safeTALK delivered at a distance An approach to training ... delivered at a distanc… · An...

safeTALK delivered at a distance

An approach to training using Video Conferencing

Increasing access to Mental Healthcare Education for Remote and Rural Staff

Remote and Rural Healthcare Educational Alliance

safeTALK an approach to training using Video Confer encing delivered at a distance

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Acknowledgements

NHS Health Scotland

Livingworks (Canada)

NHS Highland

NHS 24 Breathing Space

Inverness College

NHS Orkney

Health Improvement Team; NHS Education for Scotland.


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CONTENTS

Executive Summary .................................. .................................................................. 5

Introduction............................................................................................................................. 5

Method.................................................................................................................................... 5

Results.................................................................................................................................... 5

Conclusion.............................................................................................................................. 6

Introduction....................................... ........................................................................... 7

Partnership Working ................................ ................................................................... 8

RRHEAL ................................................................................................................................. 8

Scottish Remote and Rural Healthcare Context ...................................................................... 8

NHS Health Scotland.............................................................................................................. 9

LivingWorks Education ......................................................................................................... 10

safeTALK.............................................................................................................................. 10

NHS 24 - Breathing Space.................................................................................................... 11

Purpose ............................................ .......................................................................... 11

Pilot Design....................................... ......................................................................... 11

Length of the session............................................................................................................ 12

Technical Challenges............................................................................................................ 12

Safety Considerations........................................................................................................... 13

Recruitment of Trainer .......................................................................................................... 14

VC Training for trainer........................................................................................................... 14

Recruitment of Participants ................................................................................................... 15

Course Administration........................................................................................................... 15

Trainer and Participant Etiquette........................................................................................... 16

Evaluation............................................................................................................................. 16

Reflective Accounts – The trainers perspective..................................................................... 17

Results ............................................ ........................................................................... 17

Impact of Training ................................. .................................................................... 18

Summary of Reflective accounts from Trainers..................................................................... 26

Discussion ......................................... ........................................................................ 29

Did the training accomplish its objectives?............................................................................ 29

What went well?.................................................................................................................... 29


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What challenges did we encounter and why? ....................................................................... 30

Recommendations for the future ..................... ........................................................ 30

Conclusions........................................ ....................................................................... 32

References ......................................... ........................................................................ 33

Appendix A - Technical Information................. ........................................................34

Appendix B - Session Design Template ............... ....................................................35

Appendix C - Safety Documents...................... .........................................................36

Appendix D - Recruitment of participants & Administ ration..................................40

Appendix E - Etiquette............................. ..................................................................44

Appendix E - Etiquette............................. ..................................................................44

Appendix F - Pre Course Evaluation ................. .......................................................48

Appendix G - Reflective accounts from Trainer ...... ................................................54


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Executive Summary

Introduction

RRHEAL together with education partners and Health Scotland have developed a ‘Distance

Delivered safeTALK’ programme of training that gives access for remote and rural healthcare

staff to increased awareness of suicide and basic skills to manage individuals who are having

troubling thoughts about suicide.

The suicide rate in Scotland has been reducing since 2001 (Scottish Government Health

Department, 2009). In 2008 there were 843 deaths by suicide in Scotland which equates to an

age standardised rate of 16.1 per 100,000 of the population. In 2002 the Choose life strategy

was established by the then Scottish Executive with the aim of preventing suicide.

safeTALK is a programme from LivingWorks Education (Canada) delivering 2.5 to 3 hour

training sessions for everyone in the community. The programme is designed to ensure that

individuals with thoughts of suicide can be connected to helpers who are prepared to help the

person overcome their thoughts on suicide.

Access to appropriate healthcare education can be a significant issue to remote and rural health

care (Swan, Selvaraj & Godden, 2008). Staff may often work in small geographically scattered

communities.

Government policy is committed to suicide prevention. There is a particular focus within the

NHS on increasing awareness and training the workforce in suicide prevention. (Scottish

Government Health Department, 2009)

Method

An experienced safeTALK trainer was recruited and received training in tele education delivery.

The course via videoconference was offered in 2 formats of 2 x 1 ½ hour sessions and a single

3 hour session.

Results

25 health care professionals from NHS Orkney, NHS Highland Isle of Mull and the Inverness


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region participated in the training. Evaluation of the impact of training indicated an improvement

in the confidence and competence of the participants in their ability to talk to a person at risk of

suicide and in their use of video conferencing for educational purposes.

Conclusion

Development of robust support systems such as VC etiquette, administration, coordination and

technical set up allows for the smooth delivery of training by this medium.

A local champion attending the training was useful as they provided a contact point for

distributing information and was also able to lead discussions within their location. If the training

involves group discussion this study would suggest 2-4 to be the optimum number of sites

linking in for the training via a VC link.

Consideration should be given to appropriate ice breaker activities when designing video

conference courses.


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Introduction

The recruitment and retention of staff in remote and rural areas is an issue that faces many

countries across the world. Common themes that contribute to this problem are professional

and social isolation, difficulties associated with distance and travel and the wide range of skills

needed (Deaville, 2001). Professional isolation is particularly problematic for rural healthcare

practitioners who are isolated from urban centres with poor access to hospitals and specialist

units.

Decreased access to continuous professional development (CPD) contributes to professional

isolation and is believed to have a significant influence on recruitment and retention (Curran,

Fleet & Kirby, 2006). Curran et al, in their study of the factors which influenced rural health care

professionals access to CPD, suggest that the barriers to access may be grouped as follows: -

• Geographical

• Organisational

• Financial

• Attitudinal

• Technological

The use of existing information and communication technologies in the delivery of education

can overcome many of these barriers. They can provide many remote and rural practitioners

with increased opportunities for CPD in order that they can keep up to date with a rapidly

changing body of knowledge.

Video conferencing (VC) has been successfully used to deliver high quality and effective

education to remote and rural practitioners. The North of Scotland Tele-education Project

(NoSTEP) aimed to improve access to CPD by using video-conferencing, to deliver training to

rural and island health communities (Swan & Godden, 2005).

The principle findings of the study are as follows:

• Technology is becoming more and more embedded in clinical practice and is

increasingly being used to support education.

• There are considerable cost benefits to local NHS Boards and individuals receiving


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education.

• Geographic isolation can be overcome to allow remote practitioners to take part in group

activity and peer supported learning.

• Knowledge transfer is occurring and this is demonstrated by the changes that individuals

are making in their clinical practice and the developments that they are planning for the

future.

Partnership Working

RRHEAL

The Remote and Rural Healthcare Educational Alliance (RRHEAL) was developed by NHS

Education for Scotland (NES) in response to extensive consultation with NHS Boards, frontline

staff and partnership agencies. RRHEAL was endorsed by the Scottish Government in 2008

and provides assistance to remote and rural NHS Boards and is a linking force between

healthcare services and education providers.

RRHEAL has been designed as a sustainable structure and to be of value by supporting the

current and future remote and rural healthcare workforce education needs. RRHEAL has

established a national alliance infrastructure that provides a coordinated response to education

needs for all healthcare staff across the remote and rural areas of Scotland. RRHEAL is

committed to the ongoing development of practical, structured educational networks that make

links between existing resources, systems and institutions more effective. RRHEAL provides

the NES input to the Scottish Governments Remote and Rural Action Plan and represents NES

within the Remote and Rural Implementation Group (RRIG). Delivering for Remote and Rural

Healthcare (2008) states access, rural specific content and support for remote and rural

learners as the key issues to be addressed by RRHEAL(Scottish Government May 2008).

