Objectives

Training frontline providers to effectively:

  • Acknowledge the range of beliefs and attitudes about abortion among their peers, at work, and in their community.
  • Remember how it feels to be misunderstood, and to behave in a principled fashion despite that misunderstanding.
  • To identify ways that their workplace can become a more supportive and respectful environment for all staff and clients.
  • Place abortion in the context of normal reproductive health care.

Duration

60 minutes, including:

  • 10 Minutes: Introduction to the Module
  • 25 Minutes: Activity: Champions of Mutual Respect
  • 25 Minutes: Activity: Site Self-Reflection

Materials Needed

Introduction to the Module

(10 minutes)

Materials: Power Point Presentation of STAR Module

After welcoming the group and introducing yourself:

  1. Remind trainees about the referrals training sessions they have attended thus far.
  2. Using the Power Point presentation of the STAR Module, stress the importance of the STAR model for making effective referrals (especially when dealing with special topics in reproductive health care like abortion) and go through the elements of STAR referral-making.
  3. Acknowledge that making STAR referrals for clients/patients could lead to judgment in the workplace.
  4. Explain that the next activity is geared toward creating an atmosphere of mutual respect in the workplace, especially around referral-making.

Note

This exercise may feel repetitive when participants are being trained on the entire curriculum in one day. If that is the case, trainers should modify accordingly.

Champions of Mutual Respect

(25 minutes)

Participants describe cases that may generate judgmental comments or stigmatizing behavior, including from co-workers. They identify ways to strengthen a culture of mutual respect at work, including for abortion referrals.

Materials: Flipchart and markers

  1. Mention that the previous sessions have brought a few issues to light. Remind them that:
  1. The goal is to serve clients, which includes honoring their autonomy and confidentiality.
  2. Most of us have experienced judgmental behavior from providers, and this experience felt really bad.
  3. We all also have diverse beliefs and attitudes about the decisions that some clients make (such as terminating a pregnancy or having unprotected sex).
  4. Being aware of our own values can help us be supportive and nonjudgmental in interactions with clients, and respect client autonomy.
  5. Sometimes our referrals, or even our judgments, can be influenced by the information we hear, so being sure of the accuracy of our information can help us develop confidence and comfort that we are making STAR referrals.
  6. Providers themselves can sometimes feel misunderstood for providing care to certain types of clients or referrals for certain types of services.
  7. Providers could feel vulnerable because referring for stigmatized services could be an indicator of their personal beliefs to others.
  8. The reality is that co-workers, family, and friends may or may not know where a provider stands when fulfilling their client-centered professional responsibility to make a referral.
  1. Explain the purpose of the session is for participants:
  1. To explore what can happen when providers feel misunderstood while carrying out their professional responsibilities.
  2. To consider what it means to have an environment of mutual respect—in one’s community, and at work.
  1. Ask for examples of judgmental comments or misunderstandings they have heard—in their neighborhood, church, or community about:
  1. Certain types of clients who attend their agency? Or clients seeking certain types of services? [Probe if they have ever heard judgmental comments about women seeking abortion.]
  2. Ask if they have ever heard such comments from someone who knows they provide care to these clients [including for women seeking abortion].
  1. Shift to exploring whether misunderstandings sometimes even arise in the work setting. Acknowledge that we like to think that every single client gets equally supportive, thorough, respectful care—no matter whom they reach at the worksite. Ask if that’s always the case in reality.
  2. Ask them to think about (but not reply verbally) if they have ever heard anyone in their work environment make derogatory comments about:
  1. A certain type of client (based on, for example, the client’s religion, gender identity, race, physical appearance, nationality, or other social factor)?
  2. A person seeking a referral for a certain type of service?
  1. Have participants to take out a piece of paper (or pass out sheets). Ask them to jot down:
  1. An example or reflection about this kind of judgmental behavior in their work environment—whether by themselves or by someone else—and to describe it in a few words (but not to refer to anyone by name, nor sign their own name!)
  2. If they think everyone in their work environment is always respectful toward all clients and their choices, they should write that. They should then instead write an example of judgmental comments or behavior by someone in their lives outside of work (e.g., at church or home). If they cannot think of any examples in their lives outside of work, they should write that.
  3. Allow a moment for them to finish, then ask them to fold their sheet of paper in half.
  1. If you are working with trainees from the same site, tell them this will be anonymous, that you will collect the slips and read them yourself.
  2. If you are working with trainees from different agencies and feel confident that anonymity can be preserved you can read them aloud.
  1. Collect the sheets or slips of paper, and share the examples back with the group:
  1. If you are working with trainees from the same site: Read aloud the examples of judgmental attitudes and copy them onto a flipchart.
  2. If you are working with trainees from different agencies: Redistribute the slips and ask participants to read aloud the slip of paper they receive.
  1. Ask: What effect can this have:
  1. On the staff member who feels judged for making referrals or serving clients disparaged by other staff members?
  2. On the overall work environment?
  3. On the way people feel about the work they do?
  4. On providers’ comfort and ability to make referrals and to serve all clients?
  5. On clients?
  1. Shift to discussing ways to ensure a mutually respectful workplace.
  1. Ask if difficult situations of this kind have to be a part of our experience.
  2. Remind participants that staff members may not feel safe to address derogatory comments or stigmatizing behavior directly; that is how stigma works. However, all staff can contribute toward a more respectful environment and can be champions of dignity.
  1. Seek concrete suggestions for ensuring a safe and respectful work environment:
  1. If participants are from the same site:
  1. Encourage an open discussion of items to address or ideas for improvement, to feed back to supervisors.
  2. Clarify and emphasize the underlying principles at stake: respecting each other’s’ feelings and right to their beliefs; complying with professional responsibility, including to ensure attention to clients’ needs and autonomy.
  3. Record these principles on the flipchart to share later with the supervisor.
  1. If participants are from different agencies: review some of the steps for strengthening mutual respect and support for referral-making within the workplace environment:
  1. Identifying if there is a problem (the problem may be hidden).
  2. Clarifying and emphasizing the underlying principles at stake: respecting each other’s’ feelings and right to their beliefs; honoring clients’ needs and autonomy.
  3. Providing solidarity to staff; reminding all staff that stigmatizing attitudes usually do not reflect the norm; finding ways to cope (or help others cope).
  4. Developing organizational personnel protocols (or quality of care/best practices protocols) to give staff clear guidance and expectations.
  5. Sharing accurate information that can help staff overcome myths, and develop greater comfort to make STAR referrals.

