Sex education (terza parte)

SEX EDUCATION WORK WITH YOUNG PEOPLE . THEORY AND PRACTICE

Training and practice experience of medics at Sverdlovosk Oblast family planning Centre June 1999- November 2000

Juliana Slobodian

Terza parte

SEX EDUCATION WORK WITH YOUNG PEOPLE

As discussed in other sections, the medic is ideally placed to deliver sex education programs based on their training and medical experience. However, to be effective in the role as sex educator with young people demands the medic adapt skills associated with their profession. It is essential in a changing society for the medic to ‘be in touch’ with the client group and learn from them what is an appropriate response to their sex education needs. One effective way to achieve this is to apply the skills used in individual consultation to the group setting. Therefore a medic not only imparts facts but also facilitates the group members communicating and debating the wider issues associated with relationships and sexual activity. This section considers the dynamics between medic and client in a clinical setting. Similar processes take place with groups and the same skills are needed to work with them.

Professionals talking to young people in clinical settings

The following is based on experiences of British medics working in clinical settings with young people. It includes the medics perceptions of the ways in which young people communicate, the difficulties encountered and the professional response were probed. In addition to understanding the interaction from the medic perspective, the research sought to identify areas of good practice in communication in clinical settings.

How young people communicate – medic perspective and response Gender

The vast majority of visitors to family planning clinics are female. Young men who attend come under the guise of accompanying their girlfriend. Young men who do attend regarding their own concerns find it more difficult than women to communicate with medics.

First impressions

The manner in which a young person enters a consultation indicates their level of apprehension. Some attempt to drag in friends, some march in confidently, while others saunter in nonchalantly. Some pull away their chair from the medic while others pull it up close. Expressions range from uncomfortable to distressed, timid and pensive to confident and relaxed. Medics claim they can quickly discern the extent to which a young person is feeling at ease. They constantly observe non-verbal cues, all the while adapting their approach to the perceived level of ease displayed by the young person. Simply by being human and ordinary, a medic can break down initial defences.

Presenting with friends and relatives

Young clients often appear with friends and relatives. Medics report that it is not uncommon for groups of friends to be noisy in the waiting room. The outward display of bravado usually dissipates once inside the consultation room. Medics are careful to deal with this behaviour sensitively since the cause is typically fear and anxiety.

Friends may accompany the young person in the consultation room. They come to provide moral support or listen to the advice, but occasionally may be an enthusiastic mother, keen that her daughter should receive some family planning advice. Medics always ascertain the identity of the supporting person and ensure that the young person is happy for them to stay. Sometimes the presence of a third party hinders the consultation. In this situation, most medics politely ask the supporter to leave.

Showing fear

Young people are often quite anxious, particularly when attending for the first time. This anxiety manifests itself in a number of ways, including both shyness and aggression. Fear is sometimes disguised behind a pseudo-sophisticated, “I know what I want” attitude, or by feigning disinterest. Medics use several strategies to break down these defences

Avoid asking probing questions which might push away the young person
Interpret how the young person might be feeling and reflect this back to them. For instance if a young person looks distressed, you might say “This is difficult for you isn’t it?” If it is inaccurate, the young person can deny it – and the channel of communication is open.
Gently remind a young person that they can decide what to talk about.
Where an impending physical examination is the source of anxiety, take care to offer concise explanations and reassure the young person that feeling anxious is common, understandable and acceptable.
Reassure the young person by reminding them that you have seen and heard about all of problems and are therefore difficult to shock.

Giving false or inconsistent information

It is not uncommon for young people to give inconsistent information. This may stem from a desire to give the ‘right’ answer (e.g.”yes, I use condoms all the time”), in which case further gentle probing is needed to reveal the truth. However, young people may also be genuinely confused, perhaps due to unfamiliar language. A young person may deliberately withhold the truth, through embarrassment, shame, and fear of being judged or fear of non-confidentiality. Once alerted to inconsistencies, medics have to decide whether to pick up on them. If information is critical to treatment it is unavoidable. Highlighting inconsistencies requires sensitivity if the young person is not to be left feeling humiliated. Sometimes refusal to give information, provision of blatantly false information is not necessarily a sign of non-cooperation. It can be an attempt to remain anonymous. Some medics consider it worth sacrificing the collection of routine data in order to open a channel of communication with a suspicious and anxious young person.

