontheschedule).Ask foratranslatortohelpinterviewmothersintheearlymorning,ifneeded.(Itwilloftenbe necessarytoprovideastipendtothisindividual.) 2. 3. 4. Visittheward.Seehowthewardislaidout,thescheduleofadmissions,meals,etc.Find outtimespatientsareavailableornotavailable. From this information, plan a possible schedule for the clinical sessions in the inpatient wardduringthetraining. Togetherwiththeclinicalinstructor:
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Setthescheduleforinpatientandoutpatientsessions,soeachgroupwillvisitone outpatientclinicandtheinpatientwardeachday. Reviewyourresponsibilitiesandplansforconductingtheinpatientsessions. Planthecontentofeachinpatientsessiondependingonthetrainingschedule.
5. Ifachecklistformonitoringinpatientsessionsisused,teachtheclinicalinstructorhowto useitbeforethetrainingbegins.
2.3 SELECTTRAINERSANDPLANFORTHEIRPREPARATION
2.3.1 FACILITATORS
Criteriaforfacilitators FacilitatorsmustbetrainedinIMCI.Ideally,facilitatorsofanICATTbasedIMCItrainingshould betrainedIMCIfacilitators,andthereforehaveundergonethe5dayIMCIfacilitatortrainingand haveconductedatleastoneIMCIcoursebeforetheybecomefacilitatorsforanICATTbasedIMCI training. Facilitators for the computer training also must have computer skills sufficient to learn and teachusingtheICATTeasily(routineuseofMSWindowsandWordisadequate). FacilitatorsforthecomputertrainingmusthaveaneasyaccesstoacomputerwithICATTduring thewholetraining. If facilitators are also expected to conduct the followup visit they need to be trained for conducting the follow up visits (WHO Guidelines for conducting the follow up training are availableintheICATTLibrary).Iftheyarenottrained,theyshouldbetrainedorothersolution needstobeidentified. If trained IMCI facilitators are not available, the future facilitators of an ICATT based IMCI trainingshouldalsomeetthecriterialistedinBox2.
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Box2
Criteriaforselectingfacilitators notyettrained infacilitation of IMCIcourses
Facilitatorsshouldbecurrentlyactiveinclinicalcare.Theymusthavethebasicclinicalskillsand technicalknowledgewhichwillallowthemtoteachtheintegratedcasemanagementprocess usedinthetraining. TheymustrecentlyhavebeenparticipantsintheIMCIcourse. Theymusthavegoodcommunicationskills,includingtheabilitytoexplainthingsclearlyand simplytoothers. Facilitatorsmustbeconfidentinanoutpatientclinicsetting.Theymustbeabletoworkwith clinicstaffinselectingpatientsforparticipantstosee.Theymustsupervisetheparticipants' workintheclinicbyensuringtheyaregivencasestomanageandcheckingtheirassessments, classifications,treatments,andcounselling. Theymustbeorganized.Theymustbeabletokeepthegrouponscheduleandensurethatthey arriveforclinicalpracticeontimeandwiththenecessarysupplies. Theymustbeflexibleinordertousetimewell.Forexample,ifachildwithararelyseenclinical signappears,theymustbeabletostopwhattheyaredoingandpresentthesigntothegroup. Facilitatorsmustbeavailableduringalloffacilitatortrainingandduringtheentiretraining.They musthavetheenergyandmotivationtoworkalongdaywithparticipantsandthenattenda facilitatormeetingtoreviewtheday'sworkandprepareforthenextday. Facilitatorsshouldbeavailabletoteachseveralsubsequenttrainings,ifpossible.
Facilitatorparticipantratio Facilitators tasks are different in different training configurations and are described in Box 2. ForthisreasonthedesirablefacilitatorparticipantratioforICATTbasedtrainingisdifferentin differenttrainingconfigurations.
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Box3 Tasksofafacilitatorindifferenttrainingconfigurations Classroombasedtrainingwithindividualcomputers Introducethetraining,IMCI,andICATT. TeachparticipantshowtonavigateinICATT. ExplainhowtheparticipantsshouldworkthroughICATT. Monitortheprogressofparticipants.Thedurationofworkthrougheachtrainingunitshouldbeapproximately asindicatedinthetrainingschedule. Provideassistancetoparticipantswhentheyaskforhelpandactivelyseekparticipantswhomayneedhelpbut donotaskforit. Provideindividualfeedbackoncompletedprintedrecordingformsforselectedexercises. Conductdemonstrations,drills,androleplays. Prepareparticipantsforclinicalpracticesessionsandconducttheoutpatientsessions. Summarizeeachdayswork. Assistthetrainingdirectorincollectingdataduringthetraining. ClassroombasedtrainingwithLCDprojector Introducethetraining,IMCI,andICATT. WorkthroughallICATTunitsandsectionstogetherwiththeparticipantsasaninteractiveactivity: Readand/orsummarizeallthetextscreenstogetherwiththeparticipants, Runthevideosandflashmoviesandshowthepicturesanddiscussthemasneeded, WorkthroughthePRACTISEpartexercises(TESTexercisesareoptional). Checkparticipantsunderstanding. Conductdemonstrations,drills,androleplays. Prepareparticipantsforclinicalpracticesessionsandconducttheoutpatientsessions. Keeptheschedule.Thedurationofworkthrougheachtrainingunitshouldbeapproximatelyasindicatedinthe trainingschedule. Assistthetrainingdirectorincollectingdataduringthetraining. Distancelearningtraining Conductthefacilitatorparticipantencountersaccordingtotheagenda. o Introducethetraining,IMCI,andICATT. o TeachparticipantshowtoinstallICATTorrunitfromaDVD/USBflashdisk,howtonavigateinICATT, andhowtotransfertheStudentprofile. o Explainhowtheparticipantsshouldworkduringtheselflearningphases. o Checktheparticipantsprogressduringtheselflearningphases. Providesupporttoparticipantsduringtheselflearningperiodsasagreeduponwiththetrainingdirector. Encouragetheparticipantsandhelpthemwithanyindividualproblemsduringthefacilitatorparticipant encounters,andencouragethemtocallwhenevertheyhaveaproblembetweentheencounters. Assistthetrainingdirectorincollectingdataduringthetraining. Regularlyreportonprogresstothedirector.
Onefacilitatorper1015participantsissufficientforcomputertraininginaclassroom based training with individual computers because the assistance in ICATT navigation and clarification ofIMCIcontentifneededisprovidedtotheparticipantsover thewhole trainingperiod. The facilitator participant ratio for computer training should be 1:68 in a classroom based training with LCD projector. One facilitator works through the ICATT content togetherwiththeparticipants,anotheroneormorefacilitatorshelptheparticipantsto dotherequiredtasks(e.g.findrelevantinformationinthechartbookletorcompletea caserecordingformcorrectly).ItisNOTrecommendedtoworkinagrouplargerthan20 participants it would increase the time needed for the interaction of facilitators with participantsordecreasetheinteractionandthereforethequalityoftraining. Inadistancelearningtraining,thefacilitatorparticipantratioforICATTbasedtraining shouldbe1:45duringthefacilitatorparticipantencounters.Duringtheencountersthe facilitators teach participants how to navigate in the ICATT, check participants work
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duringtheselflearningphases,providefeedbackonitandsolvepotentialproblemsina limited time. One facilitator for 10 participants should be designated to provide assistancetoparticipantsduringtheselflearningphasebyphone,emailorothermeans ofcommunication. The facilitator participant ratio for outpatient clinical practice should be 1:34 as in a standardIMCIcourseinordertoensureaqualityclinicalpractice.Thismeansthatone or more facilitators will be needed for conducting the outpatient clinical sessions in addition to facilitators responsible for computer training who will also conduct the outpatientclinicalpractice.
Facilitatortraining Facilitator training for an ICATT based IMCI training is needed even for facilitators routinely facilitatingstandardIMCIcourses.Theyneedto: GetfamiliarwithICATT, LearnfacilitatortechniquesusedintheICATTbasedpartofthetraining, Obtaininformationabouttheorganizationofthetraining,and Obtaininformationabouttheirrolesandtasksduringthetraining. A3dayfacilitatortraininghasbeendevelopedforthetrainingoffacilitatorswhohavealready been trained in facilitating standard IMCI courses (See part Trainingfacilitators in this guide). ThetrainingschedulefocusesonteachingskillsneededforworkingthroughtheICATT.Onlyone halfofadayisdevotedtotheoutpatientclinicalpractice,whichconsistsmainlyofrefreshingthe facilitator techniques used in the outpatient clinical practice and information about the organizationoftheclinicalsessions.Theobjectivesofafacilitatortrainingarethesameforall 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.Aftercompletingthefacilitatortraining,thefacilitatorswillbeabletoconductanytype ofICATTbasedIMCItrainingafterashortbriefing. AnotheroptionforthetrainingofexperiencedIMCIfacilitatorswhoroutinelyconductstandard IMCIcoursescanbe: Aninitial23hoursessiononnavigationintheICATT. ApproximatelyonemonthselflearningphaseforworkingthroughtheICATTincluding 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 trainingdirectorasaproofoftheirworkthroughtheICATT. Final one day session to learn facilitator techniques that will be used in the training, obtaininformationabouttheorganizationofthetraining,aboutthefacilitatorsrolesand tasksduringthetraining. Thisschedulerequiresa substantialselfdisciplineofthefacilitatorstopreparethemselveson theirown. A4dayfacilitatortrainingthatincludesthreeclinicalsessionssimilartothoseinWHOstandard facilitator training (See WHO generic Course directors guide in ICATT library, section IMCI TrainingCourse)isrecommendedforthetrainingoffacilitatorswhohavenotyetbeentrainedin facilitatingIMCIstandardcourses.
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2.3.2 INPATIENTINSTRUCTOR
Oneinpatientinstructorisneededforinpatientclinicalsessions.Theinpatientclinicalsessions will be scheduled separately for groups of 68 participants (See section 2.2.3 Schedule of inpatientandoutpatientclinicalpractice). TheresponsibilitiesoftheinpatientinstructorarethesameasinastandardIMCItraining.The inpatientinstructor'stasksaredescribedindetailintheGuideforclinicalpractice.
Box4 Responsibilitiesoftheinpatientinstructor StudythoroughlythepartsofGuideforclinicalpracticerelatedtoinpatients. Discusshisorherresponsibilitiesandanyquestionswiththetrainingdirector,sothatbothunderstandand agreewhatheorshewilldo. Obtainthenecessarypermissionsandsupplies. Meetandbriefthestaffintheinpatientward. Findoutthewardroutineandlayout,sothathecanselectchildreninthemorningandconductthesessions efficientlyandalsowithoutdisruptingtheward. RefertotheGuideforclinicalpractice,partClinicalpracticeintheinpatientwardfordetailsonhowheorshe shouldpreparehimselforherselfandtheinpatientward.Gooverthelisttobesurethateverythingisready, andmakearrangementsforanyremainingitems. Iftheinpatientinstructorisexpectedtocollectdataonthecasesandtheperformanceofparticipantsduringthetraining, thetrainingdirectorshouldensurethatheorsheunderstandshowtocompletetheChecklistformonitoringinpatient sessions(SeeAnnex5oftheGuideforclinicalpracticeforinstructionshowtocompletethechecklist).
Ideallytheinpatientinstructorshouldhavebeenalreadytrainedforconductinginpatient clinicalpracticeinIMCIcoursesbeforeheorshebecomesaclinicalinstructorforanIMCI trainingusingICATT. Ifatrainedclinicalinstructorisnotavailable,usethecriteriaforhisorherselectiondescribedin Box5.
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Criteriaforselectinginpatientinstructorwhohasnotyetbeenpreparedforconducting IMCIinpatientsessions: Theinpatientinstructorshouldbecurrentlyactiveinclinicalcareofchildren,ifpossibleonthe inpatientwardofthefacilitywherethetrainingisbeingconducted.(Iftheinpatientinstructoris notonthestaffofthefacility,astaffassistantwillbeneededtohelpwitharrangements.) Theinpatientinstructorshouldhaveprovenclinicalteachingskills. Theinpatientinstructorshouldbeveryfamiliarwiththeintegratedcasemanagementprocess andhaveexperienceusingit.HeorsheshouldhaveparticipatedintheIMCItrainingpreviously asaparticipantorfacilitator. Heorsheshouldbeclinicallyconfident,inordertosortthroughawardofchildrenquickly, identifyclinicalsignsthatparticipantsneedtoobserve,andassessandclassifychildreneasily accordingtotheASSESS&CLASSIFYcharts.Heorsheshouldunderstandthechild'sclinical diagnosesandprognosissoastoavoidconfusingcasesandcriticallyillchildrenwhoneed urgentcare.Heorsheshouldbecomfortablehandlingsickchildrenandconveyapositive, handsonapproach. Heorshemusthavegoodorganizationalability.Itisnecessarytobeefficienttoaccomplishallof thetasksineachclinicalsession.Theindividualmustbeabletostayonthesubject,avoidingany extraneousinstructionordiscussion. Theindividualmustbeoutgoingandabletocommunicatewithwardstaff,participants,and mothers.Heorsheshouldbeagoodrolemodelintalkingwithmothers. Itishelpfuliftheindividualhassometrainingorexperiencewithneonatesandinassessing breastfeedingandteachingmotherstoimprovepositioningandattachmentforbreastfeeding. Ifpossible,inpreparationforthisrole,theindividualshouldworkasanassistanttoaninpatient instructoratanothertrainingtoseehowtoselectcases,organizetheclinicalsessionsand interactwithparticipants.Oranotherskilledinpatientinstructorcanjoinhimorherduringthe firstfewdaysofthefacilitatortrainingorthetraining. Theinpatientinstructormustbeavailable12dayspriortofacilitatortraining,duringallof facilitatortraining,andduringtheentiretraining.(Ifhehaspreviouslyattendedfacilitator training,hedoesnotneedtorepeatthistraining,butitisimportanttoattendfacilitatortraining atleastoncetolearnfacilitationskills.)Theinpatientinstructormustbewillingandmotivated togetupearlyeachmorningduringthetrainingtoselectcasesintheinpatientwardand preparefortheday'sclinicalsessions. Theinpatientinstructorshouldbeavailabletoteachseveralothertrainingsoverthenextyear,if possible.
Box5.
2.4. SELECTPARTICIPANTS
Anyhealthprofessionalsresponsibleformanagementsickchildrenageupto5yearsareeligible forthetraining. Motivation of participants is very important. The selection of participants for an inservice trainingshouldbeideallydoneonvoluntarybasis.Thissupposestoensurehigherinterestand motivation.Developingincentives,suchasacertificateand/orincorporatingIMCItraining,into continuous education for inservice participants and incorporating IMCI into paediatric examinationforpreservicestudentsarerecommended. Optimally,theinservicetrainingshouldpromotetheideaofteamlearningagroupofhealth professionalsfromagivenhealthfacilitydoctor,nurse,healthassistantthisapproachallows toachieveseveraltasks:i)createacriticalmassinafacility,ii)stimulateexchangeofknowledge andskillsinagivenfacility,iii)tohelpmaketrainingmorecosteffective.
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Numberofparticipantsintraining Depending on the training configuration, the number of participants in one training will be limitedbythenumberofcomputersavailable(Seesection PlanforICATTbasedtraininginthis chapter), facilitators available (See section Select trainers and plan for their preparation Facilitatorsinthischapter),and/orthepossibilityforadequateclinicalpracticewithsufficient numberofpatients(SeesectionPlanforclinicalpracticeinthischapter). Participantscomputerskills Futureparticipantsdonotneedtohaveanycomputerskillspriortothetraining. When planning your training with individual computer use, you should however obtain informationabouttheparticipantsexpectedcomputerskills:Dotheyuseacomputer?Ifyes,do theyuseitalittleorfrequently?Iftherearemanyparticipantswhohavenoorlittlecomputer skills,allocatemoretimeforthesessiononnavigationinICATTandconsiderusinganoptional flash movie How to use a computer that helps the participants to learn the basics about a computerthatcanbefoundinICATTtrainingplayer,sectionSupportmaterialsTrainingaids.
2.5. PLANFORDATACOLLECTION
Anumberoftoolsformonitoringparticipantwork,evaluationofparticipantsandevaluationof thetrainingareavailableeitherinthetrainingsetorin ICATTsupportmaterialsFormsfordata collection.Youneedtodecidewhichtoolsyouwilluse.
2.5.1 MONITORINGTOOLSINICATTTRAININGSET
To monitor the participants 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.
EachscreenoftheTrainingplayer shows the participants progress 1 fortheTESTexercisesdoneinthe form of a progress bar (1). The progress bar has distinct sections for each training unit. A training unit is either not begun (white,)inprogress(yellow),passed(green),orfailed(red)iflessthan80%ofquestionsare notansweredcorrectly.Theprogresswithinatrainingunitisnotevaluated. Eachparticipantofatrainingwithindividualcomputeruseorthewholegroupofparticipantsof atrainingwithLCDprojectormayrecordcasesthattheyhavemanagedassessedandclassified into the clinical practice sheet accessible from the Clinical practice (2) menu item of the Trainingplayer.
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TheProgress(3)menuitemintheTrainingplayerleadstoasummarysheet,whichdisplaysthe 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. Participantsofadistancelearningtrainingmaybeinstructedtoa)sendtheirStudentprofileby anemailtothefacilitatorforcheckingorb)transfertheirStudentprofiletoaUSBflashdiskand bring it to the facilitator or c) print the Progress summary sheet for checking. The printed Progresssummarysheets(alsofromparticipantsofaclassroombasedtrainingwithindividual computers) may be used to determine the proportion of students who completed all training unitscorrectlyfortherepo.Thisinformationwillberecordedinthetrainingreport(SeeICATT supportmaterialsDatacollectionformsA.Trainingreportform). Exampleofaclinicalpracticesheet
Exampleofasummaryprogresssheet 3
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2.5.2 DATACOLLECTIONFORMS
ICATTisanewtoolforIMCItrainingwithmanypossiblevariantsofuse.Whenyoustartusingit, you may want to know the feasibility, effort and cost effectiveness of your ICATT based IMCI trainingsandalsotocomparethemwiththestandardIMCIcoursesconductedinyourcountry, area or institution. In order to achieve this, we suggest that you gather and analyse the informationinthefollowingareas: Featuresofthetraining DetailsofworkwiththeICATT Participantevaluation Participantsviewsonthetraining Facilitatorsviewsonthetraining Trainingcosts
TheICATTsupportmaterialsData collectionformsprovidea numberofforms forcollecting dataduringthetrainingthatwillhelpyouinthistask.Theirdescriptionandinformationabout theiruseindifferenttrainingconfigurationsareinAnnexes4and5ofthisguide. The generic forms in the ICATT may have already been adapted by your national ICATT adaptationteam.Ifthey havenot been adapted, you needto adaptthem yourself.Some ofthe formsarethesameasinthegenericstandardWHO11dayIMCIclinicaltrainingcourseandyou mayalreadybeusingtheminyourstandardIMCIcourses,soyoumayreplacethegenericforms inICATTwithyourversions. Youmayalsowishtoreviewanddiscusstheinformationprovidedbythechecklists,whichare amongthedatacollectionformsatthefacilitatormeetings.Thechecklistswillhelpfacilitators 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. Themonitoringchecklistsmayalsobecollectedattheendofthetraining,andusedtodetermine 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. Trainingreportform). Itisimportanttoensurethatallthefacilitatorsaretrainedtocompletethemonitoringchecklists andknowthattheyareexpectedtodoso. Evaluationofparticipants The evaluation of participants may consist of knowledge evaluation only (written post test) and/orofskillsevaluation(clinicalcasemanagement). Conducting a written post test (available in Data collection forms) at the end of the training is suggested.Remember:Participantsareallowedtousethechartbookletduringthetest! Evaluationofclinicalskills(observationandevaluationofclinicalcasemanagement)isoptional. There is no special tool for the evaluation of a clinical performance in the ICATT support
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materials.Theevaluationofclinicalskillsmaybeconductedattheendofthetraining(butNOT before the participants had the opportunity to practice the skills to be evaluated under supervision)oritmaybedoneasapartofthefollowupvisit.Ifthisisthecase,thefollowup visitshouldbeconductedinthemorningtoincreasetheprobabilitythatasuitablepatientfor assessmentwillbeavailable.Thismeansthatonefacilitator(orotherhealthworkerconducting thefollowupvisit)canvisitonlyonehealthcentreperday.
3.
CHECKLISTFORPLANNINGANDADMINISTRATIVEARRANGEMENTS
Arrangementsapplytoalltrainingconfigurationsunlessotherwiseindicated.Theymaynotbe listedintheexactorderinwhichtheywillbemade. Please refer for details about the activities to chapter General considerations for planning and organizinganICATTbasedIMCItrainingofthisguideunlessotherwiseindicated.
3.1
INITIALPLANNING
1. Appropriateversionofadaptedand,ifneeded,translatedICATTtrainingplayerensured (Latestversiononeormoretestversionsmaybecirculating). 2. Trainingsupportmaterialsselected,adapted,ifneededtranslated,andprinted. 3. General timeframe for giving the training identified (preferably during a time of peak incidence for some of the following illnesses: pneumonia, diarrhoea, malaria, and measles). 4. Traininglocation(s)selected.Criteriaforthetraininglocation: a. Availabilityofaroomadequatetoaccommodateallparticipantsandfacilitators. Thisroomshouldbelocatedinornearabusyhealthfacilitywithanoutpatient department for clinical practice. Additional nearby outpatient clinics may be needed.Theclinicalfacilitiesmustbeallvisitedtoassesstheiradequacyinterms ofthetrainingneeds(SeesectionPlanforcomputertrainingandITsupport). b. Availabilityofcomputers(SeesectionPlanforcomputertrainingandITsupport). c. Classroombasedtrainings:Adequatelodgingforallfacilitatorsandparticipants. d. Transportationtoandfromclinicalpracticesites. e. Convenientmealservice. DistancelearningtrainingThereareseveralpossibilitieshowtoconductthefacilitator participantencounters: a. Wholegroupofparticipantsmeetwithfacilitatorsatonevenue. b. Participantsfromseveralnearby healthfacilities meetwithfacilitatorsinoneof thehealthfacilities. c. A facilitator visits a remotely located health facility with one or several participantsandconductsasessiononthespot. 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 essentialpartoftheencounterandpatientscomeinthemorningonly. d. Combination of the above, e.g. initial and final encounters are conducted at the central venue, intermediate encounter or encounters at several participants healthfacilities. 5. Healthfacilitiesfromwhichparticipantswillbeinvitedidentified.Criteria: a. AcommitmenttoimplementIMCI
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6.
7. 8. 9.
10. 11. 12. 13.
14.
b. AneedtotrainstaffinIMCI(staffnevertrainedorneedingrefreshertraining) c. Acommitmenttoalloweachparticipanttoparticipateinthetraining. d. Distancelearningtraining: i. At least one computer with correct specifications (See Annex 1 of this guide)and,ifpossible,aheadsetpercomputerinthehealthfacilityanda commitment to allow each participant to use the computer for approximately4hoursperweekduringthetraining. ii. Futureparticipantshavetheirowncomputersoranaccesstoacomputer elsewherethanintheirhealthfacility(e.g.internetcafe). 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.(SeesectionPlanforcomputertrainingandITsupport). Selectionofparticipantsdiscussedandagreeduponwiththemanagementofthehealth facilities from which the participants will be invited and, for a training with individual computeruse,informationaboutcurrentcomputerskillsoffutureparticipantsobtained (SeesectionSelectparticipants). Consentofthemanagementofthehealthfacilitiesobtainedinwriting. The format of facilitator training decided upon (See section Select trainers and plan for theirpreparation). Specificdatesofthefacilitatorandparticipanttrainingselected. When selecting the dates, makes sure that there are no holidays or other events that woulddisruptthetraining.Fordistancelearningtraining,inwhichsufficientnumberof patientsforclinicalpracticeonthedaysoffacilitatorparticipantencountersiscrucial, enquireifthepatientloadisdifferentindifferentdaysoftheweek(e.g.morepatientson market days; no sick children on the clinic immunization days) and plan the dates accordingly. Participantsselectedandinvited(SeesectionSelectparticipant). IT support person identified and arrangements made for his or her availability (See sectionPlanforcomputertrainingandITsupport). Facilitatorsandinpatientinstructorselectedandinvited (Seesection Selecttrainersand planfortheirpreparation). Availability of one computer for each facilitator during the facilitator training and the whole duration of the participant training ensured (See section Plan for computer trainingandITsupport). Distance learning training: Decision on participant support during the self learning phasesmade: a. Communication between facilitators and participants (telephone, email, personal; plan for allowances for facilitators and/or participants for telephone calls).Onefacilitatorper10participantswill beappointedtocommunicatewith theparticipantsduringtheselflearningphases.Possibleapproaches: i. Active approach: A facilitator will contact participants once a week to enquireabouttheworkprogress.Theparticipantswillbeencouragedto contact the facilitator if they have any problem. The facilitator(s) will communicatewiththedirectorasneeded.
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15.
16.
17.
18. 19.
20. 21. 22. 23.
24. 25.
Activesupporttoparticipantscontributestotheirmotivationtocomplete thetraining. ii. Passive approach: Participants will contact the designated facilitator whentheyneedhelporhavea question.Facilitatorsthemselveswillnot contacttheparticipants. b. Possible(optional)additionalsupport: 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 provideadditionalsupporttotheparticipants. ii. Mentors are another possibility of participant support. A mentor is a healthworkertrainedinIMCIworkinginthesamehealthfacilityasthe participant(s) who e.g. helps the participant to manage cases correctly accordingtoIMCIguidelinesorclarifiesIMCIcontentifneeded. Distance learning training: Information about supplies/drugs at the participants worksites obtained. Missing IMCI supplies/drugs needed for clinical practice identified andaplantoprovidesupplies/drugsfortheparticipantsmade. 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 duringtheselflearningphasesattheirhealthfacility.Ifyes,thenumberofpatientsto managedecidedupon. Personsidentifiedtoconductfollowupvisits46weeksafterthetraining.(Thesemay include training facilitators, supervisors in the district, or others with IMCI and facilitationskills.)Plansmadeforpreparingtheseindividualstoconductfollowupvisits after training. (WHO Guidelines for followup after training are available in the ICATT library). Decision on collection of monitoring and evaluation information made. Forms selected andadaptedifneeded(SeesectionPlanfordatacollection) Decision on the evaluation of participants made. Evaluation may consist of knowledge evaluationonly(writtenposttest)and/orofskillsevaluation(Seesection Planfordata collection). Materialsandsuppliesneededidentified(Seeannexes69ofthisguide). DecisionwhetherICATTtrainingplayerusedwillbeonUSBorDVDmade(Seesection PlanforcomputertrainingandITsupport). DecisionwhetherICATTtrainingplayeronDVDorUSBflashdiskwillbeprovidedtoall facilitatorsandparticipantstaken. Budgetprepared.Budgetshouldinclude: a. Trainingpersonnelcost(perdiemorremunerations,travelcosts) b. Trainingpersonnelcost(travelcosts,perdiem) c. Materials and supplies cost (printed materials, photocopies, DVDs or USBs, stationery) d. Suppliesforclinicalpracticecost e. Costsofroom,equipmentrental,andmiscellaneoussuchasrefreshments. Arrangementsmadewithonelocalinpatientfacilityandoutpatientclinic(s)toconduct clinicalpracticesessions(SeesectionPlanforclinicalpractice). Precise schedules for the facilitator and participant training prepared including the contentofeachclinicalpracticesession(SeethespecificpartandsectionPlanforclinical
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26. 27. 28. 29.
30.
31.
practice in chapter General considerations for planning and organizing an ICATT based IMCItraininginthisguide). Venueforcomputertrainingreserved. Arrangements made for a support staff (secretary) to be available to ensure that necessaryadministrativetasksaredoneandtoensurethatthingsgosmoothly. Travelauthorizationssenttofacilitatorsandparticipants. 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. (Necessarymaterialsandsuppliesarelistedintheannexes69ofthisguide.) 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.WHOorUNICEF)orrepresentativesofbilateralorganizationssuchasfrom thenationalmedicaland/ornursingassociationorthenationalpaediatricsociety. Plans for press release made. Visibility becomes more and more important; therefore considerationshouldbegiventoissuingapressrelease.
3.2
ATTHETRAININGLOCATION,BEFOREBEGINNING
12 days before the training: Training director (with clinical instructors/s if feasible) visitsthesitesforclinicalpracticeanddiscuss/confirmarrangements.(Seeitemsonthis checklist.) Classroombasedtrainings:Adequatelodgingarrangementsconfirmedforallfacilitators andparticipants. Arrangements made for welcoming facilitators and participants at the hotel, airport and/ortrainstation(ifapplicable). Arrangementsconfirmedfortheroomandcomputers. ICATTinstalledonallcomputersthatwillbeused.Iffacilitatorsand/orparticipantswill usetheirnotebooks: a. ICATTinstalledontheircomputersassoonastheyarrivetothetraininglocation, e.g.intheeveningbeforethetrainingbeginsorduringtheregistration. b. Access to electric power for the notebooks (sufficient number of multiplugs) ensured. LCDprojectoravailable.Forthebestqualityoftheprojectedimage,adjustthecomputer desktopresolutionto thenativeLCDprojectorresolution(usually1024x768pixels).If youcannotdothat,trywhichofthecomputersavailablegivesthebestprojectionresult. Arrangements made for registering facilitators and participants for the training includingregistrationforms. Arrangements made for typing and copying of materials during the training (for example, registration forms, schedules, lists of participants, training evaluation questionnaires). Arrangementsmadeformealsandcoffee/teaservice. Arrangementsmadeforpayingperdiemtoparticipantsandfacilitators. 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.(SeesectionPlanforclinicalpractice).
1. 2. 3. 4.
5.
6. 7.
8. 9. 10.
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a. Dailyschedule(ordatesandtimesinadistancelearningtraining)discussedand agreed upon with inpatient ward director. Dates and schedules confirmed in writing. b. Drugsandsuppliescheckedandsupplementedasnecessary. 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 sessionswillbeheld)andconfirmedtobesuitableforclinicalpractice.Directorandstaff informedaboutpracticesessionstobeheld.(SeesectionPlanforclinicalpractice). a. Adequate number of sick children actually available at planned time for outpatientsession. b. ORTtreatmentcornerorareaavailable. c. Quietareaorexamroomsavailablewhereparticipantscanassesspatients. d. Drugsandsuppliescheckedandsupplementedasnecessary. e. Roleofclinicstaffduringpracticesessionsdiscussedwithclinicdirector. f. Clinicstaffbriefedontheirrole. g. Schedule for clinical practice sessions discussed and confirmed in writing. The clinicalpracticeshouldbeconducted attimeswhen many patientsarelikelyto beseen,usuallyinthemorning(SeesectionScheduleclinicalpracticesessions). h. Chartshungatsitestobeusedduringthetraining(ifused). 12. Arrangementsmadefortransportationtoandfromclinicalpracticesites(ifneeded). 13. Sufficientcopiesmadeoftrainingsupportmaterials(Facilitatorguide,registrationform, trainingschedule,caserecordingforms,Mother'scard,andmonitoringchecklistsforuse inclinicalpracticesessions(ifused).
3.3
DURINGTHECLASSROOMBASEDTRAINING
1. Trainingparticipantsregisteredusingregistrationform. 2. ICATTinstalledorrunsfromtheDVD/USBflashdisk onparticipantsownnotebooks(if used). 3. Groups of up to 8 participants assigned to pairs of facilitators for outpatient clinical practice. 4. Training directory (including names and addresses of all participants, facilitators, and instructors)providedtoeveryone. 5. Trainingphotograph,ifdesired,made. 6. Training evaluation questionnaires modified as needed and reproduced in sufficient quantitytogiveacopytoeachparticipantandfacilitator. 7. PosttestadaptedaccordingtothenationalIMCIguidelinesandreproducedinsufficient quantitytogiveacopytoeachparticipant. 8. Scoringofposttestassignedtofacilitator(s)providedwiththeposttestkeyandscoring instructions. 9. Arrangementsmadeforclosingsession. 10. Trainingcompletioncertificatepreparedforeachparticipant(ifused). 11. Plansforfollowupvisitsfinalized.
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3.3
DISTANCE LEARNING TRAINING: DURING THE INITIAL FACILITATOR PARTICIPANT ENCOUNTER

