TTT-EM: Train The Trainer in Elder Mistreatment

This guide is an accumulation of evidence-based practices identified in the literature as being conducive to the train-the-trainer process. It draws upon studies of transfer training, knowledge dissemination, “cascade” barriers and facilitators, and effective teaching skills. It is inspired by the concept of self-efficacy and adult learning principles. The aim of this tool is to assist agencies to train their trainers in the prevention, detection and intervention of elder mistreatment.

Strategies are grouped in 3 sections:
  • How to prepare for training
  • How to train your champions
  • How to “cascade” the learning onto others and maintain the “train gain

I.  HOW TO PREPARE FOR TRAINING

Choose Your “Program-Based Advocates” preferably choose those who are committed to evidence-based learning (1). Consider a nomination process by their peers as well as a letter of support from their immediate supervisor confirming that the individual will be permitted to attend training sessions and in turn, to conduct training sessions during work hours (2).

Aim For A Critical Mass: Consider training more than one person as a contingency plan for staff turnover (3) and to provide a greater number of advocates of  the new process who share a common vision, skill set, and insights (4).

Know Your Trainees
  • Start with an assessment of learning needs to ensure that the offered content will enhance their knowledge, skill and abilities (5). Training must meet their expectations; otherwise, it will lead to frustration (6).

  • Ask them to answer program-specific questions and to share their challenges, personal reflections, and anxieties about addressing elder mistreatment. This will build anticipation amongst participants and provide excellent insight into their challenges (4). The facilitator can then incorporate these experiences into the teaching, encouraging learning by interacting with the trainees (7)
Promote Trainee Engagement
  • Ensure that the content is relevant to their work context: it should be aligned with work responsibilities (8), perceived as being credible and contributing positively to their work performance (9). The needs assessment conducted earlier will answer the question “Why are we learning this?” (10).

  • Provide Advance Materials: Providing trainees with the objectives of the training prior to the session increases transfer outcomes (11).  Also, provide a “kit” of handouts or tools and a facilitator guide prior to sessions. Advance reading assignments help the participants to emotionally and intellectually prepare for the sessions. They also provide repetition which enhances learning (4).

  • Pose Advance Homework assignments. Such advance preparation will set the stage for trainees, act as advance discussions, engage them in the application of the content, and encourage them to think about the challenges and opportunities ahead (4).
Utilize Self-Management Strategies:
  • Set specific but challenging Learning Goals: Both assigned (set by the trainer) and participative (set by the trainee) goal setting are encouraged. This strategy helps participants to direct their attention and action, channels their energy, favours persistence and motivates the trainee to develop strategies to attain their goals (12).  A combination of proximal (short-term) and distal (long-term) outcome goals results in increased knowledge transfer (13).

  • Use Action Plans: Establish strategies to reach expected outcomes and timelines. Discussions between supervisor and trainee are key to ensuring trainees are provided with opportunities to use the trained skills after training (5).

II. HOW TO TRAIN YOUR CHAMPIONS

Foster A Positive Learning Climate
  • Respect principles of Adult Learning (14). 
  • Establish and communicate goals for the session, promote understanding, retention, and self directed learning (15).
Enhance The Positives: Self-Efficacy And Motivation 
  • Self-efficacy is positively related to transfer maintenance (16). Interventions such as supportive feedback (17) and self-management strategies –goal setting and action planning noted earlier- (18) have been successful.

  • Behavioural modeling (BM) contributes to self-efficacy (19). Using a mixed demonstration model of both effective (positive) and ineffective (negative) behaviours, the facilitator can demonstrate effective and ineffective ways to prevent, detect and intervene in elder mistreatment, thus ensuring higher levels of behaviour change and learning  (20, 21).

  • Consider providing workplace incentives to enhance motivation such as highlighting the training in the performance appraisal, which influences retention of training (22).
Provide Training Resources
  • Provide a Tool Kit, (the NICE tools on prevention, detection and intervention of elder mistreatment, for example). This is a strategy in knowledge translation to help the learner apply best evidence (23).