Professional communication skills

Building trust and winning the confidence of young people are important prerequisites to open and honest communication. Several aspects to building trust and rapport are:

assurance of confidentiality, avoiding assumptions, acceptance, listening, patience and non-verbal communication (body language). Assurance of confidentiality is considered the most important aspect of working with young people. They need convincing that information will not be passed on to parents or teachers. Asking young people how they think parents might react gives an indication of the degree of parental support.
Accept that young people are having sex and avoid judging them for doing so. It does not necessitate the medic abandon their own value system but it is necessary to confront their own prejudices and judge whether these interfere with consultations.
Unless a young person is convinced that a medic is listening, and is genuinely interested, they will ‘switch off’. The ideal is a two-way dialogue in which information and advice is tailored to what the young person wants to know and discuss. This requires patience in providing ample pauses so that the young person can interject with their own thoughts.
The ability to be patient is important but must be considered in the light of other things such as queues in the waiting room. However in certain contexts and with certain vulnerable young people there is no substitute for spending time with that young person and slowly encouraging a trusting relationship to develop at a pace dictated by the individual.
Non-verbal communication is important in conveying interest and helping young people feel ‘safe’. Training and experience teaches medics to be aware of the way in which their own non-verbal communication affects the consultation. Non-verbal communication works both ways: the medic observes the young people, and young people will also be observing the medic. Verbal communication is often less significant than non-verbal. It is the gestures and expressions which are the true indication of a persons thoughts and feelings. Consequently, any behaviours a medic displays associated with discomfort will be communicated non-verbally to the group or individual. It is worth practicing alone the phrases and language required for the work before undertaking the session with young people!

Features of non-verbal communication

• Personal distance – individuals often have a sense of what distance from another person feels comfortable. Should an individual move away, they may be feeling their ‘personal space’ is being intruded upon, or are uncomfortable about the group situation or the subject being discussed. In a clinical consultation setting, allow the young person to define their own comfortable distance in terms of where they prefer to sit. This will enable better communication possibilities with the medic. In a group situation, if several members appear physically excluded, change the activity to a pairs exercise.

• Eye contact – making eye contact with another person indicates the medic is interested in what the young person has to say. Prolonged eye contact may be experienced as intrusive and discomfort will result. Position chairs in a clinical setting such that they are at an angle of about 120 degrees and enable both people to look away when sensitive subjects raise the level of discomfort. Returning to make appropriate eye contact will be easy in this position.

• Gestures – are small body movements such as biting nails, wringing hands, playing with hair and fidgeting. They become exaggerated when under stress. When leading a session, it is useful for the medic to be aware of what gestures he or she repeats when nervous and to control them to a degree. Likewise, observing gestures of young people in an individual or group situation will indicate their comfort level with the setting or task. The medic can chose to alter their behaviour or the task accordingly to promote effective communication. When people are upset, it is a natural response to physically reach out and touch them. In most situations this is relevant. However, if the subject area triggering the emotion is one associated with physical matters (such as physical or sexual abuse) resist the urge to touch without permission as this may reinforce and not alleviate the painful issue.

• Expression – like gestures, expressions present the true picture of how a person thinks or feels about an idea or situation. Should a young person say ‘No’ to a question but nod their head in agreement, it is the gesture that is likely to be their intention. Similarly, giggling while relating a tragic or painful story is contrary to the words expressed. This may need to be mentioned to the young person. In a group exercise on assertiveness it is vital to point out that a person who smiles while stating ‘No’ is giving a conflicting message and needs to have the appropriate facial expression to accompany it.