1. Trainingparticipantsregisteredusingregistrationform. 2. ICATTinstalledorrunsfromtheDVD/USBflashdiskonparticipantsownnotebooks(if used). 3. Training directory (including names and addresses of all participants, facilitators, instructors,andtheITsupportperson)providedtoeveryone. 4. Participantsassignedtoafacilitatortocommunicatewithduringselflearningphases. 5. Trainingphotograph,ifdesired,made.
3.4 DISTANCE LEARNING TRAINING: BEFORE THE INTERMEDIATE AND FINAL FACILITATOR PARTICIPANTENCOUNTERS
1. 2. 3. 4. 5. 6. Participantsremindedoftheencounter. Arrangementsconfirmedfortheroom,computers,andLCDprojector. Arrangementsconfirmedforthesitesforclinicalpractice. Arrangementsmadefortransportationtoandfromclinicalpracticesites. Arrangementsmadeformealsandcoffee/teaservice. Arrangementsmadeforpayingperdiemtoparticipantsandfacilitators.
Beforethefinalencounteralso: 7. Training evaluation questionnaires modified as needed and reproduced in sufficient quantitytogiveacopytoeachparticipantandfacilitator. 8. PosttestadaptedaccordingtothenationalIMCIguidelinesandreproducedinsufficient quantitytogiveacopytoeachparticipant. 9. Scoringofposttestassignedtofacilitator(s)providedwiththeposttestkeyandscoring instructions. 10. Arrangementsmadeforclosingsession. 11. Trainingcompletioncertificatepreparedforeachparticipant(ifused). 12. Plansforfollowupvisitsfinalized.
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4. PREPARINGTHECLINICALINSTRUCTOR
Aninpatientinstructorwhohasnotyetbeenpreparedforconductedinpatientclinicalpractice 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 conductedinpatientsessionsinapreviousIMCIcourseorhasbeenaparticipantorfacilitatorin 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 withtheroleofaninpatientinstructor.However,ifhehasnotyetactedasaclinicalinstructor, hemustadapttothemethodofselectingandreviewingcasespresentedinthe Guideforclinical practice. As the training director, you are responsible for supervision of the inpatient instructor. Preparationoftheinpatientinstructorshouldincludethefollowingsteps: 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 notbeconductedduringfacilitatortraining,onlyduringthecourse.) Theinpatientinstructorshoulddiscusshisresponsibilitiesandanyquestionswithyou, sothatyoubothunderstandandagreewhathewilldo. Withassistancefromyouasneeded,theinpatientinstructorshouldobtainthenecessary permissionsandsupplies. Heshouldmeetandbriefthestaffintheinpatientward. He should find out the ward routine and layout, so that he can select children in the morningandconductthesessionsefficientlyandalsowithoutdisruptingtheward. He shouldbeginworkingwiththeclinicalassistantneedediftheinpatientinstructoris notonthestaffofthefacility,topreparetheassistantforhistasks. At some time before the training begins, he should go early inthe morning to practice working with the clinical assistant to select at least 6 children and prepare recording formsforaclinicalsession.Heshouldthenshowyou,theselectedcasesandrecording forms and work out any problems encountered during the practice. The inpatient instructor should also do a practice demonstration for you using one of the selected children. Refertothe Guideforclinicalpracticefordetailsonhowtheinpatientinstructorshould preparehimselfandtheinpatientward.Gooverthelistwiththeinpatientinstructorto besurethateverythingisready,andmakearrangementsforanyremainingitems. Ifyouexpecttheinpatientinstructortocollectdataonthecasesandtheperformanceof participantsduringthetraining,discussthatwithhim.Ensurethatheunderstandshow tocompletethechecklistformonitoringinpatientsessions(SeeAnnex5ofthe Guidefor clinicalpracticeforinstructionsforcompletingthechecklist.
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5. TRAININGFACILITATORS
5.1 INTRODUCTION
This3dayICATTfacilitatortrainingwasdesignedforfacilitatorswhohavealreadybeentrained inthefacilitationofstandardIMCIcourseswithprintedmoduleswhoarenotyetfamiliarwith ICATT. ICATTfacilitatortraineesmusthavereasonablecomputerskillstolearnandteachusingICATT easilyroutineuseofMSWordissufficient. TheobjectivesofICATTfacilitatortrainingare: LearninghowtouseICATTandgettingfamiliarwiththewayhowIMCIispresented inICATT. LearningfacilitatortechniquesusedinanICATTbasedIMCItrainingandpracticing relevantfacilitator techniquesusedinastandardIMCIcourse(including techniques usedinclinicalpracticesessions). Getting informed about the organization of the training and facilitator responsibilities.
5.2
GENERALSTRUCTURE
This 3day ICATT facilitator training is recommended before the participant training. As the trainingdirector,youareresponsibleforconductingthefacilitatortraining.Forasmallgroupof ICATTfacilitatortrainees(upto45)youcanconductthetrainingyourself.Foralargergroup, you should be assisted by an experienced facilitator familiar with ICATT. As the training is intensive,itisveryhelpfultohavetwopeopleworktogether.Byworkingtogether,youcanalso demonstratehowcofacilitatorssharetheworkduringtheactualICATTtraining. The agenda of the ICATT facilitator training is suitable for all training configurations. The objectivesoftheICATTfacilitatortrainingandthescheduleremainthesameinpreparationfor 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 configurationsinchapter GeneralconsiderationsforplanningandorganizinganICATTbasedIMCI training of this guide), therefore different facilitator techniques need to be emphasised in preparation of facilitators for different training configurations. After completing the 3day facilitator training, the ICATT facilitators will be able to conduct any type of ICATT based trainingonlyafterashortbriefing. One computer with ICATT training player must be available for each facilitator trainee during thewholefacilitatortraining(exceptfortheclinicalsession).Alsoeachfacilitatormusthavean unrestrictedaccesstoacomputerwithICATTtrainingplayerduringthewholetraining. Facilitator training for conducting ICATT based IMCI trainings is extremely important. During theICATTfacilitatortrainingthefacilitatorsmustlearnhowtoworkwithICATT,howtheIMCI materialsareorganizedinICATTandhowtoconductthetraining.Welltrainedandsupportive facilitatorsusingICATTwithconfidencearenecessaryforthesuccessoftheICATTbasedIMCI training. ICATTfacilitatortraineeswillworkquicklythroughICATT;taketurnsinpresentingthecontent ofICATTtrainingunitsandinpracticingtheteachingactivitiesdescribedintheFacilitatorguide fortheparticulartrainingconfigurationthattheywillconduct.
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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 preparationofICATTfacilitatorstoconductclinicalpracticesessionsislimitedtoonehalfofthe third day of training and focuses on refreshing the techniques used for conducting clinical sessionsandobtaininginformationontheorganizationofclinicalsessionsinthe ICATTbased IMCItrainingthatwillfollow. FourmethodswillbeusedintheICATTfacilitatortraining: 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 PRACTISEandTESTpartexercises,provideassistancewithICATTsoftwareandrespond toquestionsconcerningtheICATTIMCIcontent. AnICATTfacilitatortraineeactsasafacilitatorspeakingtoagroupofparticipants.The trainee is practicing teaching the navigation in ICATT, delivering interactive presentation,presentingthecontentofICATTtrainingunitREADandSEEparts,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 teachingactivitiesfortheothersinthegroup. 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 distance learning) will be conducted in these trainings the ICATT content will not be presentedbyafacilitatorexceptforchaptersintheICATTcomponentINTRODUCTION). Onetraineeactsasatrainingparticipantandanotheroneactsasafacilitatorproviding assistanceandrespondingtoquestions.TheICATTfacilitatortraineeisbothpracticing and demonstrating these activities. He or she asks questions to ensure that the "participant"understandstheitem. Atraineeactsas a facilitatorwhois supervising clinicalpractice.Heidentifiespatients who have relevant signs for the day's objectives, demonstrates a clinical skill to other facilitatortrainees,assignspatients,observesothertraineesastheymanagethepatients, givesfeedbackasnecessary,completesaChecklistformonitoringoutpatientsessions,or summarizesthesessioninadiscussion.
At appropriate points during facilitator training, you will introduce the facilitator techniques describedin Facilitatorguideeitherinchapter Facilitatortechniquesorintheinstructionsfora 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, everytraineeshouldhavepracticedeachteachingtechnique.
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5.3 DAILYSCHEDULE The 3day facilitator training schedule will focus on getting familiar with ICATT software and contentandonteachingskillstobeusedintheclassroom.Thefirsttwodayswillbespentinthe classroomlearninghowtoworkwiththeICATTsoftware,reviewingtheICATTcomponent Care ofchildaged2monthsupto5years,andlearningtechniquesforconductingthetraining.Thelast day will be divided between clinical practice and classroom work. In the morning, the ICATT facilitatortraineeswillvisitoutpatientclinic,wheretheywillrefreshtheirskillshowtoconduct clinicalpractice.Intheafternoon,theywillreviewtheCareofyounginfantagedupto2months.
Asuggestedscheduleforfacilitatortrainingisprovidedinthenextsection.Thisschedulecanbe usedtomakemoreprecisescheduleincludingspecificdatesandtimesonceyouknowthem. FromtimetotimeyouwillneedtoremindICATTfacilitatortraineesfromtimetotimethatthe participanttrainingwill notbeconductedthewayfacilitatortrainingisconducted.Thetraining 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 everyoneunderstandshowtheactualtrainingwilldiffer. 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 participantswithoutpriorknowledgeofIMCI.ItisnotpossibletoworkthroughthefullICATT 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 completevarioustypesofexercises.Forthisreasonashortperiod(about1week)betweenthe facilitator and participant trainings is recommended. Facilitators should use this period for gettingmorecomfortablewiththeICATTsoftwareandcontent. The schedule should be flexible. It suggests assigning tasks for homework (if trainees have accesstocomputersintheevening)anditalsoprovidestimetopreparethetasksduringtheday (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 participantprogressandsolvingissuesinalimitedperiodoftimeandwaysofcommunications betweenfacilitatorparticipantencountersneedtobegivensufficienttimefordistancelearning 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 individuallythroughICATT(dotheexercises,runvideosetc.)
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5.4
SUGGESTEDSCHEDULEFORFACILITATORTRAINING
DAY1 Time (minutes) 30 30 20 10
Activity Opening,welcome,introductions Presentation:IMCIstrategytoimprovehealthandoverviewofIMCI implementationinthecountry Presentation:ICATTasatrainingtool Objectivesandorganizationofthefacilitatortraining
Descriptionofthetrainingstructureandintroductiontotrainingsupportmaterials 30 Interactivepresentation:ICATTHowtostartandindividualpracticeinICATT navigation PresentationfromICATT:IMCIcasemanagementprocess InteractivepresentationfromICATTanddemonstration:IMCIcasemanagement charts(chartbooklet)andrecordingforms 90 10 30
ReviewofICATTComponentCAREOFCHILDAGED2MONTHSTO5YEARS,Part1: 180 Assessandclassifythesickchild(ContinueDay2) Assigntasksforthenextday Total 10 7:20hrs
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DAY2 Activity Time (minutes)
ReviewofICATTComponentCAREOFCHILDAGED2MONTHSTO5YEARS,Part1: 60 Assessandclassifythesickchild(Finish) IndividualworkinICATTpreparationoftasksassignedonDay1(ifnotdoneas homework) Practicingfacilitatortechnique:Deliveringinteractivepresentation:ICATTHow tostart,part:RunICATT,ICATTmenu,READ,SEE,PRACTISEandTESTparts Demonstrationandindividualpractice:ProgressmonitoringtoolsinICATT, transferofStudentprofile,runorinstallICATTfromaDVD 60 15 60
30 Practicingfacilitatortechniques:InteractivepresentationfromICATTand demonstration:IMCIcasemanagementcharts(chartbooklet)andrecordingforms. Workingwithacofacilitator ReviewofICATTComponentCAREOFCHILDAGED2MONTHSTO5YEARSPart2 5 Practicingfacilitatortechniques:Leadadrill Practicingfacilitatortechniques:Conductaroleplay Assigntasksforthenextday Total DAY3 Introductiontoclinicalpractice Outpatientclinicalsession:Clinicaldemonstrations Outpatientclinicalsession:Assigningpatientsandmonitoringclinicalpractice 30 90 90 180 20 30 10 7:45hrs
ReviewoftheICATTComponentCAREOFYOUNGINFANT AGEDUPTO2MONTHS 180 Practicalarrangementsforthetrainingandclosingremarks Total 60 7:30hrs
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5.5
CONDUCTINGACTIVITIES
5.5.1 DAY1
Openingsession WelcometheICATTfacilitatortrainees. 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 informationaboutthemselves. Make any necessary announcements regarding meals, transportation, payments, hotel regulations,etc. Presentation: IMCI strategy to improve health and overview of IMCI implementation in thecountry GivethepresentationIMCIstrategytoimprovehealththatcanbe foundinTraining 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:ICATTasatrainingtool Open the ICATT training player and introduce briefly its content. Show an example of eachitemasyoudescribeit.Mentionthefollowing: 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, Counselthemother,andFollowup.ThecomponentCAREOFYOUNGINFANTAGEDUP TO2MONTHSincludesparts:Essentialcareforeveryyounginfant,Assessandclassify younginfant,Identifytreatmentforyounginfant,treatandcounsel,andFollowup.Each partincludesoneormoretrainingunitssimilartochaptersoftheprintedmodules.Each trainingunitincludesREAD,SEE,PRACTISEandTESTparts.IntheREADpart,thereisa 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 includesmanyphotographsandallvideosfromthestandardIMCIcourseandadditional 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 differentway. IMPORTANT:Assurethefacilitatortrainees,thatastheyarefamiliarwiththestandard IMCI course, they will get familiar with the ICATT training player very quickly even if thereisnotimetoworkthroughitindetailduringthisfacilitatortraining.
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Objectivesandorganizationofthefacilitatortraining AllICATTfacilitatortraineesshouldhavealreadybeentrainedasIMCIfacilitators.They should have already learned the IMCI training content, developed clinical skills in managing children using the integrated case management process, and developed facilitatingskillstoteachastandardIMCIcourse. 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 techniquesusedinthetraining,howthetrainingwillbeorganized,andwhatwillbethe facilitatorsresponsibilities. Describe the organization of the facilitator training using the information in sections GeneralstructureandDailyscheduleofchapterTrainingoffacilitatorsinthisguide. Descriptionofthetrainingstructureandintroductiontotrainingsupportmaterials Describethestructureofthetrainingaccordingtothetrainingconfigurationthatwillbe conductedaftertheICATTfacilitatortrainingreferringtotheDirectorguide. Distributeandbrieflydescribeprintedmaterialsforfacilitatorsthatwillbeusedduring theICATTbasedtraining: QuickreferenceforICATTtrainingplayerorICATTnavigationminimum(optional) Facilitator guide adapted for the training configuration that will follow the facilitatortraining IMCIchartbooklet Participantworkbook(forDistancelearningtrainingonly) CaserecordingformManagementofthesickchildaged2monthsupto5years CaserecordingformManagementofthesickyounginfantagedupto2months Othertrainingaidsiftheywillbeused(Adecisionisneededduringtheplanning phase).
AskthetraineestoopentheFacilitatorguideandreviewtheGeneralpart. ReviewthespecificpartofFacilitatorguide: Individual computer use and LCD projected trainings tasks of a facilitator, facilitator techniques, and guidelines for each ICATT component: list of activities, notes for conductingtheactivities.Explaintothetraineesthat,astheICATTprovidesinstructions 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 describedintheICATT. DLtrainingtrainingcalendar,schedulesandnotesforconductingactivitiesduringthe encounters. Interactivepresentation:ICATTHowtostartandindividualpracticeinICATTnavigation Conduct the activity as described in the Facilitator guide in Guidelines for INTRODUCTION.
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At the end of this activity assure the trainees that by the end of the facilitator training theywillbeabletonavigatethroughICATTwithconfidence. PresentationfromICATTcomponentINTRODUCTION:IMCIcasemanagementprocess Explain to the trainees that you will conduct this activity in the same way as it will be doneduringthetraining. 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. Answertheirquestions. Interactive presentation from ICATT component INTRODUCTION and demonstration: IMCIcasemanagementcharts(chartbooklet)andrecordingforms Conduct 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 doneduringthetraining. Ask the facilitator trainees if they have any questions about what they read or heard. Answertheirquestions. Review of ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS, Part 1: Assess andclassifythesickchild ShowtraineesthemenuoftheICATTcomponentINTRODUCTION.Tellthemthatinthe form of presentations you have worked with them through all chapters of this componentexceptchapter Additionalinformationonmajorcausesofchildhoodillnessand death,andontheIMCIstrategy.Thischapterisoptionalanditisnotapartofthetraining. TheymayreturntothecomponentIntroductionindividuallylater. NowtheyarereadytostartwithICATTComponentCAREOFCHILDAGED2MONTHSTO 5YEARS,Part1:Assessandclassifythesickchild. Explainthatduringthefacilitatortrainingtherewillnotbeenoughtimetoworkthrough thecompleteICATTcontent. Fortrainingwithindividualcomputers:Youwillworktogetherwiththetrainees through the training units very quickly to show how the IMCI content is organizedinICATTandhowtoworkwiththesoftware. 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 ICATTcontent.Thenyouwillgowiththetraineesthroughtheremainingtraining unitsveryquicklyjusttoshowthemhowtheIMCIcontentisorganizedinICATT. For anytrainingconfiguration: Thereis noneedtorunall videosorenlarge all picturestheICATTfacilitatortraineesalreadyknowthosethatareincludedin thestandardIMCItraining.Justmakesurethatthetraineesknowhowtoruna
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video or enlarge a picture. It is useful to run all flash movies as they are a new IMCIteachingmaterial. You will now demonstrate the first two training units, and then the trainees will take turnstodemonstratetothegroupthefollowingtrainingunits. PresenttrainingunitAskthemotheraboutchildsproblem: Brieflysummarizetheintroductorypage,openandreadtheLearningobjectives. READpart:SummarizeverybrieflytheKeyinformation.Showandtalkthrough theExamplerecordingformscreen.ShowtheFurtherreadingscreenandexplain that there is no need to read the annotation of materials linked to the Further readingscreen.Thesematerialsareoptionalparticipantsmayreadthemonlyif theywishtodosoandhavetimeforit. SEEpart:onlyshowdonotrunthevideosandpicturesthatarethere. PRACTISE and TEST part: only show the screens and tell participants that you willdosomeexercisesinthenexttrainingunit.
PresenttrainingunitCheckforgeneraldangersigns: Fortrainingwithindividualcomputers:Presenttheunitverybriefly. For training with LCD projector: Work through the training unit as you want the facilitatortraineestodoitintheparticipanttraining. Whenpresentingthetrainingunit,followthesesteps: Briefly summarize the introductory page. Open the link to chart booklet and pointoutthatthelinkSeeIMCIchartleadstotherelevantpartofeachtraining unit.ShowandreadtheLearningobjectives. READ part: Summarize the Key information. Show the Example recording form screen.ShowtheFurtherreadingscreen. SEEpart:Showonlydonotrunthevideosandpicturesthatarethere. PRACTISEpart:DoExercise2asanexampleofdualquestionexercise.Pointout that the participant get feedback (correct answer) for PRACTISE exercises immediately. TESTpart: Dothe exercise(dualquestions).Pointoutthattheparticipantdoes not get the feedback (correct answer) immediately. Demonstrate how the answersofTESTexercisesareevaluatedintheProgressbar: o There is one square for each training unit. Only TEST exercises are evaluatedintheProgressbar.Awhitesquaremeansthattheexercisehas notbeenbegun;agreensquaremeanspassed(atleast80%ofcorrect answers);ayellowsquareshowswhentheexercisehasbeenbegunAND thatparticulartrainingunitisopen;aredsquaremeansfailed.
TelltheparticipantsthatnowtheywillpresenttheREADandSEEpartsofthefollowing training units and do one exercise in the same way as you presented the training unit Generaldangersigns.
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Assigntheremainingtrainingunitsin Part1:Assessandclassifychildlistedbelowtothe participants and give them one hour to prepare individually to present the assigned trainingunits.Provideassistanceasneeded. Whentheparticipantsareready,askthemtopresentthetrainingunitsonebyoneinthe sameorderastheyappearintheTrainingplayer. 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 contentofallpartsofthetrainingunitanddooneexercise.Inadditiontogetting familiarwiththeIMCIcontentorganizationinICATT,thiswillprovidethetrainee presenting the unit a practice in navigation in ICATT while other trainees will benefitfromgoingthroughthenavigationstepsrepeatedly.Donotfocusonhow the trainee summarizes the training unit content he or she will not do this duringthetraining. 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 orsheshouldonlySHOWthecontentoftheunit. Fortraining withLCDprojector: Thetraineesshouldpracticeworkingthrough the training units in the same way as they will do it in the participant training. Askthetraineestoreadfacilitatortechniques TeachingtheinformationinICATT, Demonstratingaudiovisualmaterials,and Conductingexercisesin Facilitatorguide andfollowtheinstructionswhenpresentingtheirassignedtrainingunit. NOTE:AsthetraineesarefamiliarwithIMCI,theytendtogivelongpresentations.If this happens, interrupt the trainee and remind him or her that he or she should summarizethecontentofREADpartwherepossible.
Leadashortdiscussionaboutthetraineesperformanceafterthepresentation.Focuson howthecontentwaspresented.Moretimetopresenteachtrainingunitisneededthan fortrainingwithindividualcomputers. Assignandworkthroughthefollowingtrainingunits: _______________Assesscoughordifficultybreathing,PRATISEpartExercise6(number,one ofmany,dualquestions) _______________Assessdiarrhoea,PRATISEpartExercise5video. 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.TellthemthatseveralexercisesinICATTinstructtheparticipantto complete aprintedrecordingform(Informationaboutwhichexercisesthesearecanbefound 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 formswill be used. After the exercise is done,checkifthetraineeshavecompletedtheformscorrectly. _______________Assessfever,TESTexerciseClassifyfever(oneofmany,severalofmany) _______________Assessearproblem,TESTexercise
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_______________ Check for malnutrition and anaemia, PRACTISE Exercise 5 use growth chart _______________Checkimmunization,vitaminAanddewormingstatus,TESTexercise Present very briefly training unit Assess other problems & review of assess and classify yourself (As described above for training unit Ask the mother about childs problem). Tell the trainees that in this training unit, there are a large number of exercises.Inaclassroombasedtraining,theremaynotbeenoughtimetoworkthrough theseexercises. Assigntasksforthenextday AssignICATTfacilitatortrainees: _______________ Interactive presentation: ICATT How to start, part: Run ICATT, ICATT menu,READ,SEE,PRACTISEandTESTparts _______________InteractivepresentationIMCIcasemanagementchartsandrecordingforms: partaboutIMCIcasemanagementcharts _______________ Interactive presentationIMCIcasemanagementchartsandrecordingforms partaboutrecordingforms Askforonevolunteertoserveasacofacilitatorforeachfacilitator. This will be repetitive, because you delivered the presentations during the first day of trainingbutitisimportanttopracticeteachingtechniquesandalsotheICATTfacilitator traineeswillbenefitfromgoingthroughtheseactivitiesagain. AlsoassigndemonstratingtrainingunitsinICATTComponentCAREOFCHILDAGED2 MONTHSTO5YEARSPart25 Part2:Identifytreatment _______________Identifytreatment,PRACTISEExercise2 Part3:Treat _______________SelectionoforaldrugPRACTISEExercise1 NOTE:Makesurethatalltraineesknowhowtoinsertnumbersintheanswers. _______________Teachingmothertogiveoraldrugsandtreatlocalinfectionsathome,TEST exercise _______________Givetreatmentsandimmunizethechildattheclinic,TESTexercise
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_______________ Give extra fluid for diarrhoea and continue feeding PRACTISE exercises 1 and2 NOTE:Makesurethattraineesknowhowtoinserttheamountsoffluids. Part4:Counselthemother _______________Assessfeedingandmakerecommendations.TESTexercise _______________Usegoodcommunicationskills,TESTexercise Part:5Followup _______________Followup Coordinating role play: Teaching a mother to give oral drugs Dasar (Annex 4 of the Facilitatorguide). _______________Facilitator _______________Healthworker _______________Mother
5.5.2 DAY2
Review of ICATT Component CARE OF CHILD AGED 2 MONTHS TO 5 YEARS, Part 1 Assess andclassifythesickchild(Finish) Ask participants to present remaining training units in ICATT Component CARE OF CHILDAGED2MONTHSTO5YEARS,Part1Assessandclassifythesickchild IndividualworkinICATTpreparationoftasksassignedonDay1 TraineesworkindividuallyinICATT.Iftheyhavenothadthepossibilitytopreparethe tasksassignedyesterdayintheevening(nocomputers),theypreparethemnow.Provide assistanceasneeded. Practicingfacilitatortechniques:Interactivepresentation:ICATTHowtostart,part:Run ICATT,ICATTmenu,READ,SEE,PRACTISEandTESTparts;workingwithacofacilitator AskthetraineestodeliverthepresentationsassignedtothemonDay1.Asktheassigned facilitator trainees to serve as cofacilitators. Provide constructive feedback after the presentation. Answeranyquestionsthatthetraineesmayhave. Demonstration and individual practice: Progress monitoring tools in ICATT, transfer of Studentprofile,installingICATTandrunningitfromDVD TraineeshavealreadylearnedabouttheProgressbar.
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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 howtoopenit. Demonstrate the Clinical practice sheet recording of cases seen. Discuss whether the participantswillusethisformforrecordingcasesseen. 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 participantswillnotdoit. For DL training: Explain how to check the participants progress and provide feedback duringFacilitatorparticipantencounters(seeFacilitatorguide). DemonstrateandpracticeinstallingICATTandrunningitfromDVD. Practicing facilitator techniques: Delivering interactive presentation from ICATT and demonstration: IMCI case management charts (chart booklet) and recording forms; workingwithacofacilitator Ask the trainees to deliver the presentations assigned to them on day One. Ask the assigned facilitator trainees to serve as cofacilitators. Provide constructive feedback aftereachpresentation. ReviewofICATTComponentCAREOFCHILDAGED2MONTHSTO5YEARSPart25 AskparticipantstopresenttheassignedtrainingunitsonebyoneusingLCDprojection: technical content and ICATT features. Provide constructive feedback after the presentation. Answeranyquestionsthatthetraineesmayhave. Practisingfacilitatortechniques:Leadadrill Practiseleadingadrillanytimeduringthedaybeforeorafterabreakorwhentrainees needabreakfromworkwithICATT. Telltraineesthatnowtheywillpracticeleadinganoraldrill.Remindthemthatcertain skillsneedalotofpractice.Oraldrillshelptodeveloptheseskills. Ask trainees to open their Facilitator guide at page Facilitator techniques: Lead a drill. Referringtoitremindtraineeshowtoleadanoraldrill. AsktraineestofindthedrillReviewinformationontheASSESSandCLASSIFYchartinthe Annex2ofthe Facilitatorguide.Beginthedrill.Then,afterthepaceofthedrillisset,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 comfortablewiththeprocess?Weretherewaysthatthedrillcouldhavebeenimproved? Remind trainees that they have some flexibility in when to lead a drill during the training.Theymayleadadrillwhenitismentionedintheschedule,ortheymayleadit
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whenparticipantsneedabreakfromworkinICATT.Theymaydoadrillafterateabreak orlunch,asawaytofocusthegroup'sattention.However,theyshouldnotforgettodo thedrillsometimeduringtheday. Practisingfacilitatortechniques:Coordinatearoleplay Practise coordinating a role play any time during the day before or after a break or whentraineesneedabreakfromworkwithICATT. Telltraineesthatnowtheywillpracticecoordinatingaroleplay.Remindthemthatrole playsareespeciallyusefulforpractisingcommunicationskills,andsoareusedoftento practise instructing the mother on continuing treatment at home, and to practice counsellingthemother. 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 questions.Alsoreviewthefollowingpoints: Role plays will not (and should not) be perfectly prepared and rehearsed performances.Thepointofroleplaysistopracticedealingwithnewlyacquired information about the child, or unexpected but realistic characteristics of the mother. Theperson playingtheroleofthehealthworker shouldnot betoldin advance any more information than is provided in the Facilitator guide; however, this personshouldbeencouragedtoreviewtherelevantsectionsofthemanagement charts,orthecommunicationskillstobeused.Thefacilitatorshouldbesurethat the health worker understands the purpose of the role play and the steps or pointstocover. The person playing the role of the mother should behave realistically, incorporatinganybackgroundinformationgiventoheraboutherrole.Shemay make up additional information if necessary, as long as it is realistic and consistentwiththebackgroundinformation. Itisimportanttolookaheadinthe Facilitatorguidetoseewhenroleplayswill occurandprepareforthem.Someroleplaysrequiresuppliessuchasdrugsora baby doll. These supplies will be listed in the instructions for the role play. Explainwherethesesuppliesarelocatednowandthatmostofthesupplieswill befurnishedinthetrainingroomduringthetraining.
Have facilitator trainees practice the role play Teaching a mother to give oral drugs Dasar(Annex4oftheFacilitatorguide)forwhichtheroleswereassignedyesterday. Assigntasksforthenextday Assign demonstrating training units in ICATT Component CARE OF YOUNG INFANT AGEDUPTO2MONTHStotrainees Part1:Essentialcareforeveryyounginfant _______________Essentialcareforeveryyounginfant
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Part2:Assessandclassifyyounginfant _______________Checkyounginfantforveryseverediseaseandlocalbacterialinfection _______________Checkyounginfantforjaundice _______________Assessyounginfantfordiarrhoea _______________Checkyounginfantforfeedingproblemorlowweight _______________Checkimmunizationandassessotherproblemsoftheyounginfant Part3:Identifytreatmentforyounginfant,treatandcounsel _______________Identifytreatmentforyounginfant,treatandcounsel Part4:Followuptheyounginfant _______________Followuptheyounginfant
5.5.3 DAY3
Introductiontoclinicalpractice 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 areto: LearnhowtheclinicalsessionswillbeorganizedintheICATTbasedIMCItraining, and Refreshthetechniquesusedforconductingclinicalsessions.
Distributethe Guideforclinicalpractice(ThismaybetheICATTguideadaptedaccordingto 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 clinicalpracticeinchapter GeneralconsiderationsforplanningandorganizinganICATTbased IMCItrainingofthisguide.).TheseinstructionsrefertotheICATT Guideforclinicalpractice. Ifyouwilluseyourownguide,youneedtoadjusttheinstructionsaccordingly. Review the guide and explain to the facilitator trainees how the clinical practice will be conductedduringtheparticipanttraining. 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 thetrainingandfacilitatortraineesinformedaccordingly(SeesectionPlanforclinicalpractice inchapter GeneralconsiderationsforplanningandorganizinganICATTbasedIMCItrainingof thisguide). Explain to the participants how the clinical practice will be conducted in this facilitator training. Outpatientclinicalsession:Clinicaldemonstrations
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On arrival at the clinic, make the proper introductions and become oriented to the clinic's routine.Discusswiththeclinicstaffthetypesofchildrenyouwillwanttoseethroughoutthe morning. FacilitatorTechniques:Clinicaldemonstrations Ask the facilitator trainees to open the Guide for clinical practice to the Outpatient session Child1: Check for danger signs assess and classify cough and difficult breathing (or its equivalentinyournationalguide).Selectchildrenwithcoughordifficultbreathingandany childwithageneraldangersign.Letthegroupseehowyouselectthechildren.Remindthem thatselectingthechildrenfordemonstrationsandforpracticewillbeanimportantpartof theirjobasafacilitator. Followingtheguidelinesinthe Guideforclinicalpractice,dothedemonstrationofchecking for danger signs and assessing and classifying for cough and difficult breathing, identify treatmentandcounselthemotherasappropriate.Actasthoughyouareafacilitatordoing thedemonstrationforparticipantsinthetraining. After your demonstration, review the following guidelines with facilitators before they do theirassigneddemonstrations: UsetheinstructionsintheGuideforclinicalpractice. Statetheobjectivesofthedemonstration;thatis,describewhatyouaregoingtodo andthesectionsoftheIMCIchartsthatyouaregoingtouse. Standwhereeveryonecanseetheprocedureclearly. Demonstratetheentirecorrectprocedure(noshortcuts). Describethestepsaloudasyoudothem. Encourage observers to ask questions; ask them questions to check their understanding. Projectyourvoicesoallcanhear;makeeyecontactwhenspeaking. Whenshowingvisualaids(suchassectionsofthechart),ensurethatallcansee.
Practiceofclinicaldemonstrations Assigneachtrainee(orapairoftrainees)oneofthedemonstrationslistedbelow.Tellthem thattheyshouldselectchildrenfordemonstrationswhoarelikelytohaverelevantsigns.For example, if they will demonstrate how to assess and classify diarrhoea, they should find a childwithdiarrhoea. One by one, have each trainee (or a pair of trainees) select a suitable child and do the assigneddemonstrationinfrontofthegroup.(Remindthemtostartatthebeginningofthe Assessandclassifychartandgothroughtheassignedstep.) It will not be possible conduct all demonstrations in the time allocated to this session and alsotheremaynotbepatientssuitableforalldemonstrationsdoasmanydemonstrations astimeallowswiththosepatientsthatareavailable. 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 shouldtaketimetoshowthosesigns.
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_______________ Demonstrate how to assess and classify diarrhoea, identify treatment and counselthemotherasappropriate. _______________Demonstratehowtoassessandclassifyfever,identifytreatmentandcounsel themotherasappropriate. _______________ Demonstrate how to assess and classify ear problem, identify treatment and counselthemotherasappropriate. _______________ Demonstrate how to check for malnutrition and anaemia, use the weight for agechart,identifytreatmentandcounselthemotherasappropriate. _______________Assessbreastfeedingandcounselthemother. Forthisdemonstration,selectaninfantage1weekupto2months.Lookfora breastfeeding mother who may need help. Have the assigned facilitator traineesdothedemonstrationofassessingbreastfeedingandcounsellingthe mother about correct positioning and attachment according to the YOUNG INFANTchart. Duringeachclinicaldemonstration,thegroupshouldobserveandusetheirrecordingforms. After each demonstration, have the group give feedback. If the child needs treatment, wait andgivefeedbacktothetraineesafterthechildisreturnedtotheclinic'scare,sothatyoudo notdelaythechild'sreceivingtreatment. Asktraineestokeeptheirrecordingformstousewhentheyreturntotheclassroom.When theyreturn,showthemtheenlargedGroupchecklistofclinicalsigns.Havethemwritetheir 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 specialcaretopointoutthosesignswhenanappropriatechildpresents. Outpatientclinicalsession:Assigningpatientsandmonitoringclinicalpractice 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. Facilitatortechniques:Assigningpatientstoparticipants 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. Duringtheparticipanttraining,facilitatorswillneedtoworkwithclinicstafftoidentify appropriate children. Sometimes there may not be enough suitable patients. In such cases,participantsmayhavetogrouptogethertoworkwiththeavailablepatients. Facilitators should ensure that each training participant sees as many signs on the ASSESS&CLASSIFYchartaspossible.BylookingattheGroupchecklistofclinicalsigns
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each day, facilitators can see which participants have not seen certain signs and try to assignthempatientswiththosesigns. Wheneveraparticipanthasfinishedwithapatient,afacilitatorshouldgivefeedbackand quicklyfindhimanotherpatienttosee.Itisimportanttokeepparticipantsbusy.Ifthere are few patients to see, facilitators can conduct a drill or a demonstration until more patientsarrive. Facilitatortechniques:Monitoringclinicalpractice Reviewthefollowingwaystomonitorclinicalpractice: 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 participantmakeamistake,askhimtolookortryagain.Iftheparticipantcannotcorrect 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.Commentonthingsdonewellandonthingsthatneedimprovement. 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,andclassifications(and,laterinthetraining,thetreatmentplan).Discussthecase andverifytheassessmentandclassification.Iftreatmenthasbeenspecified,verifythatit iscorrect. 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. Emphasizethefollowingpoints: Teachinghaspriorityovercompletionofthemonitoringchecklist.Ifyouarevery 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,referringtotheparticipants'recordingformsasneeded.Casesmanagedby eachparticipantwillbecountedattheendofthetraining,sobesuretorecord eachcasemanaged,evenifyoudonotobservetheentireprocess. Sinceparticipantsarelearningthisprocess,someerrorsareexpected.Ifyoufind noerrorsonthechecklists,youmaynotbepayingcloseattention,oryoumaybe dismissing all problems as minor. On the other hand, do not be overly critical, findingfaultwiththeparticipant'sworkoneverystepofeverycase.
Practiceassigningpatientsandmonitoring Select one facilitator trainee to help assign patients to the others. This person should selectpatientswhomayhavefastbreathing,fever,anearproblem,ordiarrhoea.
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Dividetheremainingtraineesintogroupsoftwoorthree.Onepersonineachgroupwill 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 howtogiveanoraldrugathome.The"facilitator"shouldusetheMonitoringChecklist and give feedback. If there is a third person in the group, that person will also use the MonitoringChecklistandcompareresults. After awhile, ask a different trainee to help with assigning patients. Try to let each traineehaveaturnwiththistask. Remind trainees to keep their recording forms so that they may complete the Group checklistofclinicalsignswhentheyreturntotheclassroom. ReviewoftheICATTComponentCAREOFYOUNGINFANTAGEDUPTO2MONTHS AskparticipantstopresentthetrainingunitsonebyoneusingLCDprojection:technical contentandICATTfeatures. Practicalarrangementsforthetraining 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: Discusshowthefacilitatorswilldividetheworkforthefirstsessions. Announcetheclinicwhereeachsmallgroupwilldooutpatientclinicalpractice. 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 withthem. Givefacilitatorsthewrittenscheduleforthetrainingandthescheduleforvisits to the inpatient ward and the outpatient clinics. Explain when and where participantswillmeetfortransportationtotheclinicalsessions. Inform facilitators that lists of the participants will be prepared on the first morningassoonasparticipantshaveregistered.Facilitatorswillbegivenacopy oftheregistrationformforeachparticipant. Tellfacilitatorswhenandwheretheycanobtainthetrainingmaterials,orwhen thematerialswillbedeliveredtotheclassroom/computerlaboratorywherethe participant training will be conducted and whom to contact if they need extra suppliesormaterialsduringthetraining. Askfacilitatorstoplantimebeforethetrainingtogototheclassroom/computer laboratoryand: o arrangethetables,chairs,andmaterials, o makesurethatICATTisinstalledandrunsonallcomputersthatwillbe used, o makesurethattheLCDprojectorworks,thatthereisascreentoproject onandtheprojectioncanbeseenwell(curtainsmaybeneeded),and o putchartsonthewalls(ifused).
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Tellfacilitatorswhomtocontactiftheyneedhelpwithcomputers.
Closingremarkstofacilitators BrieflyreviewthemajortasksofafacilitatorasdescribedintheFacilitatorguide. Tellfacilitatorswhenthefacilitatormeetingswillbeheld(attheendofeachtrainingday in classroom trainings, after each facilitator participant encounter in a distance learningtraining).Explaintheobjectivesofthesebriefmeetings,whichare: Toassessprogressmadeandidentifyanyproblems.Toagreeonactionstosolve each problem. The checklists for monitoring outpatient sessions can be used to helpreportprogressandproblemsinclinicalpractice. To provide opportunity to meet with the inpatient instructor, who also has feedbackonyourparticipants. Todiscusstechniqueswhichsomefacilitatorsfoundusefulandcanrecommend toothers, Toprepareforthenextday(forexample,toreviewpointstobeemphasized,plan activitiesforclinicalsessions,discussanymodificationswhichmaybeneededin thescheduleorlocationsforclinicalpractice),and Tomakeanynecessaryadministrativeannouncements.
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,orotherideasrelatedtothetraining).Askfacilitatorstosuggestways,times,and placesthatsuchinformaldiscussionscouldtakeplace. 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 distributetoparticipants. Thankthefacilitatorsfortheirhardwork.
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O RGANIZE ICATT BASED IMCI TRAINING
DIRECTORGUIDESPECIFICPART:
CLASSROOMBASEDTRAININGWITHINDIVIDUAL COMPUTERS