  • Provide a Facilitator Guide containing: Modules organizing content matter Objectives, content outline, background information, PowerPoint slides with speaking notes, activities, case studies, discussion questions, handouts, key reference articles, complete reference list, list of typical Q&As, technological supports  (2)

  • Steps to plan an educational session- assessing training needs, defining training goals and objectives, selecting instructional strategies, developing an evaluation plan (2)

  • Effective teaching methods-small groups, interactive use of tools on cases, “icebreakers”, mini-lectures, brainstorming, personal goal-setting exercises, videotapes of Tool Kit presentations to guide the new facilitators in preparing their own (23)
Ensure A Logical Sequence Of Learning Events. 
The following learning tasks should build one upon the other (24):
  • Inductive tasks: trainees connect with what they already know, clarify their understandings and draw on their experiences (reflexive learning)

  • Input tasks: trainees work through, struggle with, contest, and recreate new content to fit their context (mini-didactic presentations, readings and discussion)

  • Implementation tasks: trainees practise, integrate, and reinforce new concepts (case studies, practise) with feedback from the trainer

  • Integration tasks: trainees incorporate new learning into their lives (role-play exercises that simulate scenarios and challenges possibly encountered in the work environment, practise teaching, goal setting) (8)
Design Training Strategies To Build Competence 
  • Encourage Reflexive Learning to place trainees in charge of their own learning. Direct trainees to reflect upon what they have learned, its relevance to their work and past experiences and how to apply this knowledge to their challenges in elder mistreatment. Trainees are encouraged to “reinterpret the training experience” and not simply adhere to it without thought (25).

  • Avoid The Pitfall Of Passive Instructional Methods such as lecturing. Active learning provides opportunity for involvement in course material and maintains the adult attention span. Methods such as behavioural modelling, feedback, and dialogue are effective (26).

  • Demonstrate a training session on one or more of the tools in the Tool Kit followed by debriefing during which the future trainers apply principles of adult learning to what has been observed (15). This will allow future trainers to gain sufficient mastery of teaching skills to facilitate the Tool Kit sessions for future trainees (HOW TO TEACH) and sufficient mastery of content (WHAT TO TEACH) (6).

  • Organize Small Heterogeneous Groups of introverts and extroverts, which promotes higher individual transfer (27) as the latter will verbalize strategies and discuss problem solving (5).

  • Encourage Errors by utilizing error-based examples, and sharing what can go wrong if not applying the training helps trainees learn from mistakes (28). Mistakes translate to mastery as trainees work through grey areas and problem-solve.

  • Capitalize On A Powerful Case Study that provides an opportunity to apply the knowledge learned through the training (29). Complex cases must be pulled apart and then pieced back together to understand and resolve the problem. Questions can guide the facilitator in this process (30). Trainees may also bring forth knowledge gained from their own experiences (6). Have trainees work through case studies with different disciplines to foster an interdisciplinary approach from detection to intervention utilizing content material and achieving successful outcomes.

  • Practise, Practise, and Practise as it enhances long-term maintenance and application of knowledge. The cognitive or mental rehearsal (talking about the skills) and the behavioural practise (practising skills in training) are both helpful (31).

  • Offer Feedback as acknowledging knowledge gains as well as remediation opportunities enhances learning mastery (20).

  • Ensure Distributed or Spaced Practise within the context of the training event (taking breaks when practicing applying trained skills) to facilitate transfer (20).  

Transition From Trainee To Trainer

  • Play With Experiential Role Play: Create a training video where co-trainers represent a mistreated older adult and person responsible for abusive behaviour and apply the different pocket tools across the continuum of prevention, detection, and intervention (1). Training videos are a powerful tool to isolate the trainer’s first challenges when attempting to incorporate their knowledge into the workplace (30).

  • Trainee Delivers Training During Workshop: This practice contributes to skill-building (32). New trainers give presentations using the audiovisual materials and receive constructive feedback from their peers, which will increase their confidence (2). This process provides opportunities to apply ideas and practise skills in a non-threatening environment (25).

  • Prepare For Implementation: Offer a session on the logistics of home-site seminar delivery and their new roles as trainers (33) (schedule, venue, list of trainees, structure).

III. HOW TO “CASCADE” THE LEARNING ONTO OTHERS AND MAINTAIN THE “TRAIN GAIN”

When the new trainer returns to their home agency to provide the training to peers, the fragile process of dissemination must be well supported.

Know The Barriers: Assess the obstacles and the degree of support in the transfer system-(person, training, organization) which the new trainer will meet. Consider a diagnostic tool such as the LTSI-Learning Transfer System Inventory (34) to establish a plan to overcome these obstacles (20).

Know The Facilitators - Create A Positive Transfer Climate 

  • Ensure Supervisor Support: by discussing new learning, participating in training, assisting with the logistics of training peers, providing encouragement and coaching about use of new knowledge and skills on the job and providing opportunity to perform and train by modifying the employees’ normal workload (3).