• Closed body positions such as crossing arms and legs often indicate a defensive position presenting a barrier to communication. In a clinical situation it is useful for the medic to be aware of how they present themselves to the young person as well as noting the position of the young person’s limbs. It is not necessary to be over cautious about this as never crossing arms or legs can feel uncomfortable. Relaxed crossing of knees, and feet at the ankles, whilst adopting a natural open position of arms and hands is conducive to good communication. In a group activity, should the medic notice a person appear physically defended, change their role in it or make a general declaration to the group that the task is optional. The medic may wish to remind them also of optional individual time to talk at the end of sessions.

Verbal communication

Developing skill in the type of questions asked will lead to improved communication and ability to seek out the information required for treatment.

Type of question	Example	Advantage	Disadvantage
Open	begins with how, when, why, what. ‘What kind of relationship do you have with your boyfriend?’	encourages person to say more than a few words. Useful with non•talkative clients. Builds good client/medic relationship.	Don’t use with clients who talk a great deal.
Closed	‘You weren’t aware of any symptoms until now?’	clarifies specific information needed by medic and checks out facts given by the client. Useful for talkative clients as it encourages a one•word response.	The question and medic determine information retrieved. Additional vital information can be missed. Does not develop equal communication
Hypothetical	‘How do you imagine a healthy sexual relationship?’	encourages client to think and talk about an alternative behavioural or sexual scenario to their current one.
Statements	You mentioned pain. Tell me more about it.’	‘avoids the consultation resembling an interrogation
Minimal prompts	. ‘Yes..’ ‘I see…’	encourages continued talking. Shows the medic is interested	Medic must be aware when continued talking is not useful for the consultation.
Praise	‘Good idea’ excellent’	helps develop trust.	Medic must take care to avoid sounding patronising.

Environment

The environment has an important role in determining the type of methods and activities used. It also impacts on communication between group members and the medic. Often there is no choice of room and the medic works with what is available. However, if a workshop is planned then it is useful to contact the organisation beforehand and negotiate a room with plenty of space and seating to form a circle. The medic may have to adapt the activities should seating turn out to be benches or fixed furniture. Tables and desks need to be moved to provide space for participatory groupwork.

The following table considers implications of the environment on work

Room layout	Advantage		Disadvantage
Desk/table	provides barrier- improves comfort level. Useful for ‘one•off’ sessions containing sensitive material and in clinical setting with anxious young person.		Barrier prevents easy and effective two-way communication. Promotes passivity that may result in young people not receiving the information or treatment they need.
Rows of chairs	allows participants and medic to feel more comfortable because of barriers. Traditional and therefore ‘known’.		As above. Can be a significant distance between medic and group. Medic may leave the session feeling members are not interested.
Two chairs, no table	in a clinical setting young person has medic’s full attention without physical barrier.		Angle, position and distance of chairs are important. In emotional situations, the medic and young person may feel this is too intimate
Circle of chairs with central floor space	Medic is part of group- removes sense of ‘us and them’ leading to open communication. Encourages individual responsibility for participation.	Less known format. Members mayfeel ‘exposed’ initially.

Conducting clinical consultations

The shape of the consultation session

There are generally 4 stages to a consultation session

1.Establishing contact .Introductions and expectations from the session

2. Exploring and discussing the problem. Developing communication and understanding of the issues from a medical and client lifestyle perspective.

3. Problem-solving .Providing information and options for treatment with consequences. Client makes an informed decision in context of facts and personal means.

4. Exiting from contact. Client leaves with understanding of implementing the decision and information regarding any future consultation.

Beginning the consultation

Most medics begin their consultation with a welcoming, friendly smile. They introduce themselves using their first names and give a clear explanation of their professional capacity. At this stage the priority is to ensure that young people understand what is happening and that they are happy with it. Emphasising the confidential nature of the consultation helps to allay initial fears and helps the young person to relax. It is also useful to acknowledge the embarrassing nature of the subject and to congratulate the young person for having the courage to come to the clinic. The person is now more at ease and the next stage is to determine the problem and the reason for attending. Opening the discussion is a challenge; some ideas to overcome initial anxieties are suggested in the ‘showing fear’ section.