CONTENTS
CLASSROOMBASEDTRAININGWITHINDIVIDUALCOMPUTERS...............................................................1 1. 2. Exampletrainingstructure.............................................................................................................................3 Exampleschedulefor6daytraining...........................................................................................................5
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DirectorguideClassroombasedtrainingwithindividualcomputers
1. EXAMPLETRAININGSTRUCTURE Trainingobjective
Trainhealthprofessionalresponsibleformanagementofsickchildrenagedupto5years inIMCI. Participants Anyhealthprofessionalsresponsibleformanagementsickchildrenagedupto5yearsat primaryhealthcarelevel. Generaltimeframe Thetrainingwillbeconductedfor6fullconsecutivedays. Computertraining EachparticipantwillworkwithICATTindividually(onecomputerwillbeavailablefor oneparticipant)inagroupinacomputerlaboratory,supervisedandassistedbya facilitatorasneeded. EachICATTfacilitatorneedstohaveanunlimitedaccesstoacomputerduringthewhole durationofthetraining. AcompleteICATTtrainingsetadaptedaccordingtothenationalIMCIguidelineswillbe usedforthetraining. ParticipantswillbeexpectedtoworkthroughthewholeICATTtrainingsetexceptthe partsmarkedintheICATTasoptional(AdditionalinformationintheICATTcomponent INTRODUCTIONandFurtherreadingpagesintheREADsectionofeachtrainingunit). Clinicalpractice Fiveinpatientandfouroutpatientclinicalpracticesessionswillbeconducted(No outpatientsessiononSaturday). Clinicalpracticesessionswillbeconductedingroupsofupto8participantsinan outpatientclinicandinpatientward.Moreoutpatientclinicsmaybeneededforthe clinicalpractice. Interactivegroupactivities Twodrills(ReviewinformationontheASSESS&CLASSIFYchartandPractise askingcheckingquestions)andtworoleplaysTeachingamothertogiveoral
drugsDasarandUsinggoodcommunicationskillsandtheentireCOUNSEL chartandMotherscardFelicewillbeincludedintothetraining.
Humanresourcesneeded Onetrainingdirectorisneededtoplan,organize,andcoordinatethetrainingactivities andtotrainfacilitators.Thedirectormayalsoactasoneofthefacilitators.
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Anadditionaloutsidetrainingdirectorisneededifthelocaltrainingdirectorhasnotyet beentrainedinfacilitationofanIMCItrainingusingICATT. Onefacilitatorper10participantsisneededforICATTwork,drillsandroleplays. Onefacilitatorper34participantsisneededfortheoutpatientclinicalpractice(twofor eachgroupof68participants). Oneclinicalinstructorisneededforinpatientclinicalpracticesessions.(Heorshewill conducttheclinicalsessionswithgroupsofupto8participants). ITsupport:ITadministratorinchargeofthecomputersthatwillbeusedinthetraining isneededtoassistwiththeinstallationofICATTtrainingplayeronallcomputersused andtoprovideassistanceduringthetrainingifneeded. Administrativestaff:Onepersonisneededtoassiststhedirectorwithadministrative tasks,logisticsandtoensuresufficientquantityofprintedandothermaterials. Facilitatortraining A3dayfacilitatortrainingwillbeconductedoneweekbeforetheparticipanttraining. Therewillbeoneweekperiodbetweenthefacilitatortrainingandtheparticipant trainingtoprovidethefuturefacilitatorsanopportunitytogetmorecomfortablewith theICATTsoftwareandtheorganizationofitsIMCIcontent. Evaluationofparticipants ParticipantswilltakeastandardICATTwrittenposttestadaptedaccordingtothe nationalIMCIguidelinesonthelastdayoftraining. Followupafterthetraining Followupvisitwillbeconducted46weeksafterthetrainingaccordingtothestandard WHOguidelinesavailableintheICATTlibrary.
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2. EXAMPLESCHEDULEFOR6DAYTRAINING
Anexamplescheduleisprovidedonthenextpages.Thisschedulecanbeusedtomakemore precisescheduleincludingspecificdatesandtimesonceyouknowthetimesforclinicalsessions, transporttoclinicalsessions,andthearrangementsforlunch,teabreaks,etc.(Note:Ifclinic visitswillnotbeheldinthemorning,theschedulewillneedtobeadjusted.) Sinceparticipantswillworkatdifferentpace,thescheduleshouldbeflexible.Approximatetimes requiredforcompletingeachtrainingunitshouldserveasguidancetofacilitatorsinassisting theparticipantstocompleteworkthroughICATTintimelimitedbythecourseduration. Everyday,withtheexceptionofthefirstandlastday,shouldinclude4hoursofclinicalpractice. Clinicalpracticeshouldbescheduledatthetimeofdaywhenmostpatientsarrive,usuallyinthe morning.ThescheduleprovidedassumesthatthecoursewillrunMondaythroughSaturday.As thereusuallyarenooutpatientsonSaturday,only2hoursofinpatientclinicalpracticeare scheduledforSaturday.
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Activity type
Activities Day1
Time (min) 30 15 25 15 15 20 90 40 45 100 85 240 100 25 80 35 240 55 90 80 15
Registration Registrationandadministrativetasks Openingceremony,welcomeandintroductionsofparticipants Presentation:IMCIstrategytoimprovehealthandoverviewofIMCI inthecountry Introductory Objectivesofthetraining,briefoverviewofthetrainingorganization, introductionofICATTtrainingplayer group session PresentationfromICATT:IMCIcasemanagementprocess DemonstrationIMCIcasemanagementcharts(chartbooklet)and recordingforms Interactivepresentation:ICATThowtostart Careofchildaged2monthsupto5years Part1:Assessandclassifythesickchildaged2monthsupto5years Individual Askthemotheraboutthechildsproblems workwith Checkforgeneraldangersigns ICATT Assesscoughordifficultybreathing Assessdiarrhoea Day2 Checkforgeneraldangersigns Clinical Assessandclassifycoughordifficultbreathing practice Assessandclassifydiarrhoea Assessfever Individual Assessearproblem workwith Checkformalnutritionandanaemia ICATT Checkimmunization,vitaminAanddewormingstatus Day3 Clinical practice Assessandclassifyfever Assessandclassifyearproblem Checkformalnutritionandanaemia Assessotherproblemsandreviewofassessandclassify Part2:Identifytreatmentforchild Start:Identifytreatmentforchild Part3:Treatthechild Selectandgiveoraldrug Drill:ReviewinginformationontheASSESSandCLASSIFYchart
Individual workwith ICATT Drill
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Activity type Clinical practice
Activities Day4 Identifytreatmentforchild Teachthemothertogiveoraldrugs Advisemotherwhentoreturnimmediately Part3:Treatthechild Teachthemothertogivetreatmentathome Givetreatmentandimmunizethechildattheclinic Giveextrafluidfordiarrhoeaandcontinuefeeding Part4:Counselthemother Assessfeedingandmakerecommendations Demonstrationroleplay Teachingamothertogiveoraldrugsat homeusinggoodcommunicationskills,Dasar Day5 PlanA:Treatdiarrhoeaathome PlanB:TreatsomedehydrationwithORS PlanC:Treatseveredehydrationquickly Counselthemotheraboutfeedingproblems Usegoodcommunicationskills Part:5Followupthechild Followupthechild Careofyounginfantagedupto2months Part1:Essentialcareforeveryyounginfant Essentialcareforeveryyounginfant Part2:Assessandclassifyyounginfant Checkforveryseverediseaseandlocalbacterialinfection Drill:Practiseaskingcheckingquestions Roleplay:UsinggoodcommunicationskillsandtheentireCOUNSEL chart(Motherscardifused)Felice Day6 Inpatientsessiononly(NooutpatientsonSaturday) Essentialcareforallyounginfants Assessandclassifyyounginfantsforbacterialinfection,diarrhoea, andjaundice Assessbreastfeedingattachmentandsuckling Correctpositioningandattachment Checkyounginfantforjaundice Assessyounginfantfordiarrhoea Checkyounginfantforfeedingproblemorlowweight Checkimmunizationandassessotherproblemsoftheyounginfant Part3:Identifytreatmentforyounginfant,treatandcounsel Identifytreatmentforyounginfant,treatandcounsel Part4:Followuptheyounginfant Followuptheyounginfant Writtenposttest,trainingevaluationclosingofthetraining
Time (min) 240 70 45 50 55 20 240 35 60 50 60 15 20
Individual workwith ICATT
Roleplay Clinical practice
Drill Roleplay
Clinical practice
120
25 40 30 35 100 40 90
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Closing session
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CLASSROOMBASEDTRAININGWITHLCDPROJECTOR