  • Ensure Agency Support: New policies and procedures regarding prevention, identification and intervention in cases of elder mistreatment are considered an “essential piece of training”. Case conferences and interdisciplinary plans of  care are useful tools (6). An internal focus group can be created to support and encourage best practices internally (8).

  • Ensure Ongoing Trainer-Focused Consultation: Offer regular monthly consultation calls to provide coaching and supervision (1) based on the challenges encountered. Case consultation when attempting to apply the learning from the workshops to daily tasks and when trying to train others provides the opportunity to identify individual learning gaps, learn from peers and share any challenges (3, 35).

  • Create A Program Portal for “Alumni Trainers” to maintain contact with “training buddies”. Alumni can post materials of interest or post updates on their progress (4). The portal can provide a forum to build collaborative ties, facilitate networking, share strategies to problem solve and exchange successes and challenges (2, 29).

  • Provide Ongoing Information on the portal about elder mistreatment educational opportunities, research advances, web links and information about local resources (2, 29).

  • Consider Refresher/Problem-Solving/Relapse Prevention Workshops by the train-the-trainer instructor to provide further in-depth information on topics that new trainers experience difficulties with, address problems experienced during sessions, and identify new strategies or knowledge to incorporate into future sessions (2). 

OUTCOMES

Research on the train-the-trainer process has demonstrated positives outcomes such as gains in overall knowledge for the trainer and undiluted transmission of knowledge from trainer to trainee (14), increased confidence in the ability of the trainer to train others (29), and very good to excellent ability for both to use what they learned in their current positions (2). In some studies, trainers replicated the level of their own learning gain in their trainees (36).