Taking sexual histories and eliciting other information

Many young people, especially those visiting for the first time, find this an intimidating and embarrassing experience. It is essential to avoid raising the level of anxiety which will make further communication difficult. Good communication during sexual history is therefore essential. Five keys to good communication have been identified.

• Permission. Asking permission to take a history. The right to choose is considered to be an important prerequisite to cooperation. More importantly, this demonstrates that the medic respects the autonomy of the young person.

• Explanation. Explain the reasons for taking the history and how the information is to be used. Emphasise that the information collected is confidential. Accept that some young people will still give false information because they are concerned about confidentiality.

• Assumptions. Try to avoid assumptions about answers likely to be given based on appearance, attitude, family situation, area of the region the person comes from etc. Try to avoid leading questions which will engender biased answers.

• Conversation. Make the procedure as informal and natural as possible. Insensitive questions may lead to a refusal to answer further questions. It is not always necessary to stick rigidly to the history sheet as information is often offered freely during the natural course of discussion. This is gained through experience and confidence.

• Timing. Building rapport with a young person before launching into a history decreases the likelihood that the young person will feel alienated during what is regarded by many as a formal and intrusive procedure.

Giving explanations

Young people are eager for information, and those who actually make it through a door of a family planning centre want to use the opportunity to learn as much as they can. Skill is needed by medics in offering information appropriately.

First, the level of detail offered in an explanation to a young person should be tailored to pre-existing levels of knowledge, ability to comprehend and apparent level of distress. Recognise that a young person may be reticent to ask questions and it is essential to provide a non-threatening environment to encourage questions being asked. Leaflets can back up discussion when young people are shy about asking questions. Often more intimate questions (e.g. about their own bodies and what is normal) arise only when rapport has been established. Many young clients are concerned about the nature of ‘go‘good’ sexual activity and quality of their relationships. Medics must treat these questions as equally valid.

Note-taking

Information in clinical settings needs to be recorded. The medic may also need to write notes as part of a group activity. Such activity by the medic may be experienced by the young person or group as an unwillingness to relate with them. Explain to group members why this is required for the work and endeavor to maintain maximum eye contact with people throughout. Reducing the writing to a minimal level and making additional notes after the session allows more time to work with young people in the session. This must be balanced with time constraints for consultations.

Language of the medic

Medics should seek to adapt their language to the level of ease and understanding shown by each individual. Ideally they should aim for a repertoire of language that is accepted and understood by both parties. Both the ‘street language’ of young people and medical jargon should be avoided, as these risk causing misunderstanding and offence. In establishing this repertoire, medics should be alert to possible misunderstandings and positively encourage requests for clarification of terms. It is easy to talk in vague terms about sexual activity with both parties assuming that they know what the other is talking about and not checking out the reality (some young people will acknowledge the words ‘the sex act’ but have never had the mechanics explained to them). It is the professional responsibility of the medic to support young people in developing their language and understanding of sexual activity to a level where effective and useful discussion can occur.

Improving treatment outcomes

Consultation sessions require a change in attitudes and behaviour of both people involved; there should be a more equal balance of talk in the session. If medics know more about the young person’s situation and concerns, they can identify and clear up client misunderstandings and improve their use and understanding of the treatment methods. For some young people, they may have rare opportunity to attend a family planning clinic due to distance, inaccessibility and the cost involved. It is important to ‘get it right’ the first time. Young people may have more confidence in a decision that was based on a consideration of their needs and lifestyle and therefore may be committed to following through with their treatment.

4 steps to improvement

• Young people need to consider their options and which best fits their needs. Medics need to relate information to the young person’s individual situation and focus their discussion on what is appropriate and of most interest to the young person.

• Young people need to understand their own needs and priorities Medics need to encourage young people to make a self-assessment

• Young people need to consider the pros and cons of using and adhering to the method

of contraception or treatment Medics need to provide guidance on the method of use or treatment plan and question the young person’s understanding of what is prescribed and its application to their lifestyle.

