In Aravind Eye Hospital the patient cousellor training will be held for 10 days we have provided you with the details of what should be done on each day. This can be modified based on the Individual needs.

Day 1

Introductions (ice breaker exercise - relax persons - maybe tell the dolphin story)

Orientation to the course goals and objectives and structure (lecture by Senior Leaders - what the expected outcome of the course is, what knowledge and skills they will develop and need to practice as PCs)

Orientation to Aravind Eye Hospitals Philosophy and Model (interactive questioning - ohp or white board - develop a list of what the hospital is trying to do - tour the hospital facilities and observe staff at their roles - broad goals and objectives - quality eye care - ask participants what it means to be a satisfied patient from their perspective

Participants expectations for the course (interactive - ask what they hope to get out of the course - help participants to clarify their objectives and presenters to know more about participants needs)

Homework assignment (readings on the eye)

Day 2

Evolution of the PC program (a brief history of the development of the program helps to demonstrate the need / rationale for the program - Participants will develop a clear understanding of the PC program goals and objectives and how it fulfils different functions - the program is described in greater detail - in the different areas of the hospital for different purposes - a unique model adapted to the needs of the hospital and the patients - the values of better quality, more productive and efficient, and more accessible care are connected with the PC - ohp provided - lecture notes and role play provided)

Clinical orientation - Introduction to the eye and eye diseases and onset - the lecture will be geared to the patient counsellors perspective - of needing to become knowledgable on the eye from the patients perspective - review of central topics with in-depth homework assignments for when they return to their work place - a comprehensive list of specific eye problems and fixes needs to be developed for participants to have a study guide - lecture format - testing from a list developed by the PCs of common questions - review correct answers - medical alert indicators
  • anatomy of the eye
  • eye diseases and problems
  • special needs patients (hypertension, diabetes, etc.)
  • medical treatment in eye care
  • other eye care questions and answers
Group activity - the objective is to experientially feel what it is like to be blind and what it is like to have to attend to a blind person - an exercise they each have to do - go by some bananas and return - share their feelings - experiences in group - other role play or exercise as time permits.

Homework assignment

Day 3

Process and Principles of Counselling - the process of counselling is introduced as it is widely understood. Then the concept is introduced of counselling that has evolved at Aravind - is adaptive to meet the needs - goals and outcomes of each are compared and contrasted, focusing on the difference between a person who wants to see a counsellor for a personal problem and a person who comes for an eye operation and has to see the patient counsellor - concepts of engagement, assessment, interventions and planning are introduced and developed - the overall role and process of counselling in developing a trusting helpful and safe relationship is examined and applied to a hospital model - process outcomes and other outcomes are reviewed

Observation at Paying Section - to see how it done at Aravind - a work in progress - consider physical space needs and limitations - observe staff interactions with patients - discuss roles of the PC - who are they helping - how are they doing it - how could they be doing it better - how could you do it better at your facility

engagement - the important role of establishing a helping relationship is explored in the engagement phase - the greeting and introduction is closely viewed - an exercise needs to be here - PCs have the opportunity to develop self awareness and insight into their familiar patterns of communication and approach to others and are introduced to the concept of empathy -

assessment - in order to help one has to know where to begin - participants learn by asking and listening - doing assessments on each other - how assessment factors into the PC role is explored - what questions are asked depend upon what is looked for - what are common patient needs (looking at needs from differing perspectives of the patient and the doctor or hospital - assessing physical, emotional, informational needs of patients - a brief lead in to how we see problems or assess for need depends upon our model of human nature and development - a brief format of eye patient needs assessment

interventions - the intervention begins in the engagement phase and is a function of the quality of relationship developed through empathic communication (receiving and giving information with empathy) - to intervene is to influence in some way the decisions, feelings, behaviors of others - interventions can be specific tools of the trade - like knowing when to listen and when to talk - what to say and how to say it - are often tasks like giving information -

planning - the final stage in any social worker interaction - a concrete plan of action - specific next steps toward achieving the goal - requires inputs from patient and creativity on part of the PC - can include homework assignments - commitments to follow through with tasks or ideas developed in the session - discussion of how planning is relevant for PCs - what things do patients need to F/U with and how to help them do it

Homework assignment - read handouts on empathy, Carl Rogers and the Person-Centered Approach

Day 4

Understanding and working with Empathy - How can I help empathy skills training module is prepared - start with a story of empathy - ohps are prepared - exercises and role plays can be further developed on the following topics :-verbal and non-verbal communication - empathy dos and donts - active listening and attending methods - focused of feelings - attitude of genuine caring, interest -no personal agenda or need to change another