CONTENTS
CLASSROOMBASEDTRAININGWITHLCDPROJECTOR..................................................................................1 1. 2. Exampletrainingstructure.............................................................................................................................3 Exampletrainingschedulefor6daytraining ..........................................................................................5
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1. EXAMPLETRAININGSTRUCTURE
Trainingobjective Trainhealthprofessionalresponsibleformanagementofsickchildrenagedupto5years inIMCI. Participants Anyhealthprofessionalsresponsibleformanagementsickchildrenagedupto5yearsat primaryhealthcarelevel. Generaltimeframe Thetrainingwillbeconductedfor6fullconsecutivedays. Computertraining Onecomputerandoneprojectorareneededforthegroupofparticipants. EachICATTfacilitatorneedstohaveanunlimitedaccesstoacomputerduringthewhole durationofthetraining. AfacilitatorwillworkthroughtheICATTprojectedonascreentogetherwiththegroup ofparticipants. AcompleteICATTtrainingsetadaptedaccordingtothenationalIMCIguidelineswillbe usedforthetraining. Thefacilitatorwillwork,togetherwiththeparticipants,throughthewholeICATT trainingsetEXCEPT: SectionsmarkedintheICATTasoptional(AdditionalinformationintheICATT componentINTRODUCTIONandFurtherreadingpagesintheREADsectionof eachtrainingunit), PRACTISEexercisesmarkedintheFacilitatorguideasoptional,and AllTESTexercises.
ThenumberofPRACTISEexercisesworkedthroughmaybefurtherreduceddepending onthetimeavailable. Clinicalpractice Fiveinpatientandfouroutpatientclinicalpracticesessionswillbeconducted(No outpatientsessiononSaturday). Clinicalpracticesessionswillbeconductedingroupsofupto8participantsinan outpatientclinicandinpatientward.Moreoutpatientclinicsmaybeneededforthe clinicalpractice.