• Young people need to know when to return and what to do if there are problems.

Medics need to provide complete information including specific details of what problems might occur as a result of the treatment or method.

Additional factors that promote improved clinical consultation sessions

In the waiting area whilst waiting to see a specialist can provide an educational opportunity for young people in the following ways

– Information can be given through leaflets and in a pictorial format for various ages and development levels using posters, cartoons and comics.

– Information about the process of consultation: whom they will see and what will happen- using leaflets, cartoons and diagrams.

– Instructions on how to ask questions of the medic about their health and

treatment. How to ask if they don’t understand information.

– Display the ‘Patient charter of rights’. These provide information to the young people concerning expectations from the medic, young people, and the style of consultation. It promotes client participation and encourages interactive partnership. These additional considerations help reduce potential tensions and the overall length of time required in the consultation session.

GROUP WORK

Group work may take place with a small number of 3 people to a much larger gathering of 30 or more. For many professionals, talking in a large group setting and working with small groups can be an experience that raises anxiety. The ideas for planning preparation and communication in this pack may help reduce some of the concerns. However, it is practice that will provide confidence and experience!

Confidence with groups

Prior to starting sex education work with young people, it is advisable that the medic identifies their own level of comfort with the subject areas. Completing the form below helps with this. Other ways to reduce discomfort are

– Practice saying aloud the words (for example, terms used by young people to describe private body parts) when alone.

– Record the words into a tape recorder and listen to yourself

– Watch yourself saying them in front of a mirror

– Draw pictures and label them

– Perform all the above with a trusted colleague, friend or partner. Allow yourself to laugh and work through the discomfort.

Comfort with sensitive topics

How comfortable are you in discussing the following topics with young people?

Topic	Very comfortable	Somewhat comfortable	Not comfortable
How HIV is transmitted
Sexual intercourse
AIDS
Condom use
Delaying sex
Male sexual organs
Female sexual organs
Injecting drug use
Varieties of sexual behaviour
Unplanned pregnancy
Contraceptive methods
Sexually transmitted infections

Scoring procedures – comfort level

A high score on each item indicates a high degree of comfort and a low score indicates a low degree of comfort. The following scale should be used to score items (the minimum score is 12, the maximum score is 60). Very comfortable: 5 Somewhat comfortable: 3 Not comfortable: 1

Qualities of the sex educator

Personal attributes and attitude of the medic and the relationship of the medic to young people impact on the enjoyment and effectiveness of sessions. Young people identify those medics who are reluctant sex educators and those who have neither the confidence nor the skill to cope with this topic. The most important attributes are an open, relaxed attitude, a sound knowledge base and a non-shockable demeanor. Young people sometimes prefer ‘outside’ educators as they can take risks in sessions with people they do not have to see the next day. Age, gender and position impact on group dynamics and medics must adapt an appropriate role in the group. Older medics face the challenge of showing an appreciation and interest in the culture of young people without compromising their authenticity as adults. Attempting to be fashionable and young may embarrass and patronise young people. Younger educators are likely to become involved in the sexual dynamics of the group, while older medics may adopt a more maternal/paternal role.

Challenges from young people

The classroom atmosphere

Young people may react to sex education sessions in different ways. They may:€ Ask baiting questions (to try to embarrass the educator).€ Remain silent because of embarrassment.€ Shock or try to amuse by describing sexually explicit behaviours.€ Ask very personal questions about your private life.€ Make comment that open themselves to peer ridicule or criticism.€ Dominates the conversation

Is critical of others; puts other people down, usually to make himself/herself feel
superior
Tells others what to do most of the time
Often interrupts other people
Does not participate in group activity
Chats about things not related to the activity

To deal with these situations it is very important to set group rules. The young people can develop their own or a list could be provided for discussion with young people if they are fair and why they are important. The agreements are better adhered to if written on a large piece of paper (wallpaper) and placed in view during each session.

