Facilitator’s guide Depression Optimise Online workshop ...

Facilitator’s guide Depression Optimise Online workshop (tutor-led)

About this CPPE Depression Optimise online workshop This guide forms part of the Depression Optimise online workshop resources. Other resources include a PowerPoint slide presentation, the Depression Optimise card that summarises both pre-workshop (page 1) and workshop activities (page 2) for participants and a handout of Suggested answers for the workshop activities on page two of the Optimise card.

Optimise programmes have been developed to support clinically focused group learning. They can be delivered in the following ways:

• tutor-led Optimise face-to-face workshops are facilitated by CPPE tutors for a multi-sector audienceand are available for learners to book via the CPPE website

• tutor-led Optimise online workshops are facilitated by CPPE tutors for a multi-sector audience andare also available for learners to book via the CPPE website

• learner-led Optimise sessions are designed to be studied in a group at the workplace or as part of alearning community. A member of the pharmacy team can facilitate these sessions.

This facilitator’s guide contains two sections. • Section 1 provides information about planning the workshop, a summary of the running order and

hints and tips for preparing for and running the online workshop. • Section 2 contains a detailed plan for running the online workshop.

Section 1 - planning the Optimise online workshop This event is for up to 24 people and runs for 120 minutes (7.00-9.00pm)

To ensure learners have sufficient opportunity to prepare for the group learning session, you will email participants a PDF version of the Getting prepared activities to be completed before the event. You should send this email four weeks before the event or as soon as possible if participants book less than four weeks before the workshop. Look at the Getting prepared content to familiarise yourself with the tasks.

Aim In this programme, we will help you develop your confidence to engage in discussion with people with depression, to listen to their concerns, respond to their needs and support them to achieve better health outcomes.

Optimise workshops include dedicated time (20 minutes) at the end of the session to allow learners to reflect on their learning on the clinical topic and consider how they might apply this to improve their own practice and benefit people using their services. They will be able to discuss this with other participants and think about how they could use the learning and subsequent changes in practice to complete a revalidation record.

Learning objectives After completing all aspects of this workshop, participants should be able to:

• describe how to address the challenges involved when consulting with people with depression• summarise the benefits and risks of common antidepressant drugs• engage in discussion about treatment options with people with depression that meets their needs.• discuss how you will apply your learning to improve your practice and use this to contribute to your

continuing professional development and revalidation.


Optimise online workshop running order summary (full details are in Section 2)

Time Length Session or small group learning activity

Facilitator’s guide page

Facilitator

19.00 15 minutes Zoom functionality familiarisation

7 Lead tutor

19.15 10 minutes Welcome and introduction ground rules

8 Lead tutor

19:25 5 minutes Ice-breaker 8 Lead tutor

19:30 10 minutes Core facts 9 Lead and co-tutor

19.40 10 minutes Clinical challenge

9 Lead and co-tutor

19.50 20 minutes Clinical decision making

10 Lead and co-tutor

20.10 20 minutes Clinical consultation


20.30 20 minutes Reflection on learning, and planning for action


20.50 10 minutes Close of event 18 Lead tutor

Checklist to prepare for the workshop

As you book the workshop, think about the points listed below • Does the date of your workshop clash with other events?• Are you familiar with facilitating learning using Zoom meetings?• Have you confirmed another tutor to support you as the co-host?

Zoom preparation Both tutors need to be familiar with using the Zoom platform to facilitate learning. Make sure that you have accessed the recommended support materials well in advance of delivering the workshop.

You can find more information about facilitating online learning on the intranet at https://xorg.manchester.ac.uk/sites/CPPE-Intranet/Running-events-e-courses-webinars/SitePages/E-workshops.aspx


Create the workshop on Zoom (lead tutor) • Please review your account settings to make sure the meeting is set up with the functionality below:

o breakout rooms are enabledo polls are enabledo participant screen sharing is enabledo mute participants as defaulto disable participant videoso participants to be held in a waiting room before joining the meetingo participant chat box can be savedo ensure you have entered the co-tutor email address as an alternative host (you will need to

use the [email protected] format) and provide the co-tutor with the link for theworkshop for contingency purposes.

• Create a Zoom meeting and ensure the event has a password assigned and registration ismandatory.

• Set up the event on the CPPE website by completing an event arrangement form in the tutorsection of the website – remember to select the online workshop listing.

• Once the event has been approved it will be set live and available on the CPPE website for learnersto book a place.

• Once set up, the event will appear on the tutor’s and co-tutor’s list of events on the CPPE websiteand can be located by participants for booking.

• Lead tutor is responsible for monitoring the bookings and emailing learners the Zoom link to registerfor the workshop, along with pre-workshop tasks on page 1 of the Optimise card (email template inAppendix 1) – use the bulk email system. Take care to copy the link for Zoom directly from theZoom system to ensure that it appears correctly within the bulk email.

• As learners register for the zoom event, they will receive a registration confirmation and invite fromzoom.

• Lead tutor needs to monitor and prompt learners to ensure they have registered with Zoom so theycan gain access to the online workshop.

Work through the checklist below to make sure you are completely prepared.

Plan how you will market the online workshop (lead tutor and co-tutor) • Who will you target?• How will you advertise the workshop?• Who will keep a record of those attending?• What about people who book but do not attend?• Remember that learners do not have to be located in your geographical region to book a place for

an online workshop.

https://xorg.manchester.ac.uk/sites/CPPE-Intranet/Running-events-e-courses-webinars/SitePages/E-workshops.aspx

https://xorg.manchester.ac.uk/sites/CPPE-Intranet/Running-events-e-courses-webinars/SitePages/E-workshops.aspx

mailto:[email protected]


• The pre-workshop email contains confirmation of the Zoom link, timing of the workshop and areminder to download the preparation activities to be completed before the event. This is the PDFversion of the ‘Getting prepared’ tasks on page 1 of the Optimise card .