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Interactivegroupactivities 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 chartandMotherscardFelicewillbeincludedintothetraining.
Humanresourcesneeded One training director is needed to plan, organize, and coordinate the training activities andtotrainfacilitators.Thedirectormayalsoactasoneofthefacilitators. Anadditionaloutsidetrainingdirectorisneededifthelocaltrainingdirectorhasnotyet beentrainedinfacilitationofanIMCItrainingusingICATT. The facilitator participant ratio for computer training should be 1: 68. One facilitator works through the ICATT content together with the participants, another one or more facilitatorshelptheparticipantstodotherequiredtasks(e.g.findrelevantinformation in the chart booklet or complete a case recording form correctly). It is NOT recommendedtoworkinagrouplargerthan20participantsitwouldincreasethetime needed for the interaction of facilitators with participants or decrease the interaction andthereforethequalityoftraining. Onefacilitatorper34participantsisneededfortheoutpatientclinicalpractice(twofor eachgroupof68participants). One clinical instructor is needed for inpatient clinical practice sessions. (He or she will conducttheclinicalsessionswithgroupsofupto8participants). IT support is usually not needed if the director/facilitators routinely use the available equipment(computerandprojector)forteaching. Administrative staff: One person is needed to assists the director with administrative tasks,logisticsandtoensuresufficientquantityofprintedandothermaterials. Facilitatortraining A 3day 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 theICATTsoftwareandtheorganizationofitsIMCIcontent. Evaluationofparticipants Participants will take a standard ICATT written post test adapted according to the nationalIMCIguidelinesonthelastdayoftraining. Followupafterthetraining Followupvisitwillbeconducted46weeksafterthetrainingaccordingtothestandard WHOguidelinesavailableintheICATTlibrary.
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2. EXAMPLETRAININGSCHEDULEFOR6DAYTRAINING
Anexamplescheduleisprovidedonthenextpages.Thisschedulecanbeusedtomakemore 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:Ifclinicvisitswillnotbeheldinthemorning,theschedulewillneedtobeadjusted.) 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 completedaheadofschedule,thefacilitatorcanbeginworkonthenexttrainingunit.Ifthe workisbehindschedule,thefacilitatorshouldadjustthedurationofteachingthenextunit (e.g.omitsomeexercises). Every day, with the exception of the first and last day, should include 4 hours of clinical practice.Clinicalpracticeshouldbescheduledatthetimeofdaywhenmostpatientsarrive, usually in the morning. The schedule provided assumes that the course will run Monday throughSaturday.AsthereusuallyarenooutpatientsonSaturday,only2hoursofinpatient clinicalpracticearescheduledforSaturday.
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Activity type
Activities Day1
Time (min) 30 15 25 15 15 20 40 45 100 85 60
Registration Registrationandadministrativetasks Openingceremony,welcomeandintroductionsofparticipants Presentation:IMCIstrategytoimprovehealthandoverviewofIMCI inthecountry Introductory Objectivesofthetraining,briefoverviewofthetrainingorganization, group introductionofICATTtrainingplayer session PresentationfromICATT:IMCIcasemanagementprocess DemonstrationIMCIcasemanagementcharts(chartbooklet)and recordingforms Careofchildaged2monthsupto5years Part1:Assessandclassifythesickchildaged2monthsupto5years Askthemotheraboutthechildsproblems Individual Checkforgeneraldangersigns workwith ICATT Assesscoughordifficultybreathing Assessdiarrhoea Assessfever(Totaltime100) Day2 Checkforgeneraldangersigns Clinical Assessandclassifycoughordifficultbreathing practice Assessandclassifydiarrhoea Assessfeverfinish(Total100) Assessearproblem Individual workwith Checkformalnutritionandanaemia ICATT Checkimmunization,vitaminAanddewormingstatus Assessotherproblemsandreviewofassessandclassify(Total55) Day3 Clinical practice Assessandclassifyfever Assessandclassifyearproblem Checkformalnutritionandanaemia Assessotherproblemsandreviewofassessandclassify finish(Total 55) Part2:Identifytreatmentforchild Start:Identifytreatmentforchild Part3:Treatthechild Selectandgiveoraldrug Drill:ReviewinginformationontheASSESSandCLASSIFYchart
240 40 25 80 35 30 240 25 90 80 15
Drill
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Activity type Clinical practice
Activities Day4 Identifytreatmentforchild Teachthemothertogiveoraldrugs Advisemotherwhentoreturnimmediately Part3:Treatthechild Teachthemothertogivetreatmentathome Givetreatmentandimmunizethechildattheclinic Giveextrafluidfordiarrhoeaandcontinuefeeding Part4:Counselthemother Assessfeedingandmakerecommendations Demonstrationroleplay Teachingamothertogiveoraldrugsat homeusinggoodcommunicationskills,Dasar Day5 PlanA:Treatdiarrhoeaathome PlanB:TreatsomedehydrationwithORS PlanC:Treatseveredehydrationquickly Counselthemotheraboutfeedingproblems Usegoodcommunicationskills Part:5Followupthechild Followupthechild Careofyounginfantagedupto2months Part1:Essentialcareforeveryyounginfant Essentialcareforeveryyounginfant Part2:Assessandclassifyyounginfant Checkforveryseverediseaseandlocalbacterialinfection Drill:Practiseaskingcheckingquestions Roleplay:UsinggoodcommunicationskillsandtheentireCOUNSEL chart(Motherscardifused)Felice Day6 Inpatientsessiononly(NooutpatientsonSaturday) Essentialcareforallyounginfants Assessandclassifyyounginfantsforbacterialinfection,diarrhoea, andjaundice Assessbreastfeedingattachmentandsuckling Correctpositioningandattachment Checkyounginfantforjaundice Assessyounginfantfordiarrhoea Checkyounginfantforfeedingproblemorlowweight Checkimmunizationandassessotherproblemsoftheyounginfant Part3:Identifytreatmentforyounginfant,treatandcounsel Identifytreatmentforyounginfant,treatandcounsel Part4:Followuptheyounginfant Followuptheyounginfant Writtenposttest,trainingevaluationclosingofthetraining
Time (min) 240 70 45 50 55 20 240 35 60 50 60 15 20
Roleplay Clinical practice
Drill Roleplay
Clinical practice
120
25 40 30 35 100 40 90
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Closing session
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ICATTBASEDIMCIDISTANCELEARNINGTRAINING