Suggestions for basic group rules with young people

No put-downs (negative comments)
Only one person talks at a time; no interrupting of others
Everyone has a right to ‘pass’ (to decline to discuss or disclose a personal issue)
Keep on the topic; no side discussions on other topics; and
What you say stays here (information is confidential)

Remember to give full explanations of confidentiality and disclosure.

It is vital that rules apply to both staff as well as participants. Agreeing to prohibit inquiries about personal information protects everyone from disclosure and embarrassment. Young people may be offered the possibility of putting their questions anonymously to the medic. Many young people laugh and giggle about sex. This should be allowed in the beginning, as it lowers the barriers when discussing sexuality.

Ways of dealing with problems in groups

The following strategies may be used to deal with personal questions, explicit language and inappropriate behaviour.

Respond to statements that put down or reinforce stereotypes (for example,
statements that say women are available for sex because of the way they dress) by discussing the implications of such statements.
Calmly remind young people of the agreed ground rules that apply to all: “We agreed not to discuss or ask questions about group members personal lives. That includes mine.”
Be assertive in dealing with difficult situations - for example, “That topic is not appropriate for this session. If you would like to discuss it, I’d be happy to talk to you after the session”.
Avoid being overly critical about answers – so that young people will be able to
discuss their opinions openly and honestly. € Present both sides of a controversial issue. Avoid making value judgements. € It might be important to have single sex groups for activities that might be embarrassing or where separated groups may function more efficiently.
If there are disruptions, politely remind the group that there is a task or problem to solve as well as a time limit
Respond to those who interrupt by saying, “Excuse me. Just a reminder that everyone in the group has a right to speak without being interrupted”
If the behaviour is so disturbing that it can’t be ignored, deal with it in the group. Criticize what is being said or done (not the person responsible for the disruption or making the disruptive statements). Point out how the behaviour blocks the group from functioning well.
At the end of the session, lead a discussion on how the group is doing. Try to do this in such a way that feelings are not hurt.
Complete the activity ‘Dealing with behaviour in groups’

Finally, many young people associate a medic wearing a white coat with power and authority. This could create a barrier to effective communication whilst in their school or club environment. The medic must consider the image they wish to portray with young people and the best way to interact with them.

DEALING WITH BEHAVIOUR IN GROUPS

This activity can be undertaken after discussion on dealing with behaviour in small groups.

1.Place people into groups of 3 or 4. Give each group one of the following situations.

2.The group is to brainstorm solutions for 5 minutes.

3.The group is to decide on the best solution and feed this back to the whole group.

Situation 1

The group has been together for a few sessions now and it is quite clear that Ivan dominates the others. He talks most of the time and when others say something, he does not pay attention.

Situation 2

Katya has been very quiet during the first group meeting. However, suddenly she becomes very critical of the other group members. She made rude remarks to one person in particular but also objected to opinions expressed by the rest of the group.

Situation 3

Michael is a little older than the others in the group because he failed an earlier grade. He tells people in his group what to do and how to do it. No one has objected to what he is doing but you can tell they are not happy about the situation.

Situation 4

Lena is not really interested in the class. When she is in the group she acts ‘bored’ and seldom makes any suggestions to the group. At other times she tries to talk to someone in the group about something completely off the topic. If others do not join her she becomes disruptive

Follow-up questions

After each group has fed back, discuss the following questions as a whole group activity:

1.Which 2 of these situations would be the most difficult to deal with? Why?

2. Which of the solutions offered by people here are likely to be the most effective? Why?

3.Discuss ways of reinforcing or supporting someone who is trying to behaviour in a group working on a task.