• The pre-workshop email also encourages participants to access Zoom in advance of the onlineworkshop and familiarise themselves with the settings/controls.

• All learners will have varying degrees of prior knowledge and experience in the topic. Those withsome experience in supporting people with depression and who are familiar with national guidelinesshould be able to complete the preparation tasks in 20 minutes. The preparation tasks for those withlimited knowledge and experience are likely to take longer. However, they are essential for thelearner to gain a threshold level of background knowledge and get the most from the workshop

• The group learning activities on page 2 of the Optimise card form the content of the workshop andfocus on how to use the knowledge from the pre-session tasks in practice and when consulting withpeople. Advise participants that the Optimise card will be emailed to them one week before theonline workshop

• Advise participants that e-learning is available on the CPPE website which provides optionalbackground learning should they wish to complete this before the session. This would be in additionto the minimum 20 minutes it should take participants to complete the ‘Getting prepared’ tasks.

• Ask participants to send any queries regarding the use of Zoom to you up until one week prior to theworkshop to provide you with the opportunity to respond.

• Confirm with co-tutor the sections for delivery/support, including which case studies and activitieseach tutor will cover.

• Tutors could also visit their Zoom settings to add a profile photo as videos will be switched offthroughout the workshop. This will help participants identify tutors quickly during the workshop fromthe participant list. You can also edit your name on Zoom to appear as CPPE tutor [NAME].

• Create the poll(s). If there is more than one poll, set up as separate polls as opposed to one pollwith more than one question. (Refer to Appendix 2)

• Plan in a practice-run session with co-tutor – this is an essential part of your preparation.

Practice workshop (both tutors) This is a really important part of the preparation for the workshop. Use this session to:

• Practice running the polls• Practice allocating and using break-out rooms• Sharing your screen• Handing over control• Using whiteboards (if appropriate)• Accessing and playing any videos if they are part of the workshop

One week before the workshop (lead tutor) • Confirm the number of participants booked on to the event and do any last-minute marketing to fill

final spaces.• Check how many people have registered for the event on Zoom.• Send pre-workshop email 2 (Appendix 1).• Attach the Optimise card to the email so that participants have access to the activities on page 2

which will be completed during the workshop

One month before the workshop (lead tutor) • Send out pre- workshop email 1 – Appendix 1


• Recommend that learners save copies of pre-session reading materials on a tablet or mobile devicewhich they can refer to during the online workshop if they wish

• Make sure that you and the co-tutor are familiar with the PowerPoint slides; in particular if there isany animated display of text to help drive visual engagement in the online delivery environment.

On the day of the workshop • Check that all the audio-visual equipment is working (lead tutor and co-tutor).• Download and print the CPPE register for the event (co-tutor).• Insert details of evaluation link to Slide 24 of the PowerPoint presentation (lead tutor).• Insert details of upcoming events/other resources that you wish to promote to Slide 25 of the

PowerPoint presentation (lead tutor).• Insert tutor names (lead tutor) to slide 7.• Ensure you have access to any of the ‘Getting prepared’ reading materials/resources, either as a

hard copy or on a mobile device

After the workshop • Send out the post-workshop email (see Appendix 3) (lead tutor).• Send out Suggested answers (lead tutor)• Remind participants to complete the online evaluation and include link (lead tutor).• Complete the register on the CPPE website (co-tutor). Do this as soon as possible, as the post-

workshop emails/info can only go out after the register has been completed.• Complete ‘make report’ on CPPE website (co-tutor).

Possible challenges/barriers to change – None identified

Suggested pre-session reading • Optional background e-learning can be found on the CPPE Optimise web pages:

www.cppe.ac.uk/optimise/default. Make sure that you are familiar with the ‘Getting prepared’tasks.

Helpful hints <The time allocated for each of the activities on the Small group learning page of the Optimise card has been increased for the tutor-led workshops to facilitate feedback and discussion with participants in a larger group setting when compared with learner led (non-tutor led) Optimise. Timings for this workshop vary slightly therefore from the Optimise card. Use the timings in this Facilitator’s guide when running the workshop. >

Related CPPE learning programmes • Signpost participants to the following programme: Depression Focal point provides further optional

background learning available at www.cppe.ac.uk/programmes/l/depress-p-01/

https://www.cppe.ac.uk/optimise/default

https://www.cppe.ac.uk/programmes/l/depress-p-01/


Section 2 Running the CPPE Optimise workshop This section of the facilitator’s guide gives a detailed plan of the workshop, which you can refer to during the workshop.

Tutor preparation (before 7pm) • Ensure tutor and co-tutor can log in to the meeting without any IT issues• Check have hard copy of register (co-tutor)• Have blank Word document ready to populate with participant objectives (co-tutor)• Try putting comment in chat box and pasting in Word document – if this doesn’t work be prepared to

handwrite summary bullet points of participant objectives to verbally feedback later (co-tutor)• Have link for Optimise card ready to insert in chat box for participants who do not already have

access – practice inserting this in chat box (lead tutor and co-tutor) – please note participants canonly see chat box content from the time they join the meeting, so co-tutor should add the link to chatbox again just before 7.15pm (co-tutor)

• Have PowerPoint slides open on desktop (lead tutor and co-tutor). Although the lead tutor will runthe slide set, the co-tutor should have quick access in case the lead tutor’s slides becomeunavailable at any point

• Tutors should have a contingency to contact one another for emergencies outside the Zoommeeting, such as mobile telephone numbers

• Tutors should check their profile photo and change their name to the required format – CPPE tutor[Name] (lead tutor and co-tutor)

Lead tutor should change co-tutor’s participant status to co-host


Zoom functionality - as participants log in (15 mins before delivery of learning commences) (7:00pm, 15 minutes, slide 1-5)

Ensure you have the first slide up. Encourage participants to speak and/or introduce themselves in the chat box (lead tutor).