RRHEAL is committed to working in alliance with key partners to ensure that remote and rural

education and training is accessible, affordable and of high quality.

Scottish Remote and Rural Healthcare Context

Over twenty percent of the Scottish population live in a remote or rural community spread over

ninety–six percent of the land mass of Scotland. The provision of high quality healthcare

services across this widely dispersed geography presents some significant challenges. The

Scottish Government published Delivering for Remote and Rural Healthcare (Scottish


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Government, 2008) providing a framework for sustainable healthcare services in remote and

rural Scotland.

The report recognises the interdependence of individual services and focuses on the integration

between different aspects across what is described as the ‘continuum of care’. This is defined

as self care and preventative care within the local community through the different levels of

supported care up to that which requires the resources provided by a tertiary centre.

NHS Health Scotland

NHS Health Scotland is a special health board and is the national agency tasked with improving

the health of Scotland’s population. They have responsibility for the delivery of the Choose life

strategy to reduce the rate of suicide in Scotland (NHS Health Scotland, 2010). The suicide

rate in Scotland has been reducing since 2001(Scottish Government, 2009). In 2008 there

were 843 deaths by suicide in Scotland which equates to an age standardised rate of 16.1 per

100,000 of the population.

In 2002, the Choose life strategy was established by then Scottish Executive with the aim of

preventing suicide. In May 2009, the Scottish Government published ‘Towards a Mentally

Flourishing Scotland, 2009-2011’ which sets out the priorities for the development of mental

health services in Scotland. Suicide prevention continues to be a key priority of the government

which aims to reduce the suicide rate by 20% by 2013. A key component of the strategy is for

50% of NHS front-line staff to be educated and trained in using suicide assessment

tools/suicide prevention training programmes by 2010 (Scottish Government, 2009).

A fundamental part of reducing suicide and achieving the objectives of Choose Life are local

action plans. Each area has a nominated Choose Life Co-ordinator who plays a key role in

implementing their local plan. In general, local Choose Life action plans focus attention on:-

• Preventing suicide within communities

• Improving the capacity of local communities to educate and raise awareness of suicide

• Delivering prevention and intervention activities

• Providing practical support to those affected by suicide

• Involving a range of partners in preventing suicide


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LivingWorks Education

LivingWorks Education (LWE) is an organisation based in Canada and is a developer of suicide

prevention training programmes (Anonymous). The LWE suite of programs is widely used and

is internationally recognized. LWE has over 4,000 community-based trainers around the world

who train over 60,000 participants annually. LWE develop suicide prevention programmes

based on the following assumptions: -

• Suicide is a community wide health problem.

• Suicide is not mental illness.

• Thoughts of suicide are understandable, complex and personal.

• Suicide can be prevented.

• Most people with thoughts of suicide want to live.

• Most people with thoughts of suicide indicate, directly or indirectly, that they want help to

live.

• Help-seeking is encouraged by open, direct and honest talk about suicide.

• The best way to identify people with thoughts of suicide is to ask them directly about their

thoughts.

• Relationships are the context of suicide intervention.

• Intervention should be the main suicide prevention focus.

• Cooperation is the essence of intervention.

• Intervention skills are known and can be learned.

• Large numbers of people can be taught intervention skills.

• Evidence of effectiveness should be broadly defined.

safeTALK

safeTALK is a programme from LivingWorks Education (Canada) and is a 2.5 to 3 hour training

programme for everyone in the community. The training is designed to ensure that individuals

with thoughts of suicide are connected to helpers who are prepared to provide first aid

interventions. Completing safeTALK alerts participants to people who may be at risk of suicide,

encouraging them to ask about suicide then refers them on to appropriate services.

• safe stands for Suicide Alertness For Everyone.

• TALK represents Tell, Ask, Listen and Keep Safe.


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The safeTALK learning process is highly structured, providing graduated exposure to practice

actions. The programme is designed to help participants explore how their attitudes and beliefs

towards suicide which can cause them to miss, dismiss or avoid suicidal alerts. Participants

practice the TALK steps actions in such a way that helps them to overcome these barriers. The

training is delivered with the support of PowerPoint and six 60 – 90 second video scenarios

(McLean et al).

NHS 24 - Breathing Space

Breathing Space Scotland is a free, confidential phone line and web service for people in

Scotland who are experiencing low mood or depression.

The Breathing Space phone line is staffed by a team of trained special phoneline advisors who

come from a range of mental health, counselling and social work backgrounds. They offer

advice and give referrals to agencies that can help with more specific problems in the caller’s

local area. Operationally the service is managed and delivered by NHS 24 and is based at their

contact centres in Cardonald, Clydebank and South Queensferry (2010).

Purpose

RRHEAL worked in partnership with LWE and NHS Health Scotland to develop a ‘Distance

Delivered safeTALK’ programme of training, specifically raising awareness of suicide and

providing basic skills in how to manage suicidal ideation for a wide range of remote and rural

healthcare staff. This will be the first time this type of training in Mental Health has been

delivered at distance using VC and remote communications technologies.

Pilot Design

Considerable thought was given to what would be required for the safe and effective delivery of

safeTALK via VC.

The issues highlighted were:-

• Length of the session.

• Technical challenges.

• Safety considerations.


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• Recruitment of trainer.

• VC Training for trainer.

• Recruitment of participants.

• Trainer and participant etiquette.

• Course administration.

• Evaluation.

Length of the session

The initial plan for this project was to run 4 sessions of safeTALK in a rural location in the

following format:-

1. A split site safeTALK VC delivery conducted via a 1½ hour and a 1¾ hour session.

2. A split site safeTALK VC session conducted via a 3 hour session.

3. A single site safeTALK face to face delivery conducted via a 1½ hour and a 1¾ hour

session in another remote/rural location.

4. Traditional session (similar to the original safeTALK design) as a control group.

Due to delays in the recruitment of both trainer and participants it was only possible to run the

sessions 1 and 2 sessions.

Technical Challenges

Simultaneous VC between three or more remote points is possible by means of a Multipoint

Control Unit (MCU). This is a bridge that interconnects calls from several sources (in a similar

way to an audio conference call). NHS Grampian hosts and manages an MCU and provides a

service to NES to connect multiple VC sites. This service is known as the NHS

Grampian Bridge (Scottish Centre for Telehealth, 2010).

Appendix A contains the bridge booking forms and Appendix B contains the Session Design

Template used for this project.

Testing was carried out with the support of NES Information Technology, NHS Grampian Bridge

and NHS Orkney. The system testing involved running 2 test sessions to check how the system

coped with PowerPoint which included an embedded video clip delivered via VC.


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The first test was VC to VC which discovered that there was a need to adjust settings of the

camera. This involved adjusting the camera settings from static to motion at the transmitter site

to allow improved vision. Separate audio cables were also required to allow the video sound to

be transmitted. The second test was VC via the bridge to 2 sites that would be receiving

training. This test confirmed that the above adjustments allowed the adequate transmission of

video with sound.

Discussion with the bridge service was required in advance of the training to ensure that the

view required from the site presenting the training was optimal. The delivery site would benefit

from a large view of the receiving sites. This is helpful for the delivery of power point

presentations and allows for the trainer to identify any person indicating that they would like to

ask a question and for any adverse reactions. This is important to observe for and maintain the

wellbeing of participants. Further detail regarding this point follows later.