J. Lindenbach, MScN
Professor
Laurentian University, Sudbury (ON)


References

  1. Martino, S., Ball, S. A., Nich, C., Canning-Ball, M., Rounsaville, B. J., & Carroll, K. M. (2010). Teaching community program clinicians motivational interviewing using expert and train-the-trainer strategies. Addiction, 106, 428-441. 
  2. Connell, C. M., Holmes, S. B., Voelkl, J. E., & Bakalar, H. R. (2002). Providing dementia outreach education to rural communities: Lessons learned from a train-the-trainer program. Journal of Applied Gerontology, 21(3), 294-313. 
  3. Hasson, F., Kernohan, W. G., Waldron, M., Whittaker, E., & McLaughlin, D. (2008). The palliative care link nurse role in nursing homes: Barriers and facilitators. Journal of Advanced Nursing, 64(3), 233-242.
  4. Haskins, M. E., & Clawson, J. G. (2006). Making it sticky: How to facilitate the transfer of executive education experiences back to the workplace. Journal of Management Development, 25(9), 850-869.
  5. Burke, L. A., & Hutchins, H. M. (2007). Training transfer: An integrative literature review.  Human Resource Development Review, 6(3), 263-296.
  6. Radensky, L., & Parikh, D. (2008). Developing a “train the trainer” program to identify elder abuse and neglect: The Jewish Home Lifecare system model. Home Health Care Management & Practice, 20(3), 254-259. 
  7. Vella, J. (2002). Learning to listen, learning to teach: The power of dialogue in educating adults. Revised edition. San Francisco: Jossey-Bass. 
  8. Hutchins, H. M. (2009). In the trainer’s voice: A study of training transfer practices. Performance Improvement Quarterly, 22(1), 69-93. 
  9. Yelon, S., Sheppard, L., Sleight, D., & Ford, J. K. (2004). Intention to transfer: How do autonomous professionals become motivated to use new ideas? Performance Improvement Quarterly, 17(2), 82-103.
  10. Haugen, C. S. (2006). Environmental adult educator training: Suggestions for effective practice. Convergence, 39(4), 91-106).
  11. Kraiger, L., Salas, E., & Cannon-Bowers, J. A. (1995). Measuring knowledge organization as a method for assessing learning during training. Human Factors, 37, 804-816. 
  12. Kontoghiorghes, C. (2001). Factors affecting training effectiveness in the context of the introduction of new technology – A US case study. International Journal of Training and Development, 5, 248-260.
  13. Brown, T. (2005). Effectiveness of distal and proximal goals as transfer of training intervention: A field experiment. Human Resource Development Quarterly, 16(3), 369-387.
  14. Nyamathi, A., Vatsa, M., Khakha, D. C. McNeese-Smith, D., Leake, B., & Fahey, J. L. (2008). HIV knowledge improvement among nurses in India: Using a train-the-trainer program. Journal of the Association of Nurses in AIDS Care, 19(6), 443-449. 
  15. Harvey, R. M., Horvath, K. J., Levine, S. A., & Volicer, L. (2005). Models of physician education for Alzheimer’s disease and dementia: Practical application in an integrated network. Clinical Gerontologist, 29(2), 11-23.
  16. Chiaburu, D. S., & Marinova, S. V. (2005). What predicts skill transfer? An exploratory study of goal orientation, training self-efficacy and organizational supports. International Journal of Training and Development, 9, 110-123.
  17. Gist, M. E. (1986). The influence of training method on self-efficacy and idea generation among managers. Personnel Psychology, 42, 787-805. 
  18. Gist, M. E., Stevens, C. K., & Bavetta, A. G. (1991). Effects of self-efficacy and post-training intervention on the acquisition and maintenance of complex interpersonal skills. Personnel Psychology, 44, 837-861.
  19. Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122-147.
  20. Russ-Eft, D. (2002). A typology of training design and work environment factors affecting workplace learning and transfer. Human Resource Development Review, 1(1), 45-65. 
  21. Skeff, K. M., Stratos, G. A., Berman, J., & Bergen, M. R. (1992). Improving clinical teaching: Evaluation of a national dissemination program. Archives of Internal Medicine, 152, 1156-1161.
  22. Taylor, P. J., Ruiss-Eft, D. F., & Chan, D. W. L. (2005). A meta-analytic review of behavior modeling training. Journal of Applied Psychology, 90(4), 692-709.
  23. Levine, S. A., Brett, B., Robinson, B. E., Stratos, G. A., Lascher, S. M., Granville, L., Goodwin, C., Dunn, K., & Barry, P. P. (2007). Practicing physician education in geriatrics: Lessons learned from a train-the-trainer model. Journal of the American Geriatrics Society, 55, 1281-1286.
  24. Vella, J. (2001). Taking Learning to Task: Creative Strategies for Teaching Adults. San Francisco: Jossey-Bass. 
  25. Hayes, D. (2000). Cascade training and teachers’ professional development. ELT Journal, 54(2), 135-145.
  26. Cross, W., Matthieu, M., Cerel, J., & Knox, K. (2007).  Proximate outcomes of gatekeeper training for suicide prevention in the workplace. Suicide and Life-Threatening Behavior, 37, 659-670. 
  27. Olivera, F., & Straus, S. G. (2004). Group-to-individual transfer of learning: Cognitive and social factors. Small Group Research, 35, 440-465.  
  28. Ivancic, K., & Hesketh, B. (2000). Learning from errors in a driving simulation: Effects on driving skill and self-confidence. Ergonomics, 43(12), 1966-1984.
  29. Fitzgerald, M. A., Chromy, B., Philbrick, C. A., Sanders, G. F., Muske, K. L., & Bratteli, M. (2009). The North Dakota Mental Health and Aging Education Project: Curriculum design and training outcomes for a train-the-trainer model. Gerontology & Geriatrics Education, 30(2), 114-129
  30. Langer, N. (1999). Gerontologizing health care: A train-the-trainer program for nurses. Gerontology & Geriatrics Education, 19(4), 47-56.
  31. Holladay, C. L., & Quinones, M. A. (2003). Practice variability and transfer of training: The role of self-efficacy generality. Journal of Applied Psychology, 88(6), 1094-1103. 
  32. Meneses, K. D., & Yarbro, C. H. (2008). An evaluation of the Train the Trainer International Breast Health and Breast Cancer Education: Lessons learned. Journal of Cancer Education, 23, 267-271.
  33. Stratos, G. A., Katz, S., Bergen, M. R., & Hallenback, J. (2006). Faculty development in end-of-life care: Evaluation of a national train-the-trainer program. Academic Medicine, 81(11), 1000-1007.
  34. Holton, E. F., Bates, R. A., & Ruona, W. E. A. (2000). Development of a generalized learning transfer system inventory. Human Resource Development Quarterly, 11(4), 333-360.
  35. Smith, M., Mitchell, S., Buckwalter, K. C., & Garand L. (1995). Geropsychiatric nursing consultation as an adjunct to training in long-term care facilities: The indirect approach. Issues in Mental Health Nursing, 16, 361-376. 
  36. Levy, K., Hirsch, E. F., Agababian, R. V., Segall, A., & Vanderschmidt, H. (1999). Radiation accident preparedness: Report of a training program involving the United States, Eastern Europe, and the newly independent states. American Journal of Public Health, 89, 1115-1116.
This is one in a series of tools in the NICE tool kit designed to detect, intervene in, and/or prevent abuse of seniors. For more information about this, or any of the other tools and related training events, please visit www.nicenet.ca
September 30, 2011