Ask participants to edit their name within the Zoom to the following format – preferred name/surname/GPhC number (lead tutor).

Co-tutor should provide support to individuals who may be encountering challenges with completing this task.

Explain the use of icons within Zoom – show slide 2 highlighting the icons, use this as an opportunity to check they are OK by asking them to display a green tick if they are following you so far. NB. The green tick and red cross functions are located in the participant window or in the ‘more’ section of the toolbar at the bottom of the screen depending upon which version of Zoom participants are using. Remember that if connecting on a mobile device the visual display may be slightly different, but the functions are still there.

Remind participants to turn off any other software that uses a microphone.

Encourage participants to use this time to check their computer audio and microphone (slides 3 and 4).

Explain that throughout the workshop you will be asking for engagement and feedback using the chat function (slide 5). Direct participants to open the chat box if they have not already and drag it to the side of their screen so that it is readily accessible. Remind them to send any feedback to ‘everyone’ in the chat.

You can invite participants to introduce themselves using the chat box – either tutor can start with something like, “Hello I’m xxxxxx, I work for CPPE as a local tutor and I’m based in xxxxx”.

Check that participants have access to the Optimise card displayed in slide 6 (they should have received via pre-workshop emails).

Share the link for the Optimise card in the chat box and ask them to download it if they do not already have a copy available to view. www.cppe.ac.uk/learningdocuments/pdfs/depresso-w-01/optimise%20depression%20-%20card%20-%20web.pdf

Ask participants to type their personal learning objectives into the chat function (lead tutor), acknowledging them as they are submitted by learners. Capture the objectives on a Word document and arrange by theme (co-tutor).

This can be screen-shared with participants. (co-tutor). We will revisit these objectives during the reflection section of the workshop.

For those who log in early and have no connectivity issues, let them know they have time for a comfort break, to make a drink, or to network, as the learning will begin promptly at 7:15pm.

You may need to repeat these messages numerous times if learners arrive later than 7:00pm – you have a 15-minute window to cover these and start to familiarise learners with the interactive Zoom features.

https://www.cppe.ac.uk/learningdocuments/pdfs/depresso-w-01/optimise%20depression%20-%20card%20-%20web.pdf


Mark participants off against the register. Note that the visual check of the number of participants indicated above the participant list is useful to help keep track of numbers. If new people join, they are added to the participant list alphabetically by first name (co-tutor).

As you prepare to commence the learning, ask participants to have a copy of the Optimise card available in front of them; remind them that you will be referring to this card throughout the workshop. Ask them to indicate with a green tick or red cross whether or not they have access. Be prepared to share the link for the card again in the chat box if needed or you can send to single participants if needed.

Welcome and introduction (co-tutor) (7:15pm, 10 minutes, slides 8-10)

Welcome participants and formally introduce yourself and the lead tutor. Cover general housekeeping.

Introduce the ground rules (slide 8). You can invite either participants to make any comments or contributions to these verbally or using the chat box.

Emphasise the importance of all participants engaging during the event with it being online.

Ask participants to use the green tick or red cross to signal if they are happy to accept the ground rules for the workshop.

Once the ground rules have been agreed, the lead tutor may lock the Zoom meeting if they wish, using the security feature. Remember to unlock the meeting and admit participants who need to leave and re-join the meeting due to connectivity issues. Introduce the aims and objectives (Slides 9 and 10). Remind participants that they will review their personal objectives later in the session.

Ice-breaker (7.25pm, 5 minutes, slide 11) The icebreaker introduces the topic by using a Zoom poll. Be aware that some people may not be able to see the poll depending on the device they are using. Acknowledge that there will be a variety of experience in supporting people living with depression across the participants. There are small group activities in this session to provide opportunities for pharmacy professionals from different sectors of practice to learn with and from each other.

You will now introduce a poll question to the participants (run the poll on the Zoom platform):

Q: What percentage of people with depression continue their treatment for an appropriate duration of time? Answer options:

1. 10 percent [correct answer]2. 20 percent3. 30 percent4. 40 percent

A: 10 percent


Only ten percent of people with depression continue their treatment for an appropriate period of time. This indicates that there is much scope for pharmacy professionals to engage in discussions with people who have depression. In addition, to support them to make better use of their medicines and/or treatment and achieve improved health outcomes.

Core Facts (Warm up activity)

(7.30pm, 10 minutes Slide 12) Explain to participants that the first activity on the Optimise card is Core facts. This is a warm-up activity to prepare you for both the clinical decision-making and clinical consultation activities.

The lead tutor will start by facilitating a discussion with participants about the concerns people with depression may have about taking antidepressants. This will be followed with discussing solutions on how to address these concerns. Ask participants to unmute themselves and share their thoughts about the concerns. The co-tutor can scribe the answers by opening a word document and creating two columns, one for concerns and one for solutions. The co-tutor can create the list of concerns first as the lead tutor manages feedback (5 minutes). The lead tutor can then ask participants to unmute themselves and share their solutions to each of the concerns listed in the table. The co-tutor can record the suggested solutions against the appropriate concern in the word document (5 minutes).

Use the Suggested answers to probe for any key points missing about the concerns or potential solutions, for example:

• How willing do you think people with depression are in seeking help for their condition?• What might influence their willingness to seek help?• What side effects might people be concerned about?• How might you engage with a person who believed that their newly prescribed SSRI is addictive /

would start working in a couple of days / would only need to be taken for a short period of time?