Following the delivery of the training some additional considerations were:-

• Develop a template with a list of emergency numbers and a clear plan to manage breaks

in transmission should they occur.

• Check to see if the VC venue has a spider phone. This can be used to continue the

training until transmission via VC can be re established.

• Check that the venue chair person has their mobile phone switched on as a back up.

Safety Considerations

A valid concern over the delivery of suicide training by VC was what to do if a participant had an

adverse reaction to the very sensitive issues raised during the training. In a traditional

safeTALK session the trainer is supported by a colleague who is able to identify and support

any participants who find that the training is causing distress.

The agreed solution to this issue was to incorporate a person who is trained in suicide

interventions to act as a ‘spotter’ at the delivery site. Each participant was asked to provide

their mobile phone numbers and to keep their phones on during the session. In the event of a

problem there was therefore a mechanism in place for contacting the individual. If in the event

of the VC venue not having a mobile phone signal a suitably trained individual would be

required on site. This happened to be the case for one of the VC sites which was located in a

GP surgery. A GP who had been suitably trained was identified and agreed to be available in


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the event of a problem.

An additional concern was over the split VC session where participants were left partially trained

for a week. It was agreed that appropriate instructions would be given at the end of Session 1

on what to do in the event of encountering a person at risk of suicide. This involved utilising a

list of emergency numbers and national resources such as NHS Breathing Space and the

Samaritans.

In order to manage safety effectively several documents were developed. (See Appendix C)

These included:-

• A list of participant’s mobile phone numbers.

• A room planner.

• A list of emergency numbers.

Recruitment of Trainer

A trainer was recruited using the NHS Health Scotland’s Chooselife network. VC is an under

utilised mode of training delivery and requires a trainer who is very familiar with the material

they are delivering. Several experienced safeTALK trainers were contacted and asked if they

would be interested in delivering training via VC. A suitable trainer was identified and agreed to

participate in the project.

VC Training for trainer

Training for trainers has been identified as a key component of successful tele education

programmes (Swan & Godden 2005). The training should give participants:-

• Practical skills -Increased competence in setting up the equipment and skills in booking

systems using the VC bridge for multi point connections

• Teaching skills - Ability to adapt existing teaching skills to what is, for some, a new

medium, use of VC and power point presentation and ‘Hot tips for trainers’

RRHEAL are in the process of developing a tele education package. As part of the

development of this course, workshops were run. The workshops were aimed at educators and

lead clinicians to address some practical issues around use of VC equipment.


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Recruitment of Participants

Initially, the focus for recruitment was NHS Orkney but when uptake of the training was slow this

was extended to other remote and rural health boards. The local choose life coordinators were

contacted and asked if they would be willing to support the delivery of VC training. This contact

was done via NHS HS and directly by RRHEAL.

Some scepticism was encountered around the suitability of safeTALK training via VC.

Feedback from the some areas is noted below:-

‘ I have been in a number of discussions with our local trainers in ……. , as well as some of the practices we would be targeting, and the general feeling seems to be that this project just wouldn’t work in these areas - mainly in terms of the small numbers of people that would be attending but also in terms of the fact that people like to be taught by someone that they know and someone who is local. This is probably something to do with it being such a small but wide spread community, but liking to know that if they have been taught a new skill that there is someone experienced nearby that they can off load to.’

Other areas were enthusiastic and pragmatic about receiving training but did not have enough

time to arrange the training but were positive around its application in their area.

‘Good luck with the VC training, I certainly hope it is successful and you have opportunity to cascade it further, in my opinion it is the way we need to go with training as commitments and geography are putting an increasing strain on what is already a time and financially constrained workforce.’ ‘I would just like to add my support to the discussions around training via VC. The OT service across xxxxx has approximately 40 staff and the use of VC would save a significant amount of time and expense for courses that are mandatory.’

Recruitment of participants depended on a local champion to advertise and promote the course.

This champion was required to identify suitable sites and recruit participants. In areas where

this champion was absent recruitment was poor. Participants were successfully recruited from

Orkney, Isle of Mull and Inverness.

Course Administration

The administration of multiple sites is complex and challenging.


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Consideration needs to be given when planning VC training events to the process participants

undertake to register for the course, such as the receipt of pre course materials and evaluation

materials. In this project such administration was carried out manually but use could be made

of supportive technology. Effective communication with the local champions was also required

to support the administration of the course.

Appendix D contains documents that supported the recruitment of participants and course

administration.

Trainer and Participant Etiquette

In order for VC training to be delivered effectively clear etiquette is required for the trainer and

participants. Copies of the trainer and participant etiquette forms developed for the training

programme are shown in Appendix E.

Evaluation

Course specific evaluation forms were developed for this training (see Appendix F).

Information was collected on the profession, area of work and location of participants.

Participants were asked if they had received training via VC before and if they had previously

received training in suicide prevention.

The evaluation of the impact of the intervention focused on 5 areas:-

• Did the training improve the confidence and competence of the participants in their

ability to talk to a person about suicide?

• Did the training improve the confidence and preparedness of the participants to receive

training via VC?

• The relevance, appropriateness, enjoyment and length of the session.

• Comments on the benefits and drawbacks of the training.

• How long did it take to travel to the training venue?

NHS HS provided data from face to face safeTALK sessions for analysis and comparison. The

evaluation forms (see appendix G), used as part of ‘normal’ safeTALK courses differ from the


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evaluation carried out for this project however the key question of preparedness to engage with

a person with suicidal ideation is a common comparable theme.

Reflective Accounts – The trainers perspective

The course trainer was asked to complete 2 reflective accounts using Gibbs reflective cycle

(Gibbs, 1988). One account followed the first split VC session and the second account followed

the final full VC session. The purpose of this exercise was to gather knowledge on the

challenges faced by the trainer in VC delivery. Figure 1 describes the reflective cycle.

Figure 1 - Six stages of GIBBS Reflective Cycle (Gibbs, 1988)

Results

A total of 23 participants received training in safeTALK via VC. Table 1 shows the location and

attendance profiles for the sessions and table 2 the job roles of the participants. The majority of

staff worked in the community as either registered nurses or as clinical support staff.

Table 1 – Location of Participants

Split Session 3 hour Session

Inverness 2 2

Orkney - Kirkwall 6 3

Orkney - Dounby 0 4

Isle of Mull 0 6

Total 8 15


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Impact of Training

Graphs 1 and graph 2 shows the confidence and competence of the participants improved as a

result of the training. The improvements appear greatest in the split VC group.

Table 2 – Job Role of Participants

Job Role full VC split VC Total

Community care assistant 2 2

Lecturer 2 2 4

nurse 9 4 13

Nurse / Midwife 1 1

School nurse support worker 1 1

student nurse 1 1

Support worker 1 1

Total 15 8 23


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Graph 3 and 4 show that the majority of participants reported that their confidence and

preparedness to receive training via VC had improved as a result of the training.


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Graphs 5 and 6 show that the majority of participants reported that the training was relevant and

the methods used were appropriate.


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Graph 7 shows the level of enjoyment reported by the participant appeared greatest with the

split VC session. Graph 8 would indicate that the 3 hour VC session was too long for the

participants.


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Graph 9 indicates that the majority of participants would be willing to take part in VC training

and suicide training in the future.