The role of the counsellor - attitude, wisdom and knowledge -what are the qualities of an effective counsellor - driven by an ethical code - the kind of person that knows how to listen, non-judgmental - with compassion with professionalism - seeking to understand others feelings and values and ideas - seeking to understand self (self-awareness) - character / professional development are required - interpersonal skills in communication

Models, Methods and Techniques - an overview of models relevant to the PC role - how we think about the nature of things (human development models) determines how we try to help (process theory models) -Person-in-Environment approach sums up the values distilled from many models which include
  • person-centered approach - Carl Rogers : an empathic way of being
  • communication theory - tools of effective communication
  • human development and growth - Eric Erikson : a developmental approach
  • transactional analysis concepts and uses
  • cognitive-behavioral theory
  • social learning and role theories
  • observable psychiatric diagnostic categories / illnesses (DSM-IV)
  • genetic / biological / medical causes of behavior.
each of these are described for ten to fifteen minutes with ohps. - discuss how different models are more or less relevant in different situations - exercise : match the model to a situation

Communications Theory and Methods - a theoretical model of communication is reviewed involving sender, receiver, message, barriers - rules of good communication - speak less, think more - review of styles of communication (exercise-explore with the group some different syles of communication - different styles prefer certain communication - universal themes in communication - small talk - straight talk - control talk (heavy and light) - explore talk.

Practising Empathy and Communication Skills - more exercises based on common patient / PC interactions - difficult situations with patients

Day 5

Patient Counsellor Functions and Tasks - the actual nitty-gritty of what the PC does day in and day out is review in theory and then by observation - the goals and objectives and job description of the PC is reviewed (ohp) - there is a broad look at differing functions of the PCs which include
  • psychological / mental, emotional counselling
  • medical / educational counselling
  • social influence / motivational counselling
  • organizational / patient management
-differences between paying and free section (patients, needs, etc.) is explored along with their similarities - discussion of adapting to the differences between paying and free patients - the list of roles and responsibilities is gone through with questions or additional explanations - specific guidelines for performing the job in the paying section (op and ward) and the free section (op, ward and theatre) and eye camps

Observations at the Free Section - to see how it is done at Aravind - a work in progress - consider physical space needs and limitations - observe staff interactions with patients - discuss roles of the PC - who are they helping - how are they doing it - how could they be doing it better - how could you do it better at your facility

Homework - read the article on medical social work,

Day 6

General Patient Counsellor Guidelines - using accurate empathy - demonstrating respect and genuineness - not confrontive or challenging - not overstepping ones boundaries - understanding eye patient specific issues with respect to barriers to care
  • exploring common patient scenarios and appropriate interventions
  • giving information to fix the problem versus...
  • listening to the patients concerns and helping them to cope with issues like
the permanent loss of vision (staying with their feelings and offering proper assurances / encouragement - list of general dos and donts as a PC

Medical Social Work - the concept of helping certain patients to adapt to change - improve treatment compliance, discharge planning for recovery, issues involved and how a PC can help a patient to prepare - as a referral source for outside assistance - goals and objectives - discharge planning -detailed instructions for counselling in specific areas -specific issues to medical social work at Aravind

Motivational Counselling - making it simple and brief - interactive with the patients - dont tell them what to do, ask them what they can do - giving them an opportunity to help others - understanding obstacles faced by the patients - problem exploration - review of research (interactive, role play) - form complete list and role play interventions - use Guidelines for motivational counselling handout - distribute vision quest brochure - discuss how this brochure or others like it can be introduced


Day 7

Observation of Eye Camp Counselling

Day 8

Challenges for the PC role- examples of the unique role of the PC as an emotional counsellor are given - telling how rewarding it can be - also how challenging it can be - role confusion, competing status, work load, excessive demands and competing objectives for different roles - a stress management and reduction component is included in the training - coping methods : understanding stress and stress reduction techniques (job stress ohp provided) lecture notes on identifying and dealing with three sources of stress, personal, interpersonal, and organizational - an exercise for developing self-awareness of attitude and expectations role in creating stress
Self development and awareness - participants are asked to describe themselves, and how they think others see them (write your answers) - a personality test is given to help participants explore their own patters of behavior - techniques for dealing with stress are given and practised

Day 9

Develop an implementation plan - the learning of the past several days is integrated and steps to functionalize the program are undertaken in the following areas - strategic planning, operational planning, physical facility planning and resource development

Day 10

Presentations by participants
Topics for Continuing Education of Patient Counsellors
  • helping persons with mental illnesses, identification and diagnosis
  • assessments and referrals
  • helping depressed persons
  • helping anxious persons
  • helping personality or thought disordered persons