Clinical Challenge (7.40pm, 10 minutes Slides 13-15) The co-tutor should explain to participants that we are ready to now move on to the Clinical Challenge activity on the Optimise card handout and Slide 13. In this activity, you will build upon what you learnt in some of the ’Getting prepared’ activities as you consider the challenges that people with depression might experience in having their needs understood or processing information provided. You will then explore how you might address some of these challenges. We will divide you into three groups for this activity and a tutor will visit each breakout room to check that you understand the activity, check your progress and to answer any queries.

Slide 14. In your breakout room, discuss the challenges that people with depression experience in having their needs understood or understanding the information they are given. For each of the challenges, discuss potential solutions you might suggest to address that challenge. Nominate a spokesperson to record the discussions using pen and paper or on a word document. At the end of the discussion, decide on your top challenge and solution you wish to share during group feedback. You have seven minutes for your group discussion.


Lead tutor to set up three breakout rooms and randomly assign participants equally between the groups. The tutors should decide which breakout rooms they will drop into to check participants understand the activity, are making progress and to answer any queries. The lead tutor should send a broadcast message at six minutes to provide a one-minute warning of the end of the activity and to ensure the groups have selected their top challenge and solution for feedback.

Slide 15: Once the participants have rejoined the main room, the lead tutor will ask each group in turn to share their top challenge and solution. Unmute the nominated spokesperson and allow them to share this verbally. If a group has the same top challenge as another group, invite them to share if they have any different solutions to offer and if not, whether they would like to select another challenge and solution from their discussion. (3 minutes)

If key points from the Suggested answers are missed, you may want to ask probing questions to facilitate discussion depending upon how much time you have, for example:

• Who has an example of the words and phrases they might use to understand the person’sperspective? Facilitator hint: Participants could suggest questions using the acronym LICEF

• How might a person with depression feel about themselves and their condition?• What active listening techniques could you use when consulting with a person who has depression?• How well do you think people with depression may understand the information or advice you give

and why?• What support groups could we refer a person to who has depression?

Remind participants that you will send the Suggested answers after the workshop which they can use to compare with their small group discussions.

Clinical decision-making (7.50pm 20 minutes, Slides 16-18)

Explain to participants that now we will apply some of the underpinning knowledge you have learnt from pre-workshop and workshop activities so far to clinical decision making when consulting with people with depression. The purpose of this activity is to help you develop a greater understanding and awareness of the perspective of a person with depression about antidepressants, explore factors that can affect medicines adherence and apply this to clinical practice. We have already explored the reasons why people with depression have reported feeling reluctant about taking antidepressants. In this activity, we encourage you to consider the person with depression in more holistic terms, eg, reflect on changes in the person’s life that may be impacting upon their mood alongside the clinical issues.

The clinical decision-making scenario from the Optimise card is on this slide 16. Take a couple of minutes to read the scenario.

The scenario is also written below: Saif is a 24-year-old accountant. He was hit by a car cycling home from work last summer and spent six weeks in hospital with spine and leg injuries. He has been prescribed pain relief and referred for physiotherapy. He has returned to work but cannot cycle at the moment because he is still in pain and has since been referred to the pharmacist led pain clinic at the hospital


Saif was diagnosed with mild to moderate depression a week ago and has been prescribed sertraline 50mg tablets. Saif is attending a consultation with the pharmacist to review his medication. When asked about his concerns, Saif reports feeling frustrated with his health, that he doesn’t feel his depression has improved since starting sertraline and that he is experiencing unwanted effects.

You will now be divided into groups of four people (the lead tutor will divide the group into a maximum of six breakout rooms depending upon participant numbers) to consider Saif’s situation and answer the questions which appear on this slide 17. These questions are also on the Optimise handout:

• Is sertraline an appropriate first-line therapy choice for Saif?• What concerns might you have about him?• What additional questions would you ask him?

Working in your breakout room, please consider the answers to the questions. To make best use of the time available, we are asking each group to start with a specific question and then work through the other questions depending upon the time they have. This way, each question will have been covered. Each group must nominate a spokesperson to provide feedback about the question they were asked to start with. The allocation to the groups for their first question is as follows:

• Groups 1 and 2: Is sertraline an appropriate first-line therapy choice for Saif?• Groups 3 and 4: What concerns might you have about him?• Groups 5 and 6: What additional questions would you ask him?

NB: If there are fewer than 24 participants, the lead tutor may need to reduce the number of breakout rooms. Please still ensure each question is allocated to at least one group as their first question.

Groups have nine minutes to discuss their allocated question plus any additional questions they have time for. You may wish to refer to the scenario in your breakout rooms from the Optimise card. The nominated spokesperson can collate the group responses on a word document, or notebook and pen. Tutors will drop into breakout rooms to check you understand the activity, to help with any queries and to ensure you have nominated a spokesperson to provide feedback to the other groups. You may also use the Invite host button if you would like one of us to join your group. Tutors will send an announcement at eight minutes to warn you that breakout rooms will close in one minute to prompt you to record your final thoughts.

Slide 18: Once the breakout rooms have closed, the lead tutor to invite the spokesperson for breakout room one to provide feedback about their allocated question. The spokesperson can share their word document or read out their handwritten notes. Once group one has finished their feedback, ask group two who started with the same question if they have any further points to add. The lead tutor to repeat this process for feedback from groups three plus four and five plus six. The lead tutor to use the Suggested answers to facilitate discussion and probe for further thoughts and reflection from participants. If discussions are not forthcoming, you can use the prompt questions below to encourage discussion from the whole group. (9 minutes).

Question 1: Is sertraline an appropriate first-line therapy choice for Saif? Prompt questions: • What does NICE guidance say about SSRIs in the treatment of depression?• What are the benefits and risks of sertraline over other SSRIs?• Which non-drug treatment options could we consider?


• What are the benefits and risks of these non-drug treatment options?

