Facilitator Guide

In order to respond to the review of the literature and focus group feedback on effective interviewing of adolescent and young adult males, we created 5 vignettes and discussion guides for medical and mental health providers to enhance interviewing skills during clinical visits.

Facilitator Preparation

Facilitators should thoroughly review the materials and AV needs in advance of teaching each module. Review the literature review and findings from the focus groups to increase your understanding of the concerns of adolescent boys during health and mental health visits. Reflect on ways boys may indicate that they are comfortable or uncomfortable with the topic in the interview. View the vignettes and read the comments. Unless already discussed as part of the trainee curriculum, you should become knowledgeable about confidentiality in the treatment of adolescents. Laws governing confidentiality vary from state to state, and adolescents are afforded the right to confidentiality around some issues in all states. If teaching about interviewing older adolescents/young men, review the preventive guidelines (see reference 14) and discuss developmental differences. Make a lesson plan so you know how much time you will need to allot for the vignettes and discussion. Plan for 10 minutes at the end, 5 minutes for evaluation and feedback and 5 minutes for each learner to write down the strategy they will try at their next clinical visit.

Open the Discussion

Introduce the objectives of the session. Explain that this will be an interactive discussion (not a lecture) and that the participants will be watching video clips of interviews. Use the information in the introduction to begin a discussion on treating adolescent boys and young men. Ask the following questions to begin the discussion:

1. 1. What are some of the common strengths and health risks of boys during adolescence?
2. 2. What is the HEADSS mnemonic? (see handout 1) The SHADESS? Has anyone used the mnemonic? How did it go?
3. 3. What do you think might be some of the barriers that prevent adolescent males from seeking health care? How might this differ from females?
4. 4. What can providers do differently to engage males during the visit? The HEADSS and CRAFFTS (handouts 1 and 2) handouts may be included here for participants to discuss.

Preface the discussion by telling the participants that you will be showing videos of clinical interactions between adolescent male patients and a health care provider. Ask the learners to observe and record verbal and non–verbal communication by both the provider and the patient during the video, and note what interactions are and are not going well.

To record observations, use an 8×11″ plain paper and make 3 columns. Label columns: 1. “Elements of Good Communication”, 2. “Elements That Could Be Improved”, and 3. “Suggestions for Provider”. Ask the learners to write down actual phrases, verbal or non–verbal communications, body language, behaviors, etc. while watching the vignette.

These vignettes offer new ways to think about male patients during the interview process. Mention that participants will likely recognize things in the vignettes that they have done or said, both positive and negative. Following the first vignette, ask all participants “So what do you think about this interview? What elements of communications did you jot down?” List items on a blackboard or flip chart. Then use the questions below to start the discussion. Remember that the key to successfully leading a small group is facilitating the discussion, not lecturing. Draw as many participants as possible into the discussion. Allow time for group members to think about questions such as:

1. 1. What do you notice about the communication between the patient and provider in this interview?
2. 2. What did the interviewer do well? How? Why?
3. 3. What did the interviewer do that didn’t go well? What happened? What did he/she do? Did it work? If the provider was to repeat the same interview, what might work better?

If participants have difficulty remembering specific interactions, dialog, gestures, or didn’t take notes, start at the beginning of the vignette and play each line, one at a time. Tell the participants to pay attention to the facial expressions and non–verbal communication of both the patient and the provider, in addition to verbal communication. Stop after each line and ask what the interviewer did and how the patient responded. Ask the group whether or not they thought that the intervention went well. If they thought that the intervention went well, ask why. If they thought that the intervention did not go well, ask what the provider did poorly and what he/she could have done differently. Refer to the background information for clarification and information about what boys find helpful. Refer to the vignette guide to identify positive and negative elements in the interview.

Conclusion

Refer back to group’s learning agenda and summarize the key teaching points that were made. You can write down the key points on a chalk board or large post–it notes. This will give the group a sense of accomplishment and emphasize the important messages. Suggest further sources of reading or other information if there are agenda items that were not covered in the discussion. Relevant teaching points adapted from the Kalamazoo Checklist (see handout 3) may be used to summarize recommended interviewing techniques for all adolescents. Final summary should include the points noted that are particularly relevant for adolescent boys. Each learner should commit to trying a new strategy with their next male patient visit and then reflect on how well it worked.

Selection of Vignettes

The following vignettes present critical moments in medical and mental health appointments with adolescent boys. There are a mix of skillful and unskillful provider interventions, many of which can be discerned by the patients’ verbal and non–verbal reactions. Each vignette can be viewed by trainees for critique and discussion. A single vignette can be used independently for an hour of teaching or may be combined with another vignette. On the pages that follow, a brief guide for each vignette is included.

These vignettes may be taught as stand–alone discussions or may be paired.
Suggested groupings are:

Vignette 1 – Introduction to a Preventive Services Visit
Vignette 4 – Introduction to a Mental Health Assessment

Vignettes 1 and 4 illustrate the first few minutes of an initial patient visit. The dialogue helps providers learn how to set a welcoming tone for the initial visit and the patient/provider relationship.

Vignette 3 – Asking about Depression in a Preventive Services Visit
Vignette 5 – Assessing for Depression in a Mental Health Appointment

Vignettes 3 and 5 illustrate how to screen adolescent males for depression during a medical appointment and in a subsequent mental health follow–up appointment.

Vignette 2 – Asking about Sexual Activity in a Preventive Services Visit
Vignette 3 – Asking about Depression in a Preventive Services Visit

Vignettes 2 and 3 illustrate parts of the medical visit interview that may be uncomfortable for adolescent boys and young men.

Vignette 4 – Introduction to a Mental Health Assessment
Vignette 5 – Assessing for Depression in a Mental Health Appointment

Vignettes 4 and 5 illustrate patient/provider interactions during mental health visits.