CONTENTS
ICATTBASEDIMCIDISTANCELEARNINGTRAINING.......................................................................................1 1. 2. 3. 4. 5. 6. 7. Exampletrainingstructure.............................................................................................................................3 ExampletrainingcalendarSequence,objectives,andlocationoftrainingevents................6 Initialfacilitatorparticipantencounter:Suggestedobjectivesandschedule............................7 Firstselflearningphase:Suggestedobjectivesandparticipantstasks.....................................9 Intermediatefacilitatorparticipantencounter:Suggestedobjectivesandschedule..........10 Secondselflearningphase:Suggestedobjectivesandparticipantstasks.............................11 Finalfacilitatorparticipantencounter:Suggestedobjectivesandschedule...........................12
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DirectorguideICATTbasedIMCIdistancelearningtraining
1. EXAMPLETRAININGSTRUCTURE Trainingobjective
Trainhealthprofessionalresponsibleformanagementofsickchildrenagedupto5years inIMCI. Participants Anyhealthprofessionalsresponsibleformanagementsickchildrenagedupto5yearsat primaryhealthcarelevel. Generaltimeframe Thetotaltrainingdurationwillbe 2 months. Thetrainingwillconsistofthree oneday facilitatorparticipantencountersandtwoselflearningphasesofapproximately3.5and 4.5weeksinbetween.Allfacilitatorparticipantencounterswillbeconductedatcentral level. A facilitator will communicate each week with the participants (one facilitator per 10 participants) during the selflearning phases in order to monitor participant progress, provideassistanceandsolveproblemsasneeded. Computertraining Initial encounter: One computer for a maximum of two participants is needed as the participantsneedtolearnandpracticenavigationinICATT. Intermediateandfinalencounters:Onecomputerisneededforthegroupfeedbackand problemsolvingsessions. NOTE:Ifthenumberofcomputersavailablefortheinitialfacilitatorparticipantencounter isnotsufficientfortheplannednumberofparticipants,theencountermaybeorganizedfor smallergroupsondifferentdays. Selflearning phases: Each participant must have an access to a computer for approximately4hoursperweekduringthe8weektraining. EachICATTfacilitatormusttohaveanunlimitedaccesstoacomputerduringthewhole durationofthetraining. AcompleteICATTtrainingsetadaptedaccordingtothenationalIMCIguidelineswillbe usedforthetraining. Participants will be expected to work through the whole ICATT training set except the partsmarkedintheICATTasoptional(Additional information intheICATTcomponent INTRODUCTIONandFurtherreadingpagesintheREADsectionofeachtrainingunit). Clinicalpractice One clinical demonstration session will be conducted during the initial facilitator participantencounter.Oneoutpatientandoneinpatientclinicalpracticesessionwillbe conductedduringeachsubsequentencounter.
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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 neededfortheoutpatientclinicalpractice. Participants will practice IMCI case management individually in their health facilities withasmanypatientsaspossiblebutnotlessthan20. Interactivegroupactivities Two drills (Review information on the ASSESS & CLASSIFY chart and Practise askingcheckingquestions)willbeincludedintothetraining. Humanresourcesneeded One training director is needed to plan, organize, and coordinate the training activities andtotrainfacilitators.Thedirectormayalsoactasoneofthefacilitators. Anadditionaloutsidetrainingdirectorisneededifthelocaltrainingdirectorhasnotyet beentrainedinfacilitationofanIMCItrainingusingICATT. Onefacilitatorper45participantsisneededforICATTwork,drillsandroleplaysduring theencounters. Onefacilitatorper34participantsisneededfortheoutpatientclinicalpractice(twofor eachgroupof68participants). One facilitator per 10 participants will be assigned to communicate with participants duringtheselflearningphases. One clinical instructor is needed to assists the facilitators to select patients for demonstration during the initial facilitatorparticipant encounter and to conducts the inpatientclinicalsessionsduringthesubsequentencounters.(Heorshewillconductthe clinicalsessionswithgroupsofupto8participants). 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 ICATTfromDVDorUSBflashdisk,andtosolveparticipantsITrelatedproblemsduring thetraining. Administrative staff: One person is needed to assists the director with administrative tasks,logisticsandtoensuresufficientquantityofprintedandothermaterials. Facilitatortraining A 3day 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 comfortablewiththeICATTsoftwareandtheorganizationofitsIMCIcontent.
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Evaluationofparticipants
Participants will take a standard ICATT written post test adapted according to the nationalIMCIguidelinesonthelastdayoftraining. Followupafterthetraining Followup visit will be conducted 46 weeks after the training according to standard WHOguidelinesavailableintheICATTlibrary.
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2.
EXAMPLETRAININGCALENDARSEQUENCE,OBJECTIVES,ANDLOCATIONOF TRAININGEVENTS
Duration/ date(s) Teaching/learningobjectives Facilitator Explainhowthetrainingwillbeorganizedandwhatis expectedfromtheparticipant TeachtheprinciplesoftheIMCIcasemanagement processandtheuseofthechartbookletandrecording forms Clinicalpractice:DemonstrateASSESS&CLASSIFY Teachhowtorun/installICATTandnavigateinit Location
Initialfacilitator participantencounter
1day
Central
1stselflearningphase NOTE:Workingthrough Assessandclassifychild aged2monthsupto5 yearstakes approximately10hrs; 42%ofthetotalICATT worktime Participant LearnPart1:AssessandclassifychildofICATT componentCareofchildaged2monthsupto5years Practicetheassessmentandclassificationofsick childrenaged2monthsupto5years
Approx.3.5 weeks
Participant HF
Intermediatefacilitator participantencounter
1day
Facilitator AssessparticipantprogressinICATT Solvepossibleproblems Clinicalpracticeoutpatients:Demonstrateidentifying treatment,treatingthechildandcounsellingthe mother;conductparticipantsindividualpracticeinthe assessmentandclassificationofchildrenaged2 monthsupto5years Clinicalpracticeinpatients:Conductparticipants individualpracticeintheassessmentandclassification ofchildrenaged2monthsupto5years
Central
2ndselflearningphase
NOTE: WorkingthroughPart25 Careofchildaged2months upto5yearstakes approximately8hrs;33%of thetotalICATTworktime. WorkingthroughCareof younginfantagedupto2 monthstakesapproximately 6.5hrs;25%ofthetotal ICATTworktime.
Approx.4.5 weeks
Participant LearnpartsIdentifytreatment,Treat,Counselthe motherandFollowupofICATTcomponentCareof childaged2monthsupto5years LearnICATTcomponentCareofyounginfantagedup to2months Practicemanagingsickchildrenagedupto5years
Participant HF
Facilitator CheckifparticipantshavefinalizedtheICATT Solvepossibleproblems Clinicalpracticeoutpatients:Conductparticipants individualpracticeincompletecasemanagementof childrenaged2monthsupto5years Clinicalpracticeinpatients:Demonstrateassessment andclassificationofayounginfant;demonstrate breastfeedingassessmentandcounselling Evaluateparticipantknowledge:Writtenposttest Facilitatororanotherdesignatedperson Conductfollowupvisits
Finalfacilitator participantencounter
Central
Followupvisit
46weeks afterthe training
Participant HF
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INITIALFACILITATORPARTICIPANTENCOUNTER:SUGGESTEDOBJECTIVESAND SCHEDULE
Objectives Attheendofthesessioneachparticipantshould: Knowhowthetrainingwillbeorganizedandwhatisexpectedfromhimorher, BefamiliarwithinstallingofandnavigatingthroughICATT, Knowprinciplesofthecasemanagementprocess,and Knowprinciplesoftheuseofthechartbookletandrecordingforms.
3.
Possibleschedule An example schedule is provided below. This schedule can be used to make more precise scheduleincludingspecificdatesandtimesonceyouknowthetimeforclinicalsessionandthe arrangementsforlunch,teabreaks,etc.Whensettingthetimeofthebeginningandoftheendof the encounter, take into account the time when participants can arrive for the encounter and whentheyneedtodepart. Activity Time (minutes) Registrationandadministrativetasks Openingceremony Presentation:IMCIstrategytoimprovehealthandoverviewofIMCIinthe country Objectivesofthetraining,briefoverviewofthetrainingorganization,agendaof thisencounter,andyourroleasafacilitator PresentationfromICATT:IMCIcasemanagementprocess 30 20 30 15 15
PresentationfromICATTanddemonstration:IMCIcasemanagementchartsand 25 recordingforms Clinicalpractice:Demonstrationofassessmentandclassificationofasickchild aged2monthsupto5years 90
Interactivepresentation:ICATTHowtostartfollowedbyindividualpracticeof 160 ICATTnavigation ReviewofParticipantworkbookandannouncementofpracticalarrangements forthetraining. Totalduration

