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This module is intended to help facilitators prepare to deliver Care for the Caregiver workshops. It consists of the following sections:
Setting the Stage
Care for the Caregiver workshops have two purposes: they are designed to educate, and to support. Creating the appropriate environment to realize this dual purpose is crucial to the success of your program. The information presented in each workshop will focus on the needs of caregivers. It will enhance their existing skills by broadening their knowledge base.
All the information needed to conduct Care for the Caregiver workshops, consisting of six sessions, is found in this Manual. Each module includes objectives, agenda, educational content, and readings. An overall evaluation form is found in Appendix 5. The evaluation forms provide an effective method for feedback on your program. Both process and content must be evaluated to give an accurate reflection of effectiveness.
The first session is crucial in setting the tone for the remainder of the program. Facilitators are encouraged to be very clear about the program format. Attention must be given to the expectations of both the facilitators and the workshop participants. The workshops are designed to increase the "comfort levels" of all who participate. Remember: small things can make a big difference. Extra efforts by a facilitator will be noticed and appreciated. For example, providing cookies with juice, tea and coffee is a welcome touch at break-time.
Introductions
The facilitator should introduce him/herself and explain a bit of his/her background to the group. Ask participants to introduce themselves and share a little bit of information about themselves, including what drew them to the workshops and their caregiving situation. They may also be invited to share what they hope to gain from the sessions.
Optional Introduction and Ice breaker exercise: An option that facilitators may wish to try is to ask participants to choose a partner (someone they don't know) and "interview" each other for about 5 minutes each to acquire the information suggested above. The "pairs" are then asked to introduce each other and share the information. This helps serve as an "icebreaker" as well.
A word about expectations....
As part of the introductory session, it is helpful to ask participants what they hope to gain from these workshops, what topics they hope will be covered, and why they came to the workshop. This offers an opportunity for the facilitator to ensure that there is a "good fit" between content and expectations.
This exercise helps the facilitator to gauge "where the group is at" - that is, identify their needs, their level of knowledge or understanding, the issues most germane to the audience, and perhaps the type of case examples or situations that may be most relevant and meaningful. It will help the facilitator prepare for future sessions and fine tune the presentation topics and focus. The facilitator may decide to bring a guest speaker or provide more handout materials on a particular topic the group wishes to explore. This might also help identify gaps that could be filled before the end of the group sessions or may suggest topics for future workshops. The participants benefit by engaging in the learning process to ensure their needs are met and getting clarification about the topics to be covered (e.g., some topics may be outside the scope of the sessions or there may be insufficient time to cover them). The facilitator should acknowledge the group's expectations by charting or making a mental note of them and clarify what expectations will be met, which topics will be covered and which may have to be addressed in another way.
A word about Ice Breakers...
Many facilitators have a favourite "ice breaker" that works for them. Ice breakers can be an effective means of dismantling natural barriers among individuals in the group, increasing the comfort level of the participants, establishing rapport, promoting interaction, and preparing people to work or share with each other, depending on the purpose of the gathering. It is a short, quick exercise to be used to open a session. It is intended to set the stage for further group discussion, team work, or individual sharing by creating a climate in which people feel comfortable communicating with each other. An ice breaker can be one of the tools a facilitator uses to help set a positive tone and create a supportive learning environment for participants. Ice breakers are useful as a starting point to open dialogue and are often humourous but facilitators should avoid any exercise which makes people feel silly. Also avoid overuse of the technique (using more than one or two) as people will quickly tire of the exercise. Note that the first module includes a sharing component which also goes a long way in establishing group rapport.
Some ice breakers or exercises have specific objectives, in addition to simply promoting group interaction and increasing comfort level. They are chosen with an intent to illustrate a particular message or point and this message is an integral part of the learning objectives.
Participatory Guidelines...
Part of setting the stage is to begin with a set of "rules," agreements or operating principles and practices which will govern the group's interaction over the course of the workshops. It is recommended that these be generated by/in discussion with the group, to get group participation and commitment to the rules, and then recorded on a flip chart. There needs to be a process whereby these "Rules" are collectively adopted by the group to ensure the agreement of participants to abide by these rules during the sessions. While several ideas may be included, typical "rules", for example, often include:
Respect - that all participants will respect each other's point of view, treat each other with courtesy and allow opportunities for all to speak (as they wish).
Confidentiality - that information shared in the confines of the group is not to be shared outside the group unless expressly permitted by the person(s) to whom the information relates.
Exceptions to Confidentiality include those situations where there has been or is a risk of harm, whether threatened or actual, to others, particularly a child or vulnerable adult. The group should be made aware that if there is a disclosure of potential harm or abuse or neglect of a vulnerable adult, the facilitator may be obligated to report this to ensure the protection of the victim. All jurisdictions in Canada have laws requiring the reporting of suspected abuse or neglect of a child and some jurisdictions have legislation mandating reporting of abuse or neglect of a vulnerable adult or "adult in need of protective services".
Creative Tools
It is recognized that the potential for learning is enhanced when several methods - not just one - are employed to disseminate information. Several tools and techniques may be used: lectures, dialogue, overheads, videos, small or large group discussion/exercises, case studies to test application of new knowledge and written information in readings or flip charts to record ideas.