Question 2: What concerns might you have about him [Saif}? Prompt questions:

• What are the risk factors for Saif’s wellbeing as a young male with depression?• What safety netting advice should you consider?

Question 3:.What additional questions would you ask him? Prompt questions:

• What questions could we ask to establish a shared agenda with Saif?• What questions could we ask to establish Saif’s perspective about his medicines or condition?• What questions should we ask about Saif’s pain relief medicines and why?

Remind participants that they can compare their group discussions with the Suggested answers post event.

Clinical Consultation (8.10pm, 20 minutes, slides 19 and 20)

Explain to participants that it is time for the clinical consultation activity on the Optimise card. The details also appear on slide 19. The co-tutor should ask participants to read the clinical consultation from the slide or the Optimise card. It is also written below:

Emma is 34 years old with a history of recurrent depression. Her symptoms have been effectively managed for the last eight months with citalopram 30 mg daily. Emma tells you she is eight weeks pregnant and asks you whether it is OK to continue taking citalopram.

This activity consists of a series of four polls, which we hope you will enjoy participating in.

Slide 20: Explain to participants that we will explore Emma’s query with our first poll. (2 minutes) In a moment you will see the poll appear on your screen with Emma’s query and four options. Please select the option you think is the most appropriate response to Emma’s query. You have one minute to answer poll 1:

The poll options are: 1. Ask questions to gather further information before discussing possible options [correct option]2. Reduce the dose of or stop the citalopram3. Maintain current dose of citalopram4. Switch to another antidepressant

Lead tutor should now launch poll 1 from the Zoom platform. Close the poll after one minute. Whilst polling is open, encourage participants to answer it by providing feedback at intervals on how many people have completed the poll so far and the time left to participate. After closing the poll, publish the results so participants can see the range of responses.


Reveal that the most appropriate response to Emma’s question is option 1: Ask questions to gather further information before discussing possible options We will now explore what questions we might ask Emma to gather necessary information to help us answer her query.

Co- tutor should ask participants what questions might you want to ask Emma? The co-tutor can invite participants to type their suggestions into the chat box. Alternatively, ask participants to raise their hand, then unmute them and allow them to share their thoughts verbally. There are examples of the questions you might want to ask Emma in the Suggested answers and they are listed below here as well (3 minutes)

1. What are your concerns regarding medication during pregnancy?2. What do you know about the benefits and risks of using an antidepressant during pregnancy? What

else would you like to know? Would it be helpful to you for us to discuss that?3. What was your mental health like during and after any previous pregnancies [if appropriate]? What was

the number, severity and duration of any previous episodes, associated symptoms and impact on yournormal functioning?

4. How are you feeling at the moment? What symptoms are you experiencing, if any?5. What unwanted effects of the antidepressant are you experiencing?

Co-tutor to thank participants for their contributions. Then co-tutor to explain that we will explore some of the questions we might want to ask Emma, some potential responses from Emma and how we might help address her needs and expectations. We will do this by continuing with three further poll questions in turn.

Lead tutor to launch poll 2. (1 minute for poll, 4 minutes for discussion)

Which one of the following is the least likely to help you in addressing Emma’s concerns? 1. Discussing the risk of the baby experiencing discontinuation symptoms at birth from exposure to the

antidepressant during pregnancy2. Discussing the risk of Emma’s mental health deteriorating during and after pregnancy if the

antidepressant is stopped3. Discussing the options for reducing or stopping antidepressant treatment for the first trimester and

then reviewing4. Explaining that the risks of maternal mental illness without antidepressant treatment, outweigh the

risk of foetal harm from the antidepressant [correct answer]

After one minute, the lead tutor to close the poll. The co-tutor to reveal that option 4 is the correct answer. Invite participants to share their thoughts on why this is the correct answer and invite further discussion or questions from participants who didn’t answer correctly to clarify their understanding of key points. Points that participants may come up with include:

• The role of the pharmacy professional is to help Emma balance the potential risks of maternal mentalillness without antidepressant treatment alongside the risks of foetal harm from exposure to theantidepressant if she continues treatment.

• The risks associated with maternal mental illness will vary considerably depending on the woman’sdiagnosis, mental health history, response to treatment, social stressors, support networks, healthbeliefs, co-morbidities, etc.


• The risks of Emma stopping her antidepressant during pregnancy do not necessarily outweigh the risksof harm to the foetus.

• Support Emma to explore the benefits and risks of continuing with her antidepressant and provideevidence-based information and guidance to help Emma make an informed decision that is right for her.

Co-tutor can use the following prompt questions and Suggested answers (page 5 and 6) to stimulate discussions if participants are not forthcoming. There may not be time to ask all the questions. The previous poll 1 discussion may have already addressed some of these. Emphasise that the Suggested answers will have useful information for participants post event.

• What are the risks if Emma wants to stop the citalopram or reduce the dose?• What symptoms might a newborn present with who has been exposed to SSRIs during pregnancy?• How severe are these symptoms likely to be?• How long are these symptoms likely to last?• What could Emma do to reduce the risk and severity of discontinuation or withdrawal symptoms from

the SSRI in her newborn?• What options might you discuss with Emma if she is still concerned about continuing with citalopram

after discussing the benefits and risks?

Lead tutor to explain that we are moving to poll 3. Lead tutor to launch poll 3. (1 minute for poll, 4 minutes for discussion)

Poll 3

If Emma wants to know more about the benefits and risks of using an antidepressant medicine during pregnancy, which one of the following pieces of information is true and could be useful in helping her make an informed decision?