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30 7hrs
Possibleorganizationoftheclinicaldemonstrationsession The objective of the clinical session during the initial facilitator participant encounter is to demonstratetheassessmentandclassificationofasickchildaged2monthsupto5years.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,conductingthissessioninaninpatientwardispreferabletoconductingitinoutpatient clinicsinmostsettings.Twovariantsofapossibleorganizationoftheclinicaldemonstrationare describedbelow: a) Clinicaldemonstrationinaninpatientward: Thedemonstrationsessiontakesplaceinaninpatientward.Participantsaredividedintoas manysmallgroups(upto45peopleeach)astherearefacilitators.Askoneofthefacilitators oraclinicalinstructortoselectwiththeassistanceoftheinpatientwardsstaff45children withoneormoreIMCIsymptomsforthedemonstrationinthemorning. 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 bookletandinenteringthefindingsintotherecordingform. Afterthedemonstration,thegroupsofparticipantsrotate.Forthenextgroup,thefacilitator 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 HAVE.ThiswayeachgroupofparticipantswillseeseveralpatientswithvariousIMCIsigns. The participants should see 45 patients. If there are fewer facilitators/small groups, one facilitatorcandemonstratetwopatients. b) Clinicaldemonstrationinoutpatientclinics: Each small group of 68 people with two facilitators visits one outpatient clinic, where the facilitators demonstrate the assessment and classification process on as many patientsastimeallows. While one facilitator demonstrates on one patient the assessment and classification process,howtousethechartbookletandtherecordingform,theotherfacilitatorassists the participants in finding the relevant places in the chart booklet and entering the findingsintotherecordingform.Then,forthenextpatient,thefacilitatorschangetheir roles.
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4.
FIRSTSELFLEARNINGPHASE:SUGGESTEDOBJECTIVESANDPARTICIPANTSTASKS
Objectives At the end of this phase the participant should know and have the skills to assess andclassify sickchildrenaged2monthsupto5years. Tasks ICATT: Review the ICATT component INTRODUCTION presented during the initial facilitator participantencounter. Work through and learn Part 1 of the ICATT component CARE OF CHILD AGED 2 MONTHSUPTO5YEARS. Complete printed recording forms for those PRACTISE exercises in ICATT that require themandkeeptheformsforthefacilitator.
Clinicalpractice: 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 trainingbegins). Complete a printed recording form for each patient seen and keep them for the facilitator. Record each individual clinical practice session into the Record of clinical practice sessions(Item5inParticipantworkbook). Record the classification(s) of each child seen into the Record of classifications seen (Items6and7inParticipantworkbook).
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5.
INTERMEDIATEFACILITATORPARTICIPANTENCOUNTER:SUGGESTEDOBJECTIVES ANDSCHEDULE
Objectives AssessparticipantprogressIICATT. Solvepossibleproblems. Conductindividualclinicalpracticeinassessmentandclassificationofasickchildaged2 monthsupto5years. Demonstrateidentifytreatment,treat,andcounselthemother. Possibleschedule An example schedule is provided below. This schedule can be used to make more precise scheduleincludingspecificdatesandtimesonceyouknowthetimeforclinicalsessionandthe arrangementsforlunch,teabreaks,etc. (Note: If clinic visits will not be held in the morning, the schedulewillneedtobeadjusted.) Activity Time (minutes) Registrationandadministrativetasks.CollectionofparticipantsICATTStudent profilesandcompletedrecordingformsforchecking Objectivesandorganizationoftheintermediate facilitator participantencounter GroupoverviewofparticipantprogressinICATTandindividualclinicalpractice duringtheselflearningphase Clinicalpracticeoutpatients:Demonstrationofidentifyingtreatment,treatingthe childandcounsellingthemother;individualpracticeinassessmentand classificationofchildrenaged2monthsupto5years Clinicalpracticeinpatients:Individualpracticeinassessmentandclassificationof childrenaged2monthsupto5years Drill:ReviewinginformationontheASSESS&CLASSIFY chart Groupfeedbackandproblemsolvingsession Individualfeedbackconductedinsmallgroups Summarizetheworkandreviewtasksforthe2nd selflearningphase. Totalduration 20 90 30 30 7hrs 20 10 40 180
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6.
TASKS
SECONDSELFLEARNINGPHASE:SUGGESTEDOBJECTIVESANDPARTICIPANTS
Objectives Attheendofthisphasetheparticipantshouldknowandhavetheskillstomanagesickchildren upto5yearsaccordingtotheIMCIguidelines. Tasks ICATT: Workthroughparts25oftheICATTcomponentCAREOFCHILDAGED2MONTHSUP TO5YEARS. WorkthroughtheICATTcomponentCAREOFYOUNGINFANTAGEDUPTO2MONTHS.
Clinicalpractice: Practiseacompletecasemanagementofasmanysickchildrenupto5yearsaspossible (Optional:specifythenumberofpatientstomanageneedstobedecideduponbefore thetrainingbegins). Practisecasemanagementofyounginfants. Complete a printed recording form for each patient seen and keep them for the facilitator. Continue recording each individual clinical practice session into the Record of clinical practicesessions(Item5inParticipantworkbook). Continue recording the classification(s) of each child seen into the Record of classificationsseen(Items6and7inParticipantworkbook).
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7.
FINALFACILITATORPARTICIPANTENCOUNTER:SUGGESTEDOBJECTIVESAND SCHEDULE
Objectives CheckifparticipantsfinalizedworkingthroughICATT. Conduct individual clinical practice in complete case management of sick children aged 2 monthsupto5years. Demonstrateacompletecasemanagementoftheyounginfantincludingfeedingassessment andbreastfeedingcounselling. Evaluateknowledgeofparticipants. Possibleschedule An example schedule is provided below. This schedule can be used to make more precise scheduleincludingspecificdatesandtimesonceyouknowthetimeforclinicalsessionandthe arrangementsforlunch,teabreaks,etc. (Note: If clinic visits will not be held in the morning, the schedulewillneedtobeadjusted.) As the ICATT sessions are shorter than in the intermediate encounter, you can schedule a specifiedtimeapartfromtheencounterregularhourswhenatleastonefacilitatorisavailableto discussanyproblemsorquestions. Activity Time (minutes) 20 10 20 180
Registrationandadministrativetasks.CollectionofparticipantsICATTStudent profilesandcompletedrecordingformsforchecking. Objectivesandorganizationofthefinal facilitator participantencounter GroupoverviewofparticipantprogressinICATTandindividualclinicalpractice duringtheselflearningphase Clinicalpracticeoutpatients:Individualpracticeincompletecasemanagementof childrenaged2monthsupto5years Clinicalpracticeinpatients:Demonstrationofassessmentandclassificationofa younginfant;demonstrationofbreastfeedingassessmentandcounselling Drill:Practiseaskingcheckingquestions Groupfeedbackandproblemsolvingsession Writtenposttest,trainingevaluationclosingofthetraining Totalduration
20 80 90 7hrs
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ANNEX1:HARDWAREANDSOFTWAREREQUIREMENTSFORIMCIADAPTATION ANDTRAININGTOOL(ICATT)
Minimumhardwareandsoftwarerequirements MSWindows2000orhigher MSInternetExplorer5.5orhigher Microsoft.NetFramework1.1(includedwithMSWindows2000andhigher) WindowsMediaplayer DVDorUSBdrive About4Gbfreespaceforinstallation(notrequiredforrunningtheICATTfromUSBorDVD) Amplifiersystem Inaddition,toimprovetheusabilityofICATT,someadditionalviewerapplicationswillbe installedfromtheICATTDVD/USBiftheyarenotalreadyavailable: AdobeAcrobatViewertodisplayPDFfiles AdobeFlashPlayertoenableviewingflashmovies MSWordviewertodisplayWorddocuments MSPowerPointviewertodisplayPowerPointpresentations.
ANNEX2:LISTOFCLINICALPRACTICESESSIONSINGENERICGUIDEFORCLINICAL PRACTICE
OutpatientSessions
OutpatientsessionChild1: Checkforgeneraldangersigns Assessandclassifycoughordifficult breathing OutpatientsessionChild2: Assessandclassifydiarrhoea OutpatientsessionChild3: Assessandclassifyfever OutpatientsessionChild4: Assessandclassifyearproblem Checkformalnutritionandanaemia OutpatientsessionChild5: Identifytreatment Teachthemothertogiveoraldrugs Advisemotherwhentoreturn immediately OutpatientsessionChild6: PlanA:Treatdiarrhoeaathome PlanB:TreatsomedehydrationwithORS OutpatientsessionChild7: Counselthemotheraboutfeeding problems
InpatientSessions
InpatientsessionChild1 Checkforgeneraldangersigns Assessandclassifycoughordifficult breathing InpatientsessionChild2: Assessandclassifydiarrhoea InpatientSessionChilds3: Assessandclassifyfever InpatientsessionChild4: Assessandclassifyearproblem Checkformalnutritionandanaemia
Careofsickchildage2monthsupto5years
InpatientsessionChild5: PlanB:TreatsomedehydrationwithORS PlanC:Treatseveredehydrationquickly Assessandclassifyadditionalchildren
Careofyounginfantupto2months
OutpatientsessionInfant1: Assessandclassifyyounginfantsfor bacterialinfectionanddiarrhoea OutpatientsessionInfant2: Assessbreastfeedingattachmentand suckling Correctpositioningandattachment InpatientsessionInfant1: Essentialcareforallyounginfants InpatientSessionInfant2: Assessandclassifyyounginfantsfor bacterialinfectionanddiarrhoea InpatientSessionInfant3: Assessbreastfeedingattachmentand suckling Assessandclassifyyounginfants
ANNEX3:LISTOFTRAININGGUIDESANDAIDS
This annex provides a list of guides and other training aids developed for organizing and conductingICATTbasedIMCItraining. The documents are located in ICATT training player, section Support materials, guides folders andTrainingaids.
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 facilitatortechniquesthatareusedinanytypeoftraining.Inthetrainingconfigurationspecific parts,therearethreesections.Eachsectionprovidesguidelinesforoneofthefollowingtraining 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,thenfacilitatingtechniquesspecificforthetrainingconfigurationandthenitprovides guidelinesforconductingthetraining. 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 basedIMCItraining,printtheGeneralpart,Trainingspecificpartforthetrainingconfiguration thatyouwillconductandtheannexes.
Guide for clinical practice (Document)

Thisdocumentconsistsoftwoparts:ClinicalpracticeintheinpatientwardandClinicalpractice intheoutpatientclinic.Eachpartdescribestheroleofthetutor,generalproceduresandspecific instructionsforconductingtheclinicalsessions. Adaptationneeded:ThisguidemaybesubstitutedbylocalclinicalguidesusedinstandardIMCI trainingsoradaptedaccordingtonationalguidelines.
Quick reference for ICATT training player (Document)

This document provides detailed instructions about navigation in ICATT. It is accessible from StudentprofilescreenHelpinICATTtrainingplayer.Useofitsprintedversionisoptionaland usuallynotneeded. Adaptationneeded:None.
How to use a computer (Flash movie)

Thisflashmovieexplainsthemaincomponentsofacomputerforparticipantswithnoorvery limitedcomputerskills. Adaptationneeded:None.
ICATT How to start (PowerPoint presentation)

ThispresentationprovidesstepbystepexplanationshowtonavigateinICATTtrainingplayer. Adaptationneeded:None.
ICATT navigation minimum (Document)

Thisaidisintendedforparticipantsofdistancelearningtraining.Itprovidesinformationhowto startworkingwithICATTtrainingplayer,howtotransfertheStudentprofile,andhowtoopen QuickreferencefortheIMCIplayerthatprovidesdetailedinstructionsaboutnavigationinICATT. Adaptationneeded:None.
IMCI strategy to improve child health (PowerPoint presentation)

ThispresentationdescribestherationaleforWHO/UNICEFstrategyforIntegratedManagement ofChildhoodIllness(IMCI).ItsubstitutesICATTchapterWhatisIMCI. Adaptationneeded:IncludinganoverviewofIMCIimplementationinthecountryisdesirable.
ICATT exercises and answers (Document) The generic document is located in Adaptation and translation aids Generic ICATT content Wordfiles.It includes all ICATT exercises with correct answers. Itisanessentialdocumentfor
theICATTadaptationteamduringtheadaptationofICATTcontent.Inadditionitmaybeuseda) foradjustmentofthetrainingcontentforaparticulartargetaudienceeitherinICATTorinthe instructions of Facilitator guide and b) for quick orientation of facilitators in exercises and decisionswhichexercisesmustbeworkedthroughandwhichmaybeomittedduringclassroom basedtrainingsiftimeisshort. Adaptationneeded:AdaptationaccordingtonationalIMCIguidelinesshouldbedoneduringthe nationaladaptationofICATTtrainingplayer.
Coordinate role plays (Document)

This document provides instructions for coordinating 8 role plays included in the Facilitator guideforWHOgeneric11daytrainingadaptedaccordingtoIMCIguidelinesusedinICATT;Two oftheroleplayshavealsobeenincludedintotheICATTFacilitatorguide. This document is useful for facilitators or ICATT adaptation team if they wish to use more or otherroleplaysinthetraining. Adaptationneeded:IftheroleplaysareinyournationaladaptationofWHOIMCImodules,your nationaladaptation/translationmaybeusedinsteadofadapting/translatingthisdocument.
Lead drills (Document)

ThisdocumentprovidesinstructionsforleadingdrillsincludedintheFacilitatorguideforWHO generic 11 day training adapted according to IMCI guidelines used in ICATT; Two of the drills havealsobeenincludedintotheICATTFacilitatorguide. This document is useful for facilitators or ICATT adaptation team if they wish to use more or otherdrillsinthetraining. Adaptationneeded:IftheroleplaysareinyournationaladaptationofWHOIMCImodules,your nationaladaptation/translationmaybeusedinsteadofadapting/translatingthisdocument.
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 thetrainingstructurewillbedifferentfromthegenericone.
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 usuallyprintsbetterasWorddocument.ThegenericrecordingformislocatedinAdaptationand translationaids. Adaptationneeded:AccordingtonationalIMCIguidelines.
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 usuallyprintsbetterasWorddocument.ThegenericrecordingformislocatedinAdaptationand translationaids. Adaptationneeded:AccordingtonationalIMCIguidelines.
ANNEX4:LISTOFDATACOLLECTIONFORMS
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 trainingcourseandyoumaybealreadyusingtheirnationallyadaptedversioninyourstandard IMCIcourses. TheformsarelocatedinICATTtrainingplayer,sectionSupportmaterials,Datacollectionforms. A. Trainingreportform(Worddocument) TheTrainingreportformiscompletedbythetrainingdirectorattheendoftraining.Itincludes information on the total numbers of participants and facilitators, results of participants progress,hoursdevotedtoclinicalsessions,etc.Allofthisinformationisusefulformonitoring numbersofparticipantstrained,selectingfuturetrainingsites(basedonadequacyofcaseload), and ensuring that the training is being given as planned and not altered or shortened unacceptably. B. Participanttrainingregistrationform(Worddocument) Theformiscompletedbyparticipantsatregistrationonthefirstmorningofthetraining. C. Summaryparticipantlist(Excelsheet) The list summarizes the data of the registration forms. This information can be useful for the trainingreportandinplanningforfollowupvisits. 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 participants progress in ICATT and the extent of his or her clinical practice. It is useful for monitoringtheparticipantprogressduringselflearningperiods. E. Summaryrecordofdistancelearningtrainingparticipantprogress(Excelsheet) The list summarizes the data in Individual records of distance learning training participant progress.Thisinformationcanbeusefulforthetrainingreportandinplanningfuturetrainings. F. Timesheetforclassroombasedtraining(Worddocument) YoumaywishtorecordthetimeittakestoworkthroughICATTtrainingunitsforabettertime organizationinfuturetrainings.Thisdocumentprovidesanexamplehowthiscanbedone. G. Groupchecklistsofclinicalsigns(Worddocument) 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 clinicalpracticeforinstructionsforcompletingthischecklist. 1
H. Checklists for monitoring clinical sessions and summary of clinical practice experience(Excelsheet) 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 childrenaged2monthsupto5years,andoneforyounginfantsagedupto2months. Checklistsformonitoringinpatientsessionsarecompletedbytheinpatientinstructorattheend of each inpatient session. See Annex 6 in Guide for clinical practice for instructions for completingthischecklist,whichhastwoversions:oneforsickchildrenaged2monthsupto5 years,andoneforyounginfantsagedupto2months.Thesechecklistsareprimarilyfortheuse oftheinpatientinstructorforuseinkeepingtrackofsignsseenbyeachparticipant. Thesummaryofclinicalpracticeexperienceiscompletedbythetrainingdirectorattheendof training on the basis of checklists for monitoring inpatient and outpatient sessions. This informationcanbeusefulinplanningforfuturetrainings. I. IMCIknowledgeposttestandanswerkey(Worddocument)
Thetestcomprisesof33questions.Thedocumentincludesananswerkeyandsuggestedscoring ofresults. J. Evaluationquestionnaireparticipant(Worddocument)
Youmaywishtousethisquestionnairetodetermineparticipants'opinionsattheconclusionof thetraining.Reviewandrevisethisquestionnaireasnecessarytoensurethatitisappropriate forevaluatingthetrainingasithasbeenconducted. Youmaywishtoaddordeletespecificquestions.Ifyoumakesuchrevisions,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 evaluatehelpfulnessofaparticularactivity. K. Evaluationquestionnairefacilitator(Worddocument) You maywishtothisquestionnairetodeterminefacilitators' opinions attheconclusionof the training.Reviewandrevisethisquestionnaireasnecessarytoensurethatitisappropriatefor evaluatingthetrainingasithasbeenconducted. Youmaywishtoaddordeletespecificquestions.Ifyoumakesuchrevisions,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 evaluatehelpfulnessofaparticularactivity. L. Costingsheet(Worddocument) Thedocumentprovidessuggestionshowtocalculateatrainingcostsandcomparethecostsof anICATTbasedIMCItrainingwithcostsofastandardIMCItrainingcourse. 2
ANNEX5:CHECKLISTOFMATERIALSNEEDEDATTHETRAINING
ClassroombasedLCD projector
Classroombased individualcomputers
Numberofcopies needed
Facilitatormaterials Extent
QuickreferenceforICATTtrainingplayer ICATTnavigationminimum Facilitatorguide Guideforclinicalpractice(2) PrintedcopyofIMCIchartbooklet(3) ICATTexercisesandanswers Coordinateroleplays Leaddrills Participantworkbook CaserecordingformsManagementofthe sickchildaged2monthsupto5years CaserecordingformsManagementofthe sickyounginfantagedupto2months PowerPointpresentation:IMCIstrategy toimprovechildhealth PowerPointpresentationICATTHowto start Flashmovie:Howtouseacomputer
14pages 6pages Depends on configurati on Approx. 120pages Depends on national adaptation 120pages 26pages 45pages 8pages 1page 1page Electronic Electronic Electronic
Oneper facilitator Oneper facilitator Oneper facilitator Oneper facilitator Oneper facilitator Oneper facilitator Oneper facilitator Oneper facilitator Oneper facilitator 10per facilitator 5per facilitator
(1)
U
9 9 9
9 9 9
9 9 9 9
9 9 9
U U
(1)Optional (2)NationallyadaptedICATTGuidelinesforclinicalpracticeorstandardnationalguide(s) (3)NationalprintedcopiesorprintedfromICATT
Distancelearning training
9 9 9