Employing a variety of methods throughout the program ensures that different learning needs will be addressed. Visual aids reinforce what is being said, for example.
All methods must encourage an interactive approach between participants and facilitator. Relevant examples reinforce general concepts, helping to draw on people's personal experiences.
Profile of a Facilitator
The facilitator must prepare for the sessions by reflecting on the roles and skills of a workshop leader. In facing this challenge, the facilitator will need to draw on his/her own resources to effectively teach new skills to caregivers, and to enhance skills they already possess.
The facilitator must ensure a "safe", comfortable environment for the caregiver participants. The participants must be able to share their experiences and their feelings in a supportive, non-judgmental atmosphere. Many issues of caregiving have emotional overtones covering a wide range of feelings. The facilitator must be sensitive to the feelings of members of the group, be alert for cues of emotional distress, and respond in a caring manner. Keen observational skills are required for this role.
Facilitators must be tactful when addressing some issues; people may need to be encouraged to talk and to face difficult topics. At times, you may recognize that other professional intervention is required. In most instances, the caregivers feel tremendous relief to know that others are in similar situations and share similar reactions whether positive or negative. Often, the caregiver has felt isolated in his or her situation.
Personal Disclosures/Handling Difficult People or Situations
Participants are encouraged to discuss their own situations both to learn to apply new knowledge and skills to their situation and to avail themselves of group support but this need not result in disclosure of inappropriate intimate personal details of people's lives. Participants must respect their own and others' privacy and personal boundaries. There is a balance to be struck between building group rapport through sharing and what amounts to an invasion of personal privacy (of either the caregiver or the person receiving care). The facilitator has the responsibility of monitoring the level and nature of disclosure and exercising good judgement in ensuring the preservation of personal boundaries/confidentiality. The facilitator must also balance the needs of the group with the needs of the individual.
Strategies to steer discussion in other more appropriate directions may be employed. The facilitator may need to take steps to diffuse conflict and anger without embarrassment to the participants (take a break, intervene to change the discussion, acknowledge the difficulty of the subject matter under discussion, revisit the group "rules", and other such strategies). Some needs may be better met outside the group. As mentioned, the facilitator may need to refer someone to a professional counsellor or therapist for example. The facilitator may need to develop a response to disruptive participants or those not well suited to the workshop. Making suggestions like "Let's discuss that at the break rather than take up group time now," changing the topic of discussion, or asking/enabling someone else to speak may be appropriate. In some extreme cases, it may even be necessary to suggest to a person that they not attend further sessions, expressing concern the workshop may not be suited to them or be able to meet their needs and offering alternatives (others to speak to, information to obtain, etc.).
The facilitator also needs to be aware of his/her own attitudes, beliefs, experiences, and feelings about these sensitive issues in order to adequately monitor group dynamics and feelings and to separate their own reactions from those of the group.
The facilitator must display sensitivity to differing cultural norms, values, beliefs, and caregiving practices (providing they are not harmful and are consistent with legislation).
The facilitator must be comfortable with the sensitivity of the subject matter. Some topics may elicit strong emotional responses. Topics like death and dying, or increasing disability or reliance on others, loss of independence, changing roles and relationships, may evoke strong feelings - fear, anger, betrayal, vulnerability, grief, loss - in both caregiver participants and those to whom they offer care. The process of caregiving can be both very rewarding and exhausting physically and emotionally. When caregivers arrive at the group sessions, they may have an awareness of this and have processed their feelings in relation to these issues. They may be prepared for the possibility of declining health and the eventuality of death. Others may not have considered these things at all. Caregivers will have differing coping capacities, knowledge of aging, level of personal awareness, and skills in resolving conflict. They may be at very different stages in the caregiving process - they may be just considering taking on the responsibility of caring for another person or they may have been doing it for years. They may arrive in differing emotional states - some may really feel at "the end of their rope" and are desperately seeking help and support.
Facilitators must be prepared for a range of emotional responses (tears, leaving the room, silence, withdrawal, unwillingness to discuss the matter, anger, frustration, verbal outbursts, etc.). Even laughter and black humour may be a response to an uncomfortable, fearful, or emotionally charged situation.
Acknowledging these feelings as legitimate, and respecting a person's disclosure and privacy are important elements of the facilitator's response. Compassion and empathy will be demanded of the facilitators. The facilitator must convey understanding, as in "We know this is very painful for you to talk about." If there is a co-facilitator, s/he could be close by to offer support.
In creating a "safe" environment, the facilitator must recognize the needs of the participating caregivers. They must be involved in the process and their experience must be recognized by the facilitator as an important component of the training sessions.
The facilitator must be alert to the language of presentation. It is important not to talk down to people, and yet neither is it wise to use a lot of professional jargon. The educational and experience level will vary from group to group, as well as within a group. Assess what is appropriate at the time. The facilitator should make sure s/he can be heard.
Many workshop leaders like to begin the first session with a favoured "icebreaker". This can involve humour and relax people; however, some people find it offensive to do "silly" things, so caution is recommended. The sharing part of the first session is crucial in establishing bonds in the group and can flow quite easily even without an "ice-breaker" exercise.
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Providers & Professionals 