Graph 10 is a summary of results from a normal face to face safeTALK session. Participants

were asked to report on how prepared they felt to engage with a person about their thoughts of

suicide. The results would suggest comparable changes in preparedness with VC delivery and

face to face delivery.


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The following comments were made about the training.

‘Very useful’

‘Found that the training done by this method worked reasonably well. At the start I wasn’t sure it would work but it did.’

‘The start of the session was strained and difficult for the first 30 min or so. We then got an idea of the format of the presentation. I feel that the group discussion & feedback helped the flow of the session and got everyone interacting. I think the value of the training will be based on how well any group participates in VC and the experience of the trainer in delivering via VC’.

‘I understand that this is offered at a basic level and can see how some groups or people might benefit but I would have felt that more in depth delivery would have suited me better within this work environment. With the power point available prior to delivery, the content could have been substantially reduced.’

‘I found the training to be at a very low level indeed and very repetitive. The methods were simplistic and did not challenge. Given the content I felt that the session was too lengthy. I would be interested in suicide training which was challenging and informative given my previous experience. ‘

‘Maybe not quite so long at a time’

‘Don’t really like it. Prefer face to face. Did get a couple of good points out of it.’


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Table 3 highlights the self-reported benefits and drawbacks of receiving education by VC.

Table 3 - Benefits and Drawbacks of Education via V C Benefits of VC Drawbacks of VC

Increased access to training for remote and rural areas

‘It makes it accessible to us, without having to travel and spend at least a day off the island.’

‘Local - do not need to go off island’

‘Access, inclusive, incorporates a large number of sites’

Connection issues

‘Poor VC connection’

‘Loosing connection’

‘Time delay - a bit unusual’

‘Thought overall it went reasonably well. Connections can be slow - conversation delay etc.’

‘VC interference at times. Difficulties finding a suitable venue due to shortage of available rooms’

‘Technical hitches. Turning on and off microphones. Slight time delay’

Reduced travel

‘Don't have to travel long distances, can be done in own building.’

‘Not having to travel off the Island for the day.’

Engagement Issues

‘Not being able to talk one to one , if needed’

‘Lack of group participation Difficult to engage via VC. Difficult to hear and lack of feedback’


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More efficient use of time and money

‘We can access training that could not be provided locally in remote areas. Training is more succinct in that the time required to attend is shorter and there is no travelling time.’

‘Time saving gives us access to courses we wouldn’t otherwise get to’

‘Less expense. Chance to attend more training opportunities. Don’t have to leave Orkney’

‘Found the VC very informative and interesting. .. I gained a better insight on how to identify someone at risk of suicide and how to better approach the 'Are you thinking about suicide??... Handy… You can mute to have team discussions during the VC. Able to share others / area views/feelings.

Other

‘This type of training by VC wasn't particularly useful. I use video conferencing frequently, and do feel that only certain subject matter can be competently delivered in this method.’


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Summary of Reflective accounts from Trainers

The trainer completed 2 reflective accounts. An unabridged version of these accounts is

contained with in Appendix G. Table 4 contains a summary of the reflective account following

the first VC session.

Table 4 – Summary of 1st Reflective Account Description: -

‘The session went relatively smoothly, although there was a late start as one of the sites was late. Also, we lost the Inverness at one point. My main focus was on delivering the material and interacting with the participants through questions and short exercises.’ Feelings: -

‘I was initially very sceptical about delivering training by VC…..’

‘The biggest concern was that during the training someone might have some personal issues cropping up ‘

‘I felt very anxious beforehand. ‘

‘I was concerned about the technical issues and using the equipment……I was also concerned about looking at my notes during the training and how that might come across. ……Once we got into the training, I quickly realised that actually I did not have to look at my notes very much at all’

‘I felt very energised throughout the training, it was a real buzz. . …. engaged and thinking about the training and all the technical stuff at the same time. It was challenging and tiring, but I really enjoyed myself. ‘

‘The main drawback was the minimised interaction with participants. As a trainer, we get energy from “the room”.’

‘You can tell a lot about what’s going on with participants just from being in the same room as them, seeing their faces and their body language. Most of that is lost in VC…..’ Evaluation: -

‘The short exercises I gave them and questions worked very well over the VC. From the responses they gave me, it was clear that they understood my instructions and were engaging with the material and being quite thoughtful about their responses.’

‘Some of it did feel a bit rushed though, and on reflection, I think that was about me responding to the barriers of not being in the same room with people.’

‘Only speaking to the chairperson minimised this interaction. However, it did provide some safety for me, in that it made the group work more manageable.’


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Analysis: -

‘I would maybe slow down a bit, I think my stress levels would be a bit lower the next time round.’

‘I don’t know how feasible it is, but from a trainer’s perspective it would be nice to get comments from various members of the groups at each site, rather than just hearing from the chairperson.’

‘Any technical issues arising have the potential to be multiple and disastrous. The trainer has to have a good handle on using the equipment, but success of a session like this is also reliant on each site having a good grasp of the equipment. A technical assistant on site is a huge advantage.’

‘It is interesting because on reflection, although I missed out on that direct feedback, I think the set up of VC training actually gave each individual site more cohesion.’

‘It has also occurred to me, that to deliver training in this way, a trainer really needs to know their material inside-out.’ Conclusion: -

‘The huge amount of preparation that went into this session is what made is successful.’

‘All the pre-course information was very important and it was great that the sites received this.’ Action Plan: -

• Zooming in to be able to see the faces better • Good time-keeping for everyone at each site • Ways to get contributions from the whole group – not just the chair • Prompt to remind trainer to look at the camera and not the screen while speaking • Panning camera round to anyone else at the trainer’s site who might be speaking


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Table 5 contains a summary of the reflective account following the 3 hour VC session.

Table 5 – Summary of 2nd Reflective Account – After 3 hour VC session Description:-

‘VC whole safeTALK session with four sites from the bridge: one from Inverness, two from Orkney and one from Mull. There were a few small technical glitches at the beginning..’

‘Each site also allocated a chairperson and it was very helpful that this time the Bridge put up the names of each site so we could see them.’ Feelings:-

‘This felt different from the split sessions in many ways. Firstly I felt much more confident using all the equipment’.

‘I was not panicking about pressing buttons.’

‘I felt this worked much better and was more mirroring the ordinary training processes for safeTALK. In some ways, it did not feel a whole lot different from delivering safeTALK with the DVD co-trainer.’

‘However, I did feel like it kind of sucked up my energy more than ordinary training. In the training room, I feel I can get back some energy from participants, it’s much easier to get instant feedback from them….’

‘There were times when some participants questioned the material and not everyone wanted to ask about suicide, but this totally reflects ordinary face-to-face training around suicide.’ Evaluation:-

‘This was in my view a successful safeTALK.’

‘The participants seemed to learn what they were supposed to learn. They engaged with me, the materials and each other within and between their sites.’

‘I believe that the training they did that day by VC will contribute to making their communities safer from suicide and that is one of the aims of safeTALK.’ Analysis:-

‘To me it seems VC is a viable medium for delivering a programme like safeTALK. The way that safeTALK has been designed makes this possible.’ Conclusion:-

Preparation remains a huge part of the success of this pilot – preparation by the trainer, but also all the work that went into setting up the sites and the bridge to make everything as safe as possible. Action Plan:-

‘Good set up and work done beforehand on VC etiquette for both trainer and participants’

‘Maybe some sort of quick ice breaker if there’s time and not too many people, maybe extra time could be built in for this’

‘Trainer preparing to know the material being delivered extremely well.’