9 9 9 9 9
Classroombased individual computers
Classroombased LCDprojector
Numberofcopies needed
Participantmaterials
PrintedcopyofIMCIchartbooklet Participantworkbook ICATTminimumnavigation CaserecordingformsManagementofthe sickchildaged2monthsupto5years CaserecordingformsManagementofthe sickyounginfantagedupto2months Motherscardifusedinthecountry
Depends on national adaptation 8pages 6pages 1page 1page 1page
Oneper participant Oneper participant Oneper participant 30per participant 10per participant 10per participant
9
U U
9
U U
9 9 9
9 9 9
Distancelearning training
Extent
9 9 9 9 9 9
Classroombased individual computers
Classroombased LCDprojector
Datacollectionforms A.Trainingreportform
1page
B.Participanttrainingregistrationform C.Summaryparticipantlist D.Individualrecordof distancelearning trainingparticipantprogress E.Summaryrecordof distancelearning trainingparticipantprogress F.Timesheetforclassroombased trainings G.Groupchecklistsofclinicalsigns(1) H.Checklistformonitoringoutpatient sessionschildaged2monthsupto5 years(1) H.Checklistformonitoringoutpatient sessionsyounginfantagedupto2 months(1) H.Checklistformonitoringinpatient sessionschildaged2monthsupto5 years(1) H.Checklistformonitoringinpatient sessionsyounginfantagedupto2 months(1)
Electronic excelsheet 1page Electronic excelsheet 2pages Poster 1page
Oneper training Oneper participant Oneper training Oneper participant Oneper training Oneper training Oneper training group Oneper sessionper 4participants Oneper sessionper 4participants Oneper sessionper groupof participants Oneper sessionper groupof participants Oneper training Oneper participant 12per training Oneper participant Oneper facilitator
9 9 9
U U
9 9 9
U U
9 9 9 9 9
U U
9 9 9 9 9 9 9 9 9 9 9
9 9 9 9 9 9 9 9 9 9 9
9 9 9 9 9 9 9 9 9
1page
1page
1page
Electronic
H.Summaryofclinicalpracticeexperience excelsheet
5 pages
L.IMCIknowledgeposttest
2 pages
L.Answerkeyfortheposttest
4pages
M.Evaluationquestionnaireparticipant
4pages
N.Evaluationquestionnairefacilitator
8pages
9 9 9 12per O.Costingsheet training (1)TheformisthesameasinthegenericWHO/UNICEFIMCIclinicaltrainingcourse adaptedaccordingtoIMCIclinicalguidelinesintheICATT;youmayhaveyournationally adaptedversionforyourstandardIMCIcourses.
Distancetraining
Numberneeded
Extent
ANNEX6:CHECKLISTOFEQUIPMENTANDSUPPLIESNEEDEDATTHETRAINING
Facilitatorequipmentandsupplies Numberneededforanytraining Itemneeded configurationunlessotherwiseindicated Computertowhichthefacilitatorhasa constantaccess(preferablyhisorherownor Oneperfacilitator inhisorheroffice) ICATTtrainingplayeronDVDorUSBor Eachfacilitator installedatthefacilitatorscomputer Redpencilstomarkerrorsoncompleted Oneperfacilitator recordingforms Penorpencil Oneperfacilitator Writingpad Oneperfacilitator Foldersorbagstoholdthematerials Oneperfacilitator Equipmentandsuppliesforclassroomsessions Numberneededforanytraining Itemneeded configurationunlessotherwiseindicated USBflashdiskorDVDwithICATTtraining Optionaloneperparticipant player OnepereachcomputerinClassroombased Headset trainingwithindividualcomputers Classroombasedtrainingwithindividual computers:Oneperparticipant ClassroombasedtrainingwithLCDprojector: One Computers Distancelearningtraining:Oneper12 participantsduringInitialencounter;one duringotherencounters LCDprojector One One Flipchart Markersforflipchartoneset Setofhighlightersifchartbookletsneedtobe colored Oneset Severalsetsdependingonthenumberof participants
Onesetfortheclassroom,onesetforeach IMCIwallcharts(ifusedinthecountry):one setfortheclassroom,onesetforeachvenueof venueofclinicalsessions clinicalsessions Oneset Loudspeakers Paper 1 Severalreamsforcopyingofformsetc.
Participantequipmentandsupplies Numberneededforanytraining Itemneeded configurationunlessotherwiseindicated OneperparticipantofDistancelearning ICATTtrainingplayerDVDorUSBflashdisk training, Optionalforothertrainingconfigurations OneperparticipantofDistancelearning LabelsforUSBflashdiskstoputnameson training, themifStudentprofilewillbechecked Nametagand/ornamecardfortable Penorpencil Writingpad HeadsetonepereachcomputeratHC (optional) Folderforprintedrecordingforms Oneperparticipant Oneperparticipant Oneperparticipant OnepercomputeratparticipantHFinDistance learningtraining Oneperparticipant
ANNEX7:LISTOFMATERIALS,DRUGS,ANDSUPPLIESNEEDEDFORCLINICALPRACTICEIN OUTPATIENTSESSIONS
Thefollowinginstructionalmaterialswillbeneededforclinicalpracticesessions. ITEMNEEDEDFORCLINICALPRACTICE SetofwallsizeCasemanagementcharts tohangatclinicalpracticesites CopiesofMother'scardtodistributeto mothers Sickchildrecordingforms Younginfantrecordingforms Drugenvelopesandlabels Clipboard Bagorboxofdrugsandotherclinical supplies(suchascups)forafacilitator fromeachgrouptocarrytooutpatient clinics* 1setforeachoutpatientclinicandthe inpatientward 2percounsellingsessionperparticipant 8perparticipantpersession 8perparticipantpersession 5perparticipant,ifsiteswillusethem 1perparticipant 1foreachsmallgroup NUMBERNEEDED
Essentialdrugsandsuppliesforoutpatientsessions Drugs: ORSpackets(lowosmolarityifavailable)1 atleast8per participant Firstlineoralantibioticforpneumonia Firstlineantimalarial Firstlineoralantibioticfordysentery Mebendazole VitaminAcapsules Paracetamol Iron(tabletandsyrupifpossible) Plasticcups(oneforeachparticipant to offerdrinkstochildwithdiarrhoea) Cleanwatersupply(formixingORS,offeringfluidtochild whenassessingsignsofdehydration;andmaking crushed drugs) Enoughwatchesorothertimingdevices(participantswill usuallyusetheirownwatches) Mother'scards(ifused) Bananaorotheracceptablefoodtousewhenmixingcrushed tablets.Bananaishandy,portableandchildrenlikeit. ContainersformixingORS Spoons Oralrehydrationsaltspremixedpackets1 Thermometer Washbasin,towel,soap Functionalscaleforweighingchildrenandaccurately TapeforthemeasuringofMUAC Tetracyclineeyeointment2 1tubepergroup Gentianviolet2smallbottleof0.5% Softclothsforapplyinggentianvioletandwashingeyeswith pus Ringer'slactatesolutionforIVadministration BedsortableswithwiresaboveforhangingbottlesofIV fluid IVsuppliessuchasscalpvein(butterfly)needles
Supplies:
Otheressential suppliesforORTCorner Otheressential clinicsupplies Desirableforusein clinicalpractice: DesirableforORT cornerifIVfluidstobe given:

1
If 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 sucrose), Sodium chloride (2.6 g), Trisodium citrate, dihydrate (2.9 g) - (or 2.5 g sodium bicarbonate), Potassium chloride (1.5 g)
2Theseareunlikelytobeusedduringthesession.However,instructorscankeepasmallsupplytousewhen demonstratingtreatmentsoflocalinfections.
Itwouldbeanidealsituationifclinicswhereoutpatientsessionsareheldarestockedwith 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 afterchartsareadapted):
ToprovidecareastaughtinthecourseIntegratedManagementofChildhoodIllness: Antibiotics: Cotrimoxazole o Adulttablet(80mgtrimethoprim+400mgsulphamethoxazole) o Paediatrictablet(20mgtrimethoprim+100mg sulphamethoxazole) o Syrup(40mgtrimethoprim+200mgsulphamethoxazole) Amoxycillin o Tablet(250mg) o Syrup(125mgper5ml) Ampicillinintramuscular(250mgvial) Gentamicinintramuscular o 2mlvialcontaining20mgOR o 2mlvialcontaining80mg Ciprofloxacinetablets(250mgOR500mg) Tetracyclinetablets(250mg) Erythromycintablets(250mg) Coartemethertablets(20mgartemetherand120mglumefantrine) QuinineIntramuscular o 300mg/ml(in2mlampoulesusingquininesalt)OR o 150mg/ml(in2mlampoulesusingquininesalt) Paracetamoltablets500mgOR100mg Smallbottlesofsafe,soothingcoughremedy(optional) AdequatesuppliesofBCG,OPV,DPT,HIB,HepB,andMeaslesvaccines Sugar Clothforwickingdrainingears Largedrum(5,10,or15litresize)withcoverandsidetapforholding largequantitiesofORSinORTcorner FoodtogivepatientsonPlanB Nasogastrictube Sterilesyringesandsterileneedles: o 5ccsterilesyringesandsterileneedles o 10ccsterilesyringesandsterileneedles SterilewaterfordilutingIMantibioticsandIMantimalarials Cottonswabsandalcoholorspirits Allappropriatecoldchainsuppliessuchasareliablerefrigeratoror coldbox,sterilizers,sterilesyringesandsterileneedles,immunization cards.
Antimalarials:
Antipyretic: Otherdrugs: Vaccines: Othersupplies:
ANNEX8:LISTOFSUPPLIESNEEDEDFORCLINICALPRACTICEININPATIENTSESSIONS
Suppliesnecessaryforinstruction OnesetofwallsizeCasemanagementcharts Sickchildrecordingforms Younginfantrecordingforms Oneclipboardpertraineeinonegroup Stringortapetofastenclipboardstofootorheadofbed Highlighterpens,pens Thermometers TapesformeasuringofMUAC Scalesforweighingchildrenandinfants Cups,spoonsandcleanwater(forofferingfluidtoassessthirst) SuppliesfortreatingdehydrationaccordingtoPlanBandPlanC Essentialpaediatricinpatientsupplies ForIM/IVadministration: Quinine Gentamicin Ampicillin Diazepam D50(50%dextrose,forinjection) Fororaladministration: Paracetamol Ironsyrup/tablets VitaminA ORS Firstandsecondlineoralantimalarialsandantibioticsforpneumoniaanddysentery Mebendazole Oxygenbycylinderorconcentratorplusoxygenadministrationequipment Nasogastrictubes DisinfectanttowashusedNGtubes,oxygentubing,etc. ORTcornersupplies: Cleanwater ORSpackets Cupsandspoons ContainersformixingORSsolution IVequipmentincludingwaystoregulateinfusionrateofIVandbedsortableswithwires aboveforhangingbottlesofIVfluid IVfluidsincludingRinger'slactatesolutionandD5W Cottonswabsandalcoholorspirits Thermometer Scalewhichcanbezeroedandweighsaccurately Appropriatefoodfortubefeeding(forseverelymalnourishedchildren,andchildrennot abletofeed) KClsolutionforIVandoraluse Availabilityofsafebloodtransfusion Sterileneedlesandsyringes FoodtogivetopatientsonPlanBandotherpatients ReasonableHIVprecautionsincludingsafedisposalofneedles 1
ANNEX9:LISTOFSUPPLIESFORROLEPLAYSINCLUDEDINFACILITATORGUIDE
Roleplay:TeachingamothertogiveoraldrugsDasar Dollorother"baby" Druglabelsandapen Coartemethertablets Ironsyrup(ortablets,ifthereisnosyrupatyourclinic) Commonspoonformeasuringsyrup Smallbottles(ordrugenvelopes)formothertotakedrugshome Roleplay:UsinggoodcommunicationskillsandtheentireCOUNSELchartandMother's cardFelice Noadditionalsuppliesareneeded

Integrated Management of Childhood Illness (IMCI) : Directors Guide

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Integrated Management of Childhood Illness (IMCI) : Directors Guide

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DIRECTOR GUIDE

O RG ANIZE ICATT BASED IMCI TRAINING

2.5.1 2.5.2 3. 3.1 3.2 3.3 3.3

5.5.1 5.5.2 5.5.3

tocollectororganizecollectingdataduringthetraining, toorganizetheparticipantevaluation, toorganizetheendoftrainingevaluation,and toclosethetrainingandpresenttrainingcertificates(ifgiven).

2. GENERALCONSIDERATIONSFOR PLANNINGANDORGANIZING ANICATTBASEDIMCITRAINING

Setthescheduleforinpatientandoutpatientsessions,soeachgroupwillvisitone outpatientclinicandtheinpatientwardeachday. Reviewyourresponsibilitiesandplansforconductingtheinpatientsessions. Planthecontentofeachinpatientsessiondependingonthetrainingschedule.

Criteriaforselectingfacilitators notyettrained infacilitation of IMCIcourses

Ideallytheinpatientinstructorshouldhavebeenalreadytrainedforconductinginpatient clinicalpracticeinIMCIcoursesbeforeheorshebecomesaclinicalinstructorforanIMCI trainingusingICATT. Ifatrainedclinicalinstructorisnotavailable,usethecriteriaforhisorherselectiondescribedin Box5.

10. 11. 12. 13.

20. 21. 22. 23.

26. 27. 28. 29.

DISTANCE LEARNING TRAINING: DURING THE INITIAL FACILITATOR PARTICIPANT ENCOUNTER

Activity Opening,welcome,introductions Presentation:IMCIstrategytoimprovehealthandoverviewofIMCI implementationinthecountry Presentation:ICATTasatrainingtool Objectivesandorganizationofthefacilitatortraining

ReviewofICATTComponentCAREOFCHILDAGED2MONTHSTO5YEARS,Part1: 180 Assessandclassifythesickchild(ContinueDay2) Assigntasksforthenextday Total 10 7:20hrs

DAY2 Activity Time (minutes)

ReviewoftheICATTComponentCAREOFYOUNGINFANT AGEDUPTO2MONTHS 180 Practicalarrangementsforthetrainingandclosingremarks Total 60 7:30hrs

Time (min) 30 15 25 15 15 20 90 40 45 100 85 240 100 25 80 35 240 55 90 80 15

Individual workwith ICATT Drill

Activity type Clinical practice

Time (min) 240 70 45 50 55 20 240 35 60 50 60 15 20

Individual workwith ICATT

Roleplay Clinical practice

Individual workwith ICATT

Individual workwith ICATT

Time (min) 30 15 25 15 15 20 40 45 100 85 60

Individual workwith ICATT

Activity type Clinical practice

Time (min) 240 70 45 50 55 20 240 35 60 50 60 15 20

Individual workwith ICATT

Roleplay Clinical practice

Individual workwith ICATT

Individual workwith ICATT

Participant LearnpartsIdentifytreatment,Treat,Counselthe motherandFollowupofICATTcomponentCareof childaged2monthsupto5years LearnICATTcomponentCareofyounginfantagedup to2months Practicemanagingsickchildrenagedupto5years

46weeks afterthe training

PresentationfromICATTanddemonstration:IMCIcasemanagementchartsand 25 recordingforms Clinicalpractice:Demonstrationofassessmentandclassificationofasickchild aged2monthsupto5years 90

Interactivepresentation:ICATTHowtostartfollowedbyindividualpracticeof 160 ICATTnavigation ReviewofParticipantworkbookandannouncementofpracticalarrangements forthetraining. Totalduration

Objectives Attheendofthisphasetheparticipantshouldknowandhavetheskillstomanagesickchildren upto5yearsaccordingtotheIMCIguidelines. Tasks ICATT: Workthroughparts25oftheICATTcomponentCAREOFCHILDAGED2MONTHSUP TO5YEARS. WorkthroughtheICATTcomponentCAREOFYOUNGINFANTAGEDUPTO2MONTHS.

InpatientsessionChild5: PlanB:TreatsomedehydrationwithORS PlanC:Treatseveredehydrationquickly Assessandclassifyadditionalchildren

Facilitator guide (Document)

Guide for clinical practice (Document)

Quick reference for ICATT training player (Document)

How to use a computer (Flash movie)

ICATT How to start (PowerPoint presentation)

ICATT navigation minimum (Document)

IMCI strategy to improve child health (PowerPoint presentation)

Coordinate role plays (Document)

Lead drills (Document)

Thetestcomprisesof33questions.Thedocumentincludesananswerkeyandsuggestedscoring ofresults. J. Evaluationquestionnaireparticipant(Worddocument)

(1)Optional (2)NationallyadaptedICATTGuidelinesforclinicalpracticeorstandardnationalguide(s) (3)NationalprintedcopiesorprintedfromICATT

Classroombased individual computers

PrintedcopyofIMCIchartbooklet Participantworkbook ICATTminimumnavigation CaserecordingformsManagementofthe sickchildaged2monthsupto5years CaserecordingformsManagementofthe sickyounginfantagedupto2months Motherscardifusedinthecountry

Depends on national adaptation 8pages 6pages 1page 1page 1page

Classroombased individual computers

9 9 9 12per O.Costingsheet training (1)TheformisthesameasinthegenericWHO/UNICEFIMCIclinicaltrainingcourse adaptedaccordingtoIMCIclinicalguidelinesintheICATT;youmayhaveyournationally adaptedversionforyourstandardIMCIcourses.

Onesetfortheclassroom,onesetforeach IMCIwallcharts(ifusedinthecountry):one setfortheclassroom,onesetforeachvenueof venueofclinicalsessions clinicalsessions Oneset Loudspeakers Paper 1 Severalreamsforcopyingofformsetc.

Otheressential suppliesforORTCorner Otheressential clinicsupplies Desirableforusein clinicalpractice: DesirableforORT cornerifIVfluidstobe given:

Antipyretic: Otherdrugs: Vaccines: Othersupplies:

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