Site Self Reflection

(25 minutes)

The Site Self-Reflection Activity should be used in every training whether or not Module 5 is completed. Substitute the Systems Activity in Module 2 for this activity if you are not presenting Module 5 during a training.

Materials: Site Self-Reflection Checklist (one for each participant), flipchart, markers, paper, and pens.

  1. Explain that this exercise will help the participants identify areas in which their site is implementing high quality referrals for patients/clients with an unintended pregnancy and it will also help identify where the site could use some support to strengthen referral practices.
  2. Distribute the Site Self-Reflection Checklist. Walk the participants through the Checklist using the PowerPoint.
  3. Divide participants into groups of four or five. (If the total number of participants is too low to divide the group, the activity can be done with the entire group.) Tell the participants that they will need one person to take notes and report back to the full group.
  1. Give the group five to ten minutes to discuss:
  1. Referral practices they already have in place
  2. What the site is doing well
  3. Where participants see the need for improvement
  • Ask the participants to think about how things change at their site and pick the areas where they need help or improvement that are most likely move or change.
  1. Bring the group back together and have each group share what they discussed. Ask each group to explain what the site is doing well.
  1. On a piece of flipchart paper, write what the site is doing well to facilitate abortion referrals for patients/clients.
  2. Give participants praise for what they are doing well.
  1. Next, ask the groups to share what they discussed about areas where the site needs improvement.
  1. On a piece of flipchart paper, write suggestions for what the site could improve to facilitate abortion referrals for patients/clients.
  1. Ask the participants to think about how their site has handled change in the past. (This should be a relatively quick brainstorming session.)
  1. Do things change easily?
  2. Is there often resistance to change?
  3. Does change come from the top down, bottom up, or both?
  4. Who are the people that need to be on board in their site for change to occur?
  5. Given how things change at their site, which of the areas needing improvement seem most likely to change?
  1. Ask participants if outside technical assistance would help facilitate that change.
  1. Ask the group what kind of technical assistance they would need for that change to happen.

Note

It is very important to take detailed notes during this activity to ensure delivery of effective technical assistance after the training.

  1. Mention that Provide can offer follow-up technical assistance in some of these areas and explain that trainers will be in touch with the site director to discuss how to aid the site in making changes to facilitate abortion referrals for patients/clients.
  2. Close by honoring the work that these frontline workers do on behalf of their clients.