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29

Discussion

Did the training accomplish its objectives?

The purpose of this project was to demonstrate that safeTALK could be successfully delivered

‘at a distance’. The goal of safeTALK is to increase awareness of suicide and to teach

participants to recognise and engage persons who are having suicidal thoughts. The results

would suggest that these objectives were accomplished. The comments made by the

participants and reflective accounts from the trainer would suggest that the confidence and

competence of front line remote and rural staff improved in acknowledging and engaging with

individuals who are having thoughts of suicide.

What went well?

Pre session testing of the equipment exposed difficulties and provided the opportunity for

practical solutions to be identified. Regular communication with IT colleagues and with the

Grampian Bridge enabled expertise to be brought to bear on solving any problems that arose.

The delivery of these VC training sessions were made successful as a result of effective joint

working between NES, NHS HS, NHS Highland, Inverness College and NHS Orkney and NHS

Grampian (bridge). This success of the sessions was made possible by a local champion within

each area who recruited participants, distributed pre course information & reading and

coordinated the evaluation process.

The development and application of trainer and participant etiquette to meet the requirements of

these sessions supported the smooth running and effective delivery of the training.

The recruitment of a course trainer who was experienced in the delivery of safeTALK and willing

to attempt an alternative mode of delivery was significant. Attendance at a tele education

training day gave the trainer the necessary confidence and competence with the technical

aspects of VC to deliver the course.

Feedback from participants reported that the course enabled them to receive training locally and

that the format of delivery was successful.


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30

What challenges did we encounter and why?

The process of identifying local champions to recruit participants and co ordinate the training

session was a challenge. Scepticism over the use of VC was encountered in some areas. The

source of this uncertainty was unclear. A preference for face to face training, negative

experiences of VC in the past and a fear of technology may all be factors that contribute to the

reluctance to uptake VC training.

Several participants reported poor connection, slow speed and time delays as drawbacks to

training via VC. These are all issues associated with connection speed. At present NHS sites

are restricted to using ISDN lines for bridge VC connections. Improvements to the connectivity

infrastructure in remote and rural areas would help to resolve this issue. There is an on going

national dialogue around improving the connectivity of the nation.

The trainer and the participating sites reported that the start of the sessions felt awkward and

clumsy. Delays and difficulties linking up multiple sites, unfamiliarity with VC and challenges in

asking several sites to join in training all contribute to this problem.

There was a brief break in transmission to one of the sites at Inverness College who were

linking in via the UHI bridge. This was caused by an error in the booking of the bridge. This

was restored after 5 minutes and did not affect the outcome of the training.

An issue encountered by trainer and participants was the lack of interaction between and from

participants. An unavoidable consequence of VC as a mode of training may be that it is less

interactive and personal but these issues may be overcome with familiarity, practice, use of

etiquette and improvement in technology. The development of ice breakers that are designed

for use via VC may provide a safe and effective method of improving group interaction.

Recommendations for the future

• System testing – to ensure that any power point presentations / video clips can be

effectively transmitted.

• To support technical problems, develop a template with a list of contact numbers and

a clear plan to manage breaks in transmission should they occur.

• Check to see if the VC venue has a speaker phone. This can be used to continue

the training until transmission via VC can be re established.


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31

• Check that the venue chair person has their mobile phone switched on as a back up.

• It is helpful for the trainer to have access to support should a problem occur.

• Discuss with the bridge in advance the view required from the site presenting the

training i.e. does the trainer require a large view of the receiving sites? This is

particularly helpful during power points etc. so that any person indicating that they

would like to ask a question can be identified.

• A trainer who is confident and competent with face to face delivery should be

considered for video conference delivery.

• Training for the trainer in the use of tele education is an advisable prerequisite.

• Development of a robust etiquette for participants and trainers facilitates the smooth

delivery of the training.

• A local champion who is attending the training is essential in ensuring that pre

course material reaches the participants in a timely manor and that evaluations are

completed and collected.

• If training involving group discussion is being delivered to multiple sites this project

would suggest that 2 -4 is the optimum number of sites linking in for the training.

• The trainer benefits from practice with transitions on the VC, for example switching

from presentation view to camera view.

• Consideration should be given to the development of VC friendly ice breakers where

there are multiple sites involved. This would help to re enforce the etiquette

principles required for effective VC and assist in the preparation for training.

• When arranging / booking VC training, 15 – 20 minutes lead and end time is a

helpful buffer to ensure that the training runs smoothly. It took 5 – 10 minutes for the

bridge to complete all the connections and for the training to commence. This buffer

time also gives the trainer an opportunity to ensure that the receiving venue is set up

in such a way that all the participants can be seen.

• The reflective account provided by the trainer was useful in identifying strengths and

weaknesses of the mode of training.

These are some of the suggestions they made:-

• Zooming in to be able to see the faces better.

• Good time-keeping for everyone at each site.

• Ways to get contributions from the whole group – not just the chair.

• Prompt to remind trainer to look at the camera and not the screen while


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speaking.

• Panning camera round to anyone else at the trainer’s site who might be speaking.

Conclusions

This project demonstrates that it is possible to successfully deliver mental health training via VC

for remote and rural NHS staff. 23 participants received safeTALK training via VC and reported

improvements in their confidence and competence with their ability to manage an individual who

is at risk of suicide.

The key lessons learned from the training were that:-

• Development of a robust etiquette facilitates the smooth delivery of the training.

• A local champion who is attending the training is essential.

• If training that involves group discussion is being delivered this project would suggest

that 2 -4 is the optimum number of sites linking in for the training.

• Consideration needs to be given to appropriate ice breaker activities when designing

video conference courses.


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33

References

NHS 24 Breathing Space. 2010. [online]. Available from: www.breathingspacescotland.co.uk. [Accessed

July 06].

LivingWorks. [online]. Available from: http://www.livingworks.net/page/We Are LivingWorks Education

[Accessed 6/22/2010].

Curran, V., Fleet, L. & Kirby, F., 2006. 'Factors influencing rural health care professionals access to

continuing professional education'. The Australian Journal of Rural Health, 14 (2), pp. 51 .

Deaville, J., 2001. The Nature of Rural General Practice in the UK - Preliminary Research.

Gibbs, G., 1988. Learning by Doing: A guide to teaching and learning methods. Oxford: Further Education

Unit, Oxford Brookes University.

McLean, J., Schinkel, M., Woodhouse, A., Pynnomen, A. & McBryde, L., Evaluation of the Scottish

SafeTALK Pilot.

NHS Health Scotland. 2010. Choose Life. [online]. Available from: http://www.chooselife.net [Accessed

23rd June 2010].

RRHEAL. The Remote & Rural Healthcare Educational Alliance (RRHEAL). [online]. Available from:

http://www.nes.scot.nhs.uk/rrheal/ [Accessed 6/22/2010].

Scottish Centre for Telehealth. 2010. SCT. [online]. Available from:

http://www.sct.scot.nhs.uk/faq.html#q5 [Accessed 23rd June 2010].

Scottish Government. 2008. Delivering for Remote and Rural Healthcare: the final report of the remote

and rural workstream. Edinburgh: The Scottish Government.

Scottish Government. 2009, Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009-

2011, http://www.scotland.gov.uk/Publications/2009/05/06154655/0 edn.