1. The risk of foetal cardiac malformation and Persistent pulmonary hypertension in the newborn (PPHN)is significantly increased with use of a SSRI during pregnancy

2. All SSRIs are considered relatively safe during the perinatal period with no significant long-termbehavioural or developmental effects associated with babies exposed to SSRIs [correct answer]

3. Reducing the citalopram dose during pregnancy poses no risk to Emma’s health4. Switching to another SSRI with a potentially more favourable risk profile in pregnancy and

breastfeeding is preferable to continuing with current SSRI treatment even if it is well tolerated andeffective

After one minute, lead tutor to close the poll. Co-tutor to reveal that option 2 is the correct answer. Invite participants to share their thoughts on why this is the correct answer and invite further discussion or questions from participants who didn’t answer correctly to clarify their understanding of key points. Points that participants may come up with include:

1. All SSRIs are considered relatively safe during the perinatal period and evidence suggests there are nosignificant long-term behavioural or developmental effects associated with babies exposed to SSRIs.

2. A recent review of data suggests the risk of foetal cardiac malformation and Persistent pulmonaryhypertension in the newborn (PPHN) is not significantly increased with use of a SSRI during pregnancyonce confounding factors such as maternal smoking, alcohol consumption and co-prescribed


medication are taken into account. However, it is best to advise Emma to let the midwife attending her delivery know that she is taking citalopram (if Emma decides to continue taking during pregnancy)

3. Reducing the dose or discontinuing treatment increases the risk of relapse.4. Switching agents increases the risk of relapse. It also exposes the foetus / baby to more drugs; it is

preferable to continue or initiate a known effective agent during pregnancy or whilst breastfeeding

Co-tutor can use the following prompt questions and Suggested answers (page 6 and 7) to stimulate discussions if participants are not forthcoming. There may not be time to ask all the questions. Some of them may have already been addressed in the previous discussion. Emphasise that the Suggested answers will have useful information for participants post event.

• How safe are SSRIs in pregnancy and breastfeeding?• What are the risks of SSRIs to the foetus or in the newborn when used in pregnancy?• What are the risks for Emma if the citalopram dose is reduced or discontinued altogether?• What are the risks for Emma and her baby if the citalopram is switched in favour of another SSRI?

Lead tutor to explain that we are moving to poll 4. Lead tutor to launch poll 4. (1 minute for poll, 4 minutes for discussion)

Poll 4:

What is the most likely risk of relapse of Emma’s mental health symptoms if she stops her antidepressant? 1. No risk2. Low3. High risk [correct answer]

After one minute, lead tutor to close the poll. Co-tutor to reveal that option 3 is the correct answer. Invite participants to share their thoughts on why this is the correct answer and invite further discussion or questions from participants who didn’t answer correctly to clarify their understanding of key points. Points that participants may come up with include:

• Emma’s risk factors are recurrent depression, which has been managed for a relatively short periodof time and requiring treatment with an antidepressant.

• Emma is therefore at a high risk of relapse if she stops the antidepressant.Co-tutor to facilitate a further brief discussion about antidepressant use in pregnancy using the following prompt questions and the Suggested answers (page 7). Remind participants that more information is in the Suggested answers document which we will email to everyone post event.

• If on questioning, Emma is experiencing symptoms of depression despite taking citalopram, how willyou advise her?

• If Emma is experiencing unwanted effects from the citalopram, what will you advise?


Explain to learners that they have come to the end of the activities on the clinical topic and remind them that Suggested answers will be emailed after the workshop. At this point, remind participants of the workshop learning objectives on slide 21. Tell participants that they will revisit the workshop objectives and their personal learning objectives in the next section when they will have time to reflect on their learning and plan for any changes they need to make in their practice.


Reflection on learning and planning for action (8.30pm, 20 minutes including brief feedback)

The co-tutor shares the Word document of the participants’ personal learning objectives or provides verbal feedback. They will need to talk about the grouped objectives in general as there isn’t enough time to go through each one. Ask participants to use their green ticks to indicate if they have met their personal and workshop learning objectives or to use their red cross if they think they have not met all the learning objectives.

The workshop may not help some participants meet their personal objectives. If this is the case, acknowledge it by saying:

“I have had a look at your personal objectives and the learning this evening has covered most of them. If your personal objective hasn’t been fully covered, you may want to explore it further as part of your post-workshop activities.” You may find the resources on the CPPE Mental health gateway page useful in meeting additional learning needs. I have included a link to this page on a later slide.

Explain to participants that there is now some time for individual reflection to support them with their GPhC revalidation. Please take five minutes for personal reflection on the following points as listed in slide 22: Any personal learning objectives you identified and learning objectives for the session- to what extent have you met these learning objectives? What action will you take for any unmet learning objectives? What resources could you use?

Revisit your pre-workshop notes and workshop activities and consider: • What did you learn?• Why is this relevant to your practice? Think of a situation where you could apply this learning.• What will you do differently in your practice as a result of your learning?• How will this benefit the people who use your pharmacy services?

These prompts will help you to frame your reflections in terms of the revalidation framework and allow you to use the information to start a CPD or other revalidation record.

After five minutes, lead tutor to divide the participants into groups of four in a maximum of six breakout rooms depending upon participant numbers.

Slide 23: Explain that participants now have the opportunity to share their reflections with their peers if they wish. These discussions will allow you to gain different perspectives on how you can use your learning to make a difference to your practice and the people who use your pharmacy services. You may also wish to discuss how your reflections can contribute towards your revalidation records. Please use the Invite host button if you have a query and would like one of us to join your group. (10 minutes).

The tutors should agree which breakout rooms they will drop into to check for any queries and ensure participants understand the activity. Lead tutor to send an announcement at nine minutes to provide a one-minute warning of breakout room closing.

https://www.cppe.ac.uk/gateway/mentheal


Once back in the main room, co-tutor to invite participants to share any key reflection or action points and type these into chat. Lead tutor to read these out as they are typed. (5 minutes).