Helping the anxious young person

It is helpful for medics to think ahead of how they might respond to young people in the class who believe they may have been exposed to a sexually transmitted infection including HIV or have had unprotected sex. It is important that the medic behaves in such a way that young people who are worried will feel comfortable seeking their advice.
Responsibility in teaching a sex education program includes learning in advance what help and services are available in the community.
Medics must listen to the young person without imposing their values, moral judgements or opinions. They must not ask leading or suggestive questions about his or her behaviour.
They must convey concern for the young person’s health and when appropriate, tell the young person that they know of services that can help him/her. The medic can offer to start the process by contacting the one the young person chooses.
The medic must be aware of the tone in which they speak to the young person and avoid sounding patronising or authoritarian.
Continue support by being available by telephone during working hours, or if there are more sessions, confidentially ask the young person if they need further information or is still concerned about anything related to the conversation.

Giving information and making referrals

Many workers with young people feel they have a particular responsibility to provide accurate information on health issues including the social and psychological aspects. This leads to several pressures:

• A feeling that ‘I ought to know’ about a whole range of issues

• A need to know that information is correct

• A need constantly to update informationBut information is not always available. Views about what is accurate change frequently, as do views about what young people need to know and how they will learn it, which can lead to censorship and confusion.Specialist health and educational advice sessions and help-lines need to be established locally to support young people learning in these areas.

• Make a checklist of all known contacts likely to be of use

• Make a checklist of books, articles, and leaflets that may be useful and where they can be obtained.

• Practice saying ‘I don’t have that information today but I will find out for the next session.’

• Create a home task for young people using suggested contacts for discussion at the next session.

• Structure a questionnaire with young people to find out the responses to questions from their peers or family members.

• Invite representatives of outside groups and agencies (STI clinic, health clinic, and so on) to take part in a forum on young people’s needs or to speak about their work.

• Use case studies to check participants knowledge, to give practice in finding things out and to illustrate the kind of situations where making a referral is necessary

Case studies: information giving and referall

The following may be used in an adult training session. For example, what is the role of the medic in the following situations, and where else might young people get support? They may also be used for teachers, youth workers and young people themselves to consider where advice and support may be sought.

Discuss what might happen to standards of confidentiality where more than one agency or a variety of people are involved with a young person. How can confidence be safeguarded?

PLANNING

The process and structures used to pre-plan and organise workshops; meetings and sessions with young people are the same as those with staff and parents groups. The pack highlights differences relevant to each (for example, age, development, experience and lifestyle differences) but the principles are similar. What is suggested in working with these groups can be adapted and transferred to each other.

Terminology of planning programs and delivering sessions

Program A structured series of sessions that considers all related subject areas and includes all age groups. It sets out theory and practice, overall aims, and time allocated to the various elements.

Session A well planned lesson focusing on one or more aspects of a particular subject area with one age group.

Plan A structure of the session that provides activities related to the aim and objective. It considers pace and variety as well as information and teaching points. Facilitators refer to it during the session to maintain focus and good timing.

Aim A concise summary of what the medic aims to teach.

Objective A breakdown of the aim into 2 or 3 points focusing on what the young people will learn as a result of the teaching.

Monitoring Regular consultation with participants to maintain or review the program aim and objectives.

Evaluation To provide evidence of the program’s effectiveness measured against the original and revised aim and objectives.

Method What types of activities the medic uses to teach the information.

Facilitate Skills used similar to those in individual consultation that encourage partnership, individual responsibility for learning, promote sensible decision-making and apply facts to individual needs and situations.

Co-facilitate More than one person is involved in delivering the session. Sharing activities or leading them must be negotiated in the pre-planning stage of a session.

Assessment As previously stated, assessment is essential for the medic to have a clear understanding of where to begin the work with a particular group of young people. It has a similar function to individual clinical consultation: to find out the problem and provide appropriate treatment, or in this case, educational response.

Purpose of assessment

• Defines group knowledge

• Identifies gaps in learning

• Provides consultation on what young people need to know Assessment clarifies

• Course aims

• Objectives relevant to what young people will learn

• Content of the course and any specific issues for the group Assessment creates focus

• Medic plans what is needed rather than everything or too little

• Medic does not give what the group already knows

• Young peoples experience and skills are utilised for the benefit of the course.