Swan, G. & Godden, D. 2005, North of Scotland TeleEducation Project, Audit and Evaluation Report to

NHS Education for Scotland, Aberdeen.

Swan, G., Selvaraj, S. & Godden, D., 2008. Clinical peripherality: development of a peripherality

index for rural health services. BMC Health Services Research, 8 (1), pp. 23

safeTALK delivered at a distance- an approach to t raining using Video Conferencing

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Appendix A - Technical Information

VIDEOCONFERENCING BRIDGING SERVICE

BOOKING REQUEST FORM

In order that we may respond more effectively should a problem arise, we would ask you to help us by filling out the essential details below prior to booking your videoconference. Without this

information it may prove impossible to provide technical support should it be required. Please try to give at least one weeks notice.

N.B Technical support is only available 8 am – 5 pm unless prior agreement has been reached.

YOUR CONFERENCE NUMBER WILL BE ALLOCATED TO YOU ON RECEIPT OF THIS COMPLETED FORM. (The form will be returned to the person requesting the conference fo r

distribution to participants)

MEETING DETAILS:

Meeting Title:

Date: Time/Duration: _____

Location:

Booking person and contact number

Site Locations Site Telephone Number Site Contact V ideoconferencing Number

(including STD code)

Please use additional sheet if required

Dial-in No.: ______________________________ Passwor d _______________ Either email completed form to [email protected] or fax to 01224 5(50405)In the

event that you experience difficulties connecting i nto your videoconference, please do not hesitate to contact the communications centre helpdesk. Teleph one Number 01224 5(59269) or

01224 5(54455)


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Appendix B - Session Design Template


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36

Appendix C - Safety Documents

Keeping Safe

If you encounter a person who is at risk of suicide or if you feel at risk of suicide please contact one of the following numbers for help

and support.

Richard Leckerman

Richard is available to provide support

to participants of the safeTALK VC

programme

Tel:- 07789 923 312

E mail :- [email protected]

Breathing Space –

Confidential help line

Mon – Thurs 6pm – 2 am

24 hours at weekends

0800838587

Samaritans

24 hours a day confidential help line

08457 90 9090


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Appendix C – Safety documents

Tele education – template of emergency numbers

Key contacts

Name Number

Bridge

Include all bridge’s involved

Land line number for venue

Mobile of venue chairperson

(if available)

Spider phone( if available)

Local IT contact


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Appendix C - Safety documents

Participant List

Site:-

Date:-

Name Mobile number


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39

Appendix C - Safety Documents

Room Planner for safeTALK VC

Venue Date

Position

Name

Phone

Number

Site: -

Draw out Room layout


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Appendix D - Recruitment of participants & Administ ration

Information Sheet - safeTALK Video Conference Pilo t

MARCH 2010

RRHEAL are working in partnership with NHS Health Scotland and Livingworks Education

(Canada), who are the developers of safeTALK, to pilot a video conferencing version of

safeTALK. The course aims to help participants to be more aware of suicide and gives them

some basic skills in how to manage suicidal ideation and in its current form is a 3 hour course

which is delivered face to face.

Project Design & Course dates

3 pilot groups would be run and one traditional session in a rural location as a control i.e.

• A split site safeTALK video-conferenced course conducted over 2 x 1 ½ sessions.

Mon 15th March & Mon 22nd March - 1 pm - 2.30 pm

• A split site safeTALK video-conferenced course conducted over a 3 hour session.

March 26th from 1pm - 4 pm.

• A single site safeTALK face to face course conducted over 2 x 1 ½ sessions.

Dates – to be confirmed

• Traditional session.

• An evaluation report will be produced and distributed.

If you would like further information on this proje ct please contact Greg de Mello; Project

Officer with RRHEAL on [email protected]


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Appendix D - Recruitment of Participants& Administr ation

Booking Request Form - safeTALK Video Conference Pi lot

Site Name

Site Contact

Site Address

Site Telephone

Number

Site Video

Conference

Number

Please select the format of course that you would l ike to participate in

safeTALK video conferenced course run over 2 sessions on Mon 15th

March & Mon 22nd March - 1 pm - 2.30 pm

safeTALK video conferenced course run over 1 session on Fri 26th March

– 1pm – 4 pm

Number of delegates (Max 6 - 8)

If you would like further information on this proje ct please contact Greg de Mello; Project

Officer with RRHEAL on [email protected]


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42


Dear safeTALK VC participant

Re . safeTALK Video Conference Pilot - March 2010

Thank you for agreeing to take part in this pilot project to test the effectiveness of different modes of delivery of safeTALK suicide

training.

You will find enclosed your pre course and course information.

There are 2 things we would like to request you to do prior to the course:-

1. Please read through the video conference etiquet te document.

2. Please complete part 1 of your evaluation and ha nd this into your course organiser.

We hope that you find the course helpful and enjoyable

Your sincerely

Greg de Mello

Project Officer

RRHEAL

If you would like further information me at [email protected]


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43


Information check list

Pre course info for

participants

• safeTALK booklet

• sticker for safeTALK

• safeTALK card

• VC Etiquette

• NHS 24 breathing space – pen, card x2, key

ring

• Power point slides

• Keeping safe document

• Information sheet

• Part 1 evaluation forms

• Letter

Info for course organiser • Part 2 evaluation forms

• safeTALK certificates

• Return mailing envelope for evaluation forms


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Appendix E - Etiquette

safeTALK VC - Etiquette for the Trainer

• If appropriate, get the participants to introduce themselves.

• Explain that you will go to each site participating in turn for questions - this gives people

an immediate understanding of what to expect and when to ask their questions, avoids a

free for all or silence.

• Plan to have breaks in your talk. The attention of the audience starts to tail off quickly,

so plan some changes of activity such as question and answer sessions, a

demonstration, using a different type of visual aid, a group exercise etc.

• Tell participants how you want them to behave. i.e. to mute their microphone when not

speaking and / or to put up their hand if they wish to ask a questions. If sites forget to

comply – remind them.

• Tell participants how you would like them to ask questions. I.e. To ask via local chair

who will raise their hand; when instructed to do so to unmute mike and ask question.

• Ask for contributions form the participant sites in an orderly fashion – remember not to

leave out any sites. Be observant of the remote sites. Keep a lookout for people putting

their hands up.

• Ensure each site has a reasonable view from the camera. If necessary tell sites to move

/ zoom the camera or to close curtains or blinds if only a silhouette is visible.

• Only allow one person to speak at a time.

• Try to minimise background noise e.g. paper shuffling, noise from open windows, pen

clicking etc.

• Remember, your session will have a finish time and there may be another video

conference booked for that venue.


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45

• Keep visual aids simple, objectives focussed and shorten your didactic element.

• With some systems it is possible to send two video streams at a time. This enables you

to send a picture of the speaker along with a view of the slides. If it is possible to do this,

try to learn how it works. However, don’t rely on this technology as some systems are

incapable of supporting this. Have a back-up plan (see point below).

• When finished with a slide, switch video feed back to the speaker. Audience can quickly

get bored if they only hear a disembodied voice. If you need training on how to change

video sources, arrange this in advance.


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Appendix E - Etiquette

safeTALK Video Conference Project – Etiquette & Hel pful Hints for Participants

PREPARATION

• Prior to the course you should have received some pre course information:-

√ safeTALK booklet

√ Project information sheet

√ Copy of the power point slides

√ Evaluation sheet

√ Breathing space information

• Please complete part 1 of your evaluation form prior to attending the training.