Close of event (8.50pm, 10 minutes)

Signpost to the evaluation survey link (slide 24) - encourage completion – they should have received an email with the link earlier that day. If not, you can post it in the chat box, or they will receive it in their post-workshop email.

Highlight any future events that may be coming up / useful resources (slide 25).

Thank participants and lead tutor (slide 26 and 27) – close the workshop. If any of the participants have trouble leaving the meeting the lead tutor can use the 'remove participant' function on Zoom.

www.cppe.ac.uk Email: [email protected]

Telephone: 0161 778 4000


Appendix 1: Pre-workshop emails

Email 1 – includes Zoom instructions – send a minimum of 4 weeks in advance of online workshop or as soon as participants book a place (lead tutor).

Dear Colleague,

You are booked on to the Depression Optimise online workshop on [insert date] at 7:00pm.

When you booked your place, you will have received a link to join the Zoom meeting, which is: [insert link for Zoom meeting]. Please log on and register as soon as possible.

Session timings Please make sure that you log in by 7:00pm.

Tutors will be online at this time to assist you with using Zoom but will not be able to help once the session starts at 7.15pm.

The Zoom meeting will be locked once the introductions and ground rules for the workshop have been covered, you will not be able to gain access after this time.

We will finish at 9:00pm and we hope that you will feel comfortable and confident to participate and engage throughout.

Using Zoom You will need internet access and a computer to access the online workshop. (mobile devices have limited functionality, although a tablet device may be used). You will need a microphone and speaker/headset facility to participate fully.

Mobile phones are not suitable for full participation in the online workshop.

It is also possible to download the Zoom mobile app.

If you have not attended a Zoom meeting before, please ensure you do the following:

- test your connection to Zoom prior to the scheduled time by visiting: https://zoom.us/test - once on the Zoom test page, click on the blue 'Join' button to launch Zoom.

If you do not already have Zoom installed on your computer, follow the prompts to download and run Zoom. Click on the download file if it does not open automatically and follow the computer prompts to install. Once Zoom is installed, it will open the Zoom window.

Please log in early to ensure any technological difficulties are addressed as the sessions will begin on time.

https://zoom.us/test


Pre-workshop activities Pre-workshop tasks are the Getting prepared activities on page 1 of the Optimise card which has been emailed to you. To ensure that you gain the most from the online workshop you need to complete these activities in advance. This is because Optimise programmes assume learners have a threshold level of prior knowledge, skills and experience in the topic. This is not covered as part of the Optimise programme. You can put yourself in the best position to engage in the online workshop by ensuring you complete all the Getting prepared activities on page 1 of the Optimise card. This will take a minimum of 20 minutes and longer for those with limited previous knowledge and experience in supporting people with depression.

Learning materials for use during the Zoom session I will email you the Optimise card with details of the online workshop activities, one week before the workshop. Please note that hard copies of learning materials will not be posted for online workshops.

We look forward to welcoming you to the online workshop. If you have any queries or concerns regarding your participation, please do not hesitate to contact me or [insert co-tutor name].

Kind regards,

[insert tutor names and email addresses]


Email 2 – send one week before online workshop (lead tutor)

Dear Colleague,

You are booked on to the Depression optimise online workshop on [insert date] at 7:00pm.

When you booked your place, you will have received a link to join the Zoom meeting, which is: [insert link for Zoom meeting]. Please ensure you have registered.

Session timings Please make sure that you log in by 7:00pm. Tutors will be online at this time to assist you with using Zoom but will not be able to help once the session starts at 7.15pm.

We will finish at 9:00pm and we hope that you will feel comfortable and confident to participate and engage throughout. You can put yourself in the best position to engage by ensuring you complete all the Getting prepared activities on page 1 of the Optimise card. This will take a minimum of 20 minutes and longer for those with limited previous knowledge and experience in supporting people with depression.

Using Zoom Remember to ensure that you have checked your access to Zoom and, for an optimal experience, we recommend connecting to the online workshop using a laptop or PC.

Hopefully, you will be now working through the pre-workshop Getting prepared activities.

I am attaching the Optimise card with details of the online workshop activities. Please have this accessible during the workshop either as a hard printed copy or saved on your PC or iPad. You may also wish to download any resources from your pre-workshop activities and have them accessible during the workshop to refer to if you wish.

We look forward to welcoming you to the online workshop. If you have any queries or concerns regarding your participation, please do not hesitate to contact me or [insert co-tutor name].

Kind regards,

[insert tutor names and email addresses]


Appendix 2: Setting up Zoom polls for ice-breaker and clinical consultation activity (must be completed in advance of the online workshop and tested during practice run of workshop)

Full details of how to enable the settings of your Zoom account for using polls can be located in the comprehensive University of Manchester guide to using Zoom, available at: www.dropbox.com/s/tqlt20j0n70zyz5/Zoom%20User%20Guide%20for%20The%20University%20of%20Manchester.pdf?dl=1

You will need to refer to page 20 of the guide, which appears as below:

Note – you will need to create the meeting ID for the workshop in your Zoom account before you will be able to create a poll to use during the workshop.

Training videos are also available to view on the Zoom support centre at: https://support.zoom.us/hc/en-us/articles/213756303-Polling-for-Meetings

Create the poll title Ice-breaker. When creating the questions for the poll, we recommend that you do not tick the Anonymous box (screenshot below).

http://www.dropbox.com/s/tqlt20j0n70zyz5/Zoom%20User%20Guide%20for%20The%20University%20of%20Manchester.pdf?dl=1

http://www.dropbox.com/s/tqlt20j0n70zyz5/Zoom%20User%20Guide%20for%20The%20University%20of%20Manchester.pdf?dl=1

https://support.zoom.us/hc/en-us/articles/213756303-Polling-for-Meetings


The questions you need to create:

Icebreaker Question: What percentage of people with depression continue their treatment for an appropriate duration of time?