• Several sites are taking part in the training and the video conference session is being

hosted by the NHS Grampian Bridge. They will contact dial each site.

• Your contact number if you’re having problems is 07920500547.

POSITIONING & SUPPORT

• Familiarise yourself with the equipment: make sure it is powered up/microphone is

correctly positioned/muted or not as required and that you are framed effectively by the

camera e.g. not a distant figure at the end of a room!

√ Do not have camera facing the window

√ Use soft textured background avoiding white

√ Use split screen to check everyone is visible on VC at each site –

this could be carried out and alterations made during

• Please nominate a chair person for each site who will hold the remote control


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47

STARTING THE SESSION

• There will be an opportunity for each of the participants to introduce themselves at the

start of the session.

BACKGROUND NOISE

• The microphone on a video conference unit is very sensitive so: –

� Please mute the microphone when not in use

� Do not shuffle papers, whisper to each other & try to keep still while

others are speaking.

RESPECT

• Your trainer needs to be directive and participants clear and concise,

• Be aware of time-lag when speaking.

• Since multiple sites are attending raise your hand to request the floor/permission to

speak, wait for the chairperson to recognise you.

Asking a question

• The trainer will give each site an opportunity to ask questions

• Please ask questions via your local chair person.

• Since there are multiple sites please wait for the trainer to recognise you before asking

your question.

• When instructed to do so please un mute the mike and ask question.


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Appendix F - Pre Course Evaluation

safeTALK Video Conference Pilot

Evaluation & Feedback

Please help us to ensure the quality and relevance of this course by completing this evaluation.

Please complete BEFORE the session.

Date of session that your taking part

Name :-

Profession :-

Area of Work :-

Location of Work:-

Have you received training via video

conferencing in the past?

Yes � No �

If so what and when?

Have you received training in suicide

prevention in the past?

Yes � No �

If so what and when?


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49

How competent do you feel right now in your ability to talk to a person who is at risk of suicide?

Not Competent Very Competent

1 2 3 4 5

How confident do you feel right now in your ability to talk to a person who is at risk of suicide?

Not Confident Very Confident

1 2 3 4 5

How confident do you feel right now about the prospect of receiving training in this format?


1 2 3 4 5

How prepared do you feel right now to receiving training in this format?

Not Prepared Very Prepared

1 2 3 4 5

Comments:-

Please hand this into the person who organised your training before the session begins


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50

Appendix F - Post Course Evaluation

Please complete AFTER the session.

Name:-

On reflection how competent were you in your ability to talk to a person who is at risk of

suicide before this session?


1 2 3 4 5

On reflection how confident were you in your ability to to talk to a person who is at risk of

suicide before this session?


1 2 3 4 5

On reflection how confident were you before the sessions about the prospect of receiving

training in this format?


1 2 3 4 5

On reflection how prepared were you before the session to receiving training in this format?


1 2 3 4 5

Comments :-


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51

And now?

How competent do you feel now in your ability to talk to a person who is at risk of suicide?


1 2 3 4 5

How confident do you feel now in your ability to talk to a person who is at risk of suicide?


1 2 3 4 5

How confident do you feel now about the prospect of receiving training in this format in the

future?


1 2 3 4 5

How prepared do you feel now to receiving training in this format in the future?


1 2 3 4 5

Comments :-


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52

What are the benefits of receiving training in this format?

What are the drawbacks of receiving training in this format?

How long did it take you to travel to your training venue from your normal place of work?

Thank you very much for completing this evaluation.

Please indicate your level of agreement with the fo llowing statements

The session was relevant to my needs.

Strongly Disagree Strongly Agree

1 2 3 4 5

The teaching and delivery methods were appropriate .


1 2 3 4 5

Training in this format was an enjoyable experience .


1 2 3 4 5

The session was :-

� Too Long � Just right � Too Short


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53

If training were available in this format in the future, how would you take part?

Not Likely Very Likely

1 2 3 4 5

How likely are you to take part in suicide training in the future?

Not Likely Very Likely

1 2 3 4 5

Comments: -


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54

Appendix G - Reflective accounts from Trainer

VC safeTALK session 15/3/10

Description

VC split safeTALK session with two sites from the bridge from Inverness and Orkney. The session went relatively smoothly, although there was a late start as one of the sites was late. Also, we lost the Inverness at one point. My main focus was on delivering the material and interacting with the participants through questions and short exercises. XXXX took care of the technical arrangements and XXXXX was keeping an eye on the participants and what was going on with them, plus there was another observer in the room. The session lasted approx 1.5 hours. The aim of the safeTALK session was to help participants become more alert to suicide, how to identify people at risk, learn how to ask in a clear way and then connect people with further resources.

Feelings

I was initially very sceptical about delivering training by VC, particular suicide training. My concerns were around losing the connection with participants and also around their safety. My experiences of delivering safeTALK are that although many people come to the training through work, most people have some sort of personal experience of suicide as well. In a face-to-face training session, sometimes people will talk about these experiences. Although most of the safeTALKs I have done have been relatively straightforward. It is a more didactic style of delivery, so there is less space and time for participants to talk about their own experience. What often happens is that people will approach me during the break or at the end of training. The biggest concern was that during the training someone might have some personal issues cropping up and be unable to talk about them because of the VC setting. However, even in a face-to-face training, there is the barrier of other people being there, so people may not bring these issues forward anyway.

At this session, I felt very anxious beforehand. I was concerned about the technical issues and using the equipment. I was also concerned about looking at my notes during the training and how that might come across. I had some of the usual concerns that I have in ordinary training sessions – would the participants be receptive to the material? Would they be resistant? What challenges would they bring? Would they engage with me and the material?

Once we got into the training, I quickly realised that actually I did not have to look at my notes very much at all and that I could quickly glance over to make sure I hadn’t missed anything during the times when I put the slides up on the screen. What I was unsure of was what exactly the participants were seeing.

I felt very energised throughout the training, it was a real buzz. I felt like I was firing on all cylinders with every sense engaged and thinking about the training and all the technical stuff at the same time. It was challenging and tiring, but I really enjoyed myself. I felt like I was running on adrenaline with a feeling of constant movement.

I did have a sense that there was no breathing space, no time to stop and take stock of how things were going – any pauses felt tiny. The main drawback was the minimised interaction with participants. As a trainer, we get energy from “the room”. You can tell a lot about what’s going on with participants just from being in the same room as them, seeing their faces and their body


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55

language. Most of that is lost in VC, or at least in this session. It was difficult to see people’s faces because particularly in Orkney there were six people in the room, which is a lot to fit in the screen. And although there were only two people in Inverness, their camera was zoomed out quite far so it was hard to see their faces and expressions. I think this made me a bit anxious to keep going when the feedback from the group was minimal. So although I felt like something was missing, it still felt like a successful training session.

Evaluation

However, the short exercises I gave them and questions worked very well over the VC. From the responses they gave me, it was clear that they understood my instructions and were engaging with the material and being quite thoughtful about their responses. They were clearly taking on board what was being said and linking it to their own prior learning and experiences. This was very encouraging and gave me a sense that what we were doing in the session was working.

Some of it did feel a bit rushed though, and on reflection, I think that was about me responding to the barriers of not being in the same room with people. I would normally be more responsive to participants, considering their answers and getting more contributions from other participants. Only speaking to the chairperson minimised this interaction. However, it did provide some safety for me, in that it made the group work more manageable. If people were talking over each other it simply wouldn’t work.

I think in the next session I would have more faith in the technology, more faith in the participants that they are listening and engaging – although in some ways that feels a little like blind faith.

Analysis

It was very difficult to see people’s faces and expressions. I think asking each site to zoom in would be helpful. At times, it was even difficult to distinguish exactly who was speaking because I couldn’t even see people’s mouths moving. Also with the faces so far away, it was hard to tell who was taking part in group discussions and who was not engaging. Of course some people are quieter in any group, but it would be helpful to get a clearer sense of that.

I would maybe slow down a bit, I think my stress levels would be a bit lower the next time round. Doing anything new for the first time is bound to be accompanied by some anxiety that is natural and will reduce each time you do it.

I don’t know how feasible it is, but from a trainer’s perspective it would be nice to get comments from various members of the groups at each site, rather than just hearing from the chairperson. It would be helpful if people said their name as they made their contribution – this would maybe help me feel more connected with the group. However, I am aware that this is a need of a trainer and that the participants might feel that they had an opportunity to contribute and that maybe I don’t actually have to hear that coming directly from them. It would be interesting to hear their perspective. I think what I am trying to say is that in ordinary training settings, I am used to instant feedback from participants and I can respond to that accordingly, adjusting my pace or responses – this is far more difficult in a VC setting. That being set, safeTALK is a standardised programme and I would say, this session was perhaps the most standardised I have ever done.

Any technical issues arising have the potential to be multiple and disastrous. The trainer has to have a good handle on using the equipment, but success of a session like this is also reliant on


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56

each site having a good grasp of the equipment. A technical assistant on site is a huge advantage. Also having XXXXX in the room as a “spotter” was very helpful as there were things he picked up on which I missed because I was concentrating so much on the delivery.

It is interesting because on reflection, although I missed out on that direct feedback, I think the set up of VC training actually gave each individual site more cohesion. In any training (or at least the kind of training I do) it’s great to see the group taking on the responsibility of their own learning and that in some ways the trainer almost becomes invisible – just a facilitator for the material and the learning. It was nice to see each group working together on their responses and we know from adult learning theories and education research that this kind of learning is really valuable.

It has also occurred to me, that to deliver training in this way, a trainer really needs to know their material inside-out. Otherwise you would be looking at your notes all the time and the participants would only see the top of your head and have no eye contact with you. This is vital given that there are already the barriers created by distance. It was a real thrill for me to realise that I do know this stuff pretty well and can deliver it, but also still have space to be responsive to people’s questions.

Conclusion

The huge amount of preparation that went into this session is what made is successful. XXXXX’s thoroughness around trainer and participant etiquette was vital as well as safety information and contact details. All the pre-course information was very important and it was great that the sites received this. The organisation and level of detailed planning really paid off.

My feeling is that the more you use a system like this, it will become familiar and a lot less scary. There are some barriers, but actually there are many benefits too. It is possible to engage with participants and more importantly they can engage with each other.

Action points would include:

Zooming in to be able to see the faces better Good time-keeping for everyone at each site Ways to get contributions from the whole group – not just the chair Prompt to remind trainer to look at the camera and not the screen while speaking Panning camera round to anyone else at the trainer’s site who might be speaking.


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57

VC safeTALK session 26/3/10

Description

VC whole safeTALK session with four sites from the bridge: one from Inverness, two from Orkney and one from Mull. There were a few small technical glitches at the beginning, so we had a slightly late start, particularly getting a visual in Inverness. There were also minor adjustments like getting each site to zoom in so we could see their faces more clearly and to make sure we could see all participants. Each site also allocated a chairperson and it was very helpful that this time the Bridge put up the names of each site so we could see them.

Feelings

This felt different from the split sessions in many ways. Firstly I felt much more confident using all the equipment. I felt more comfortable and able to focus more on the training and the participants because I was not panicking about pressing buttons. In many ways it felt similar to an ordinary training, I was much more able to shift from site to site engaging each set of participants, encouraging their responses and including them in the discussions. It felt better to hear from a larger number of the participants than just from one chairperson at each site, I felt this worked much better and was more mirroring the ordinary training processes for safeTALK. In some ways, it did not feel a whole lot different from delivering safeTALK with the DVD co-trainer.

However, I did feel like it kind of sucked up my energy more than ordinary training. In the training room, I feel I can get back some energy from participants, it’s much easier to get instant feedback from them – not just verbal, but also relying on body language, expressions and general behaviour to guage if they are following what I’m saying and are on board with it. In VC it is much harder, although when I did go to them for their responses, it was clear that they were following me and were engaging with the process and the questions I was asking them to consider.

I felt having XXXXX there as a “spotter” gave me more confidence in these issues, because I knew that at least he was able to focus completely on their faces to watch if anyone was getting upset or disengaging. I also found that I was sticking to time pretty well, because I was following the standard procedures for safeTALK very closely. In some ways, it was much easier to keep myself on track because participants were waiting to be asked to speak rather than just spontaneously contributing as happens normally in training.

There were times when some participants questioned the material and not everyone wanted to ask about suicide, but this totally reflects ordinary face-to-face training around suicide.

The only thing that bothered me a bit was that we could see two of the sites were having more of a conversation than doing role play. This was hard to manage because we have very little control, although on reflection I could have called them on this, it has to be balanced with the fact that they are adult learners and responsible for their own learning. Although it has to be said that it is much easier for a group to go “awol” when they are not in the room with you. However, on hearing their feedback afterwards it was clear that their discussion had been fruitful and there had been some learning. I also have to say that this sometimes happens in real life training too, that pairs will have more of a discussion than do a straight role play, although this is not common, it sometimes happens.

Doing this for 3 hours straight by VC did leave me exhausted, but also excited. Again, it gave


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me confidence that I know this programme really well and that was satisfying.

Evaluation

This was in my view a successful safeTALK. The participants seemed to learn what they were supposed to learn. They engaged with me, the materials and each other within and between their sites. It is also another group of people in small communities without a lot of access to training who now are much more alert to suicide. I believe that the training they did that day by VC will contribute to making their communities safer from suicide and that is one of the aims of safeTALK.

Analysis

To me it seems VC is a viable medium for delivering a programme like safeTALK. The way that SafeTALK has been designed makes this possible. It is more didadic and also has been designed to be used with a DVD co-trainer. I think there are pros and cons. Yes, there is an element of humanness and personal connection which is lost, but this has to be balanced against an opportunity for training which would not happen otherwise.

Also, in this case participants got the benefit of hearing what four different groups of people had to contribute. If individual safeTALKS had been run in each of their areas, it is likely that the training would never have happened at all because of the small numbers. For example the Inverness site only had two people, so it would have been impossible to run a safeTALK there.

Conclusion

Preparation remains a huge part of the success of this pilot – preparation by the trainer, but also all the work that went into setting up the sites and the bridge to make everything as safe as possible. Things such as getting all participants mobile numbers, booking all the VC units and all the preparation done by XXXXX and his helpers.

I think this medium works for safeTALK and would possibly work for other programmes but definitely not for something like ASIST.

Action points would include:

Good set up and work done beforehand on VC etiquette for both trainer and participants Maybe some sort of quick ice breaker if there’s time and not too many people, maybe extra time could be built in for this

Trainer preparing to know the material being delivered extremely well.

safeTALK delivered at a distance An approach to training ... delivered at a distanc… · An...

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