Poll options are: 1. 10 percent [correct answer]2. 20 percent3. 30 percent4. 40 percent


Clinical consultation

Poll 1: Question: Emma is 34 years old with a history of recurrent depression. Her symptoms have been effectively managed for the last eight months with citalopram 30 mg daily. Emma tells you she is eight weeks pregnant and asks you whether it is OK to continue taking citalopram. Which one of the following options is the most appropriate response to Emma’s question?

Poll options are: 1. Ask questions to gather further information before discussing possible options [correct option]2. Reduce the dose of or stop the citalopram3. Maintain current dose of citalopram4. Switch to another antidepressant

Poll 2: Question: Which one of the following is the least likely to help you in addressing Emma’s concerns?

Poll options are: 2. Discussing risk of the baby experiencing discontinuation symptoms at birth from exposure to the

antidepressant during pregnancy3. Discussing risk of Emma’s mental health deteriorating during and after pregnancy if the

antidepressant is stopped4. Discussing options for reducing or stopping antidepressant treatment for the first trimester and then

reviewing5. Explaining that the risks of maternal mental illness without antidepressant treatment outweigh the

risk of foetal harm from the antidepressant [correct answer]

Poll 3: Question: If Emma wants to know more about the benefits and risks of using an antidepressant medicine during pregnancy, which one of the following pieces of information is true and could be useful in helping her make an informed decision?

Poll options are: 1. The risk of foetal cardiac malformation and Persistent pulmonary hypertension in the newborn

(PPHN) is significantly increased with use of a SSRI during pregnancy2. All SSRIs are considered relatively safe during the perinatal period with no significant long-term

behavioural or developmental effects associated with babies exposed to SSRIs [correct answer]3. Reducing the citalopram dose during pregnancy poses no risk to Emma’s health4. Switching to another SSRI with a potentially more favourable risk profile in pregnancy and

breastfeeding is preferable to continuing with current SSRI treatment that is well tolerated andeffective


1. No risk2. Low3. High risk [correct answer]

Refer to the Zoom guide for how to run the polls, view the results and end polling (see screenshot below).

Poll 4: Question: What is the most likely risk of relapse of Emma’s mental health symptoms if she stops her antidepressant?

Poll options are:


Dear All,

It was a pleasure to work with you at the Depression optimise online workshop on [insert date].

As mentioned at the workshop, please find attached the Suggested answers to the online workshop activities.

Please complete the evaluation for the online workshop, we would appreciate if you could do so at: [insert link to evaluation survey]

We value your feedback; it is important to us so that we can make any adjustments necessary to improve the learning experience. The online evaluation survey should take you no longer than five to ten minutes to complete and submit.

If you have any additional queries, please do not hesitate to contact either [insert contact details for tutor(s)] or [email protected].

Finally, we would like to thank you for your participation in our online learning and hope that we will have the opportunity to work with you again in the future.

Best wishes,

[insert tutor names]

Attachments Depression optimise Suggested answers

Appendix 3: Post-workshop email

https://cppesurveys.onlinesurveys.ac.uk/cppe-core-events-pilot

mailto:[email protected]


Appendix 4: Suggested marketing email templates

Template 1

Title: Dear Colleagues,

Book your place on the online Depression optimise workshop scheduled to run on [insert date] from 7pm until 9pm.

With at least a third of the population predicted to experience an episode of mild depression during their lifetime, it is likely that someone you know or care about will be affected by depression. But unlike physical ill heath, the symptoms of depression are often invisible. Social stigmas around depression can often inhibit people from talking about their condition or seeking help, with almost 40 percent of people who meet the criteria for major depression not going to see their doctor. Do you feel confident to talk to people with depression about their condition? Do you listen and explore what matters to the person instead of suggesting solutions? Do you understand the concerns people with depression have about their condition and treatment? If you answered NO to any of these questions, this workshop is for you.

You can participate in the same group learning from the comfort of your home, no travel required.

Visit the CPPE website to book a place today.

Best wishes

[insert names of tutors]

Template 2

Title:

Dear Colleagues,

Book a place on the CPPE online Depression optimise workshop to find out more and how you can support people in practice.

The cost to the individual, family, carers and society of untreated or inadequately treated depression is enormous. The burden is reduced if depression is recognised early and treated promptly and effectively. However, only ten percent of people with depression continue treatment for an appropriate duration of time. Do you know the misconceptions people might have about antidepressants? Can you recall the benefits and risks of antidepressant medicines? Can you make recommendations for support that people with depression may benefit from in addition to or instead of antidepressants? This workshop will equip you to identify how you can contribute to people being treated promptly and effectively, having their medicines optimised and achieving better health outcomes


This online workshop is scheduled to run on [insert date] from 7pm until 9.00pm.



Best wishes



Template 3

Title:

Dear Colleagues,

Book a place on the CPPE online Depression optimise workshop to find out more and how you can support people in practice.

The NHS Long term plan has detailed a vision to provide better support for people with poor mental health, including medicines management and support for self-harm. With only ten percent of people with depression continuing their treatment for an appropriate duration of time, there is much scope for pharmacy professionals in all sectors to support people to get the most from their medicines and address common misconceptions about antidepressants. What do you understand about the concerns people may have about antidepressants? What do you think are the challenges people with depression face and the barriers to effective communication with healthcare professionals? Use this workshop to develop your confidence and competence in these areas.

This online workshop is scheduled to run on [insert date] from 7pm until 9.00pm.



Best wishes


Document date: 25 February 2021 Version number: 1.0 Latest review: N/A Next review due: 25 February 2022

Facilitator’s guide Depression Optimise Online workshop ...

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