You Can Write It, But..
Can They Use It?
A Better Title..
How You Can Write Even Better Treatment
Training Manuals for Use With and By
Clinicians Who are Generally Time-Deprived
and Stressed
…NCTSN Should
Set the standard for practical, easy-to-use,
effective, field-based training materials for
outcomes based treatment protocols.
The Need
• Clinicians need training materials that respond to:
– Time available for learning
– Presentation of content required for mastery
– Formatting for ease of use, and
– Consistency of process elements presented
– Instructional soundness
Why These Criteria?
• Time for learning is a luxury for field practitioners
• Easier to use materials foster adoption and usage
• Consistency fosters assessment of outcomes for
effectiveness
• Effective training results in more effective treatment,
funding
The Goal
• Treatment training manuals that reflect
– The unique voice of the author
– Sound learning principles and practices
– Effective style, layout, and function
– “Transferability”
• The ability of the content to convey the information with—or
without—the author’s physical presence
Organizational / Methodological Benefits of More
Effective Manuals
• More clinicians skilled in specific outcomes-driven
protocols
• Platform established for ongoing studies of
effectiveness (efficacy already proven)
• Easier for author (and others) to teach; for learners to
acquire knowledge and skill
Considerations in Documenting Effective Treatment
Protocols
• Purpose of manual drives type of manual
• Type drives context for content, format, layout
• Author perspectives
Presentation Assumptions
• NCTSN manuals are training manuals
• Focus: replicating efficacious outcomes-based interventions
• Ideal: user-centric training
• Current state: efficacy, information, protocols exist
• Rationale: manuals make possible transfer of knowledge to
other clinicians for field use to validate effectiveness, serve
persons in need
What’s New:
Involving Instructional Design
• Systematic method for the design and development
of effective instructional materials
• ADDIE model
–
–
–
–
–
Analyze
Design
Develop
Implement
Evaluate
What’s New:
Physical Formatting & Layout
• Incorporates elements of
– Visual engineering
– Cognitive sciences
– Desktop publishing
• Focus is on increasing ease of use by impacting
“look” and “feel”
• Increases effectiveness and adoption
For example…
1
3
2
4
5
Analysis: Define the Learners
Three distinct groups or audiences:
1.
Clinicians writing manuals
2.
Clinicians acquiring and using protocols described in the
manual
3.
Persons served by the clinicians (those who apply the skill
taught by the clinician)
Analysis: What About the Learners?
• Drives voice, depth and breadth of content
– Who are you teaching?
– Define level of education, exposure and experience for
clinicians
• Match nature of content relative to purpose
• Remember the impact of stress on comprehension
Analysis: How Will They Access The Material?
• Where they “live” versus where you are—what they
would say, not what you would say
• Are they technology natives or immigrants?
• What kind of time do they—clinicians and/or clients—
have to learn?
Analysis: Program Requirements
• Reading level for clinicians for training material?
• Reading level for clients for handouts?
• Usability by those with visual impairments?
• Federal regulations for grantees?
Analysis: How to Handle Copyright?
• Who is the original author?
©
• Is content in the public domain?
• Did employment agreement specify employer owns
works created?
• Does a federal grant impact ownership?
• Has copyright been filed?
Analysis: What About Rights and Permissions?
• Who can use it
• Where it can be used
• For how long
• On what terms
Analysis / Design: Specify End-User Requirements
• Define demographics of clients for whom protocol is
suitable
– Influences examples, context, graphics, activities
•
•
•
•
Inner city versus urban affluent
Age range—developmental issues
Gender
Culture
Analysis / Design: Specify Conditions for Use
•
•
•
•
•
•
Theoretical orientation or “bent”
Prerequisite skills and knowledge
Indications for use, outcomes, assessments
For use with individual or group?
Cultural issues
Type of trauma for which indicated
–
–
–
–
Demonstrations/riots
Natural disaster
Ethnic cleansing
Mass violence or terrorism (civilian, military)
For example…
Design: Objectives
• “TWILBATs”
• What should the learner (specify which one!) be able to DO
that they can’t do now?
– Make it measurable, countable, observable
• Under what circumstances?
• To what end?
Design: Objectives “Verb Sheet”
T
a
x
o
n
o
m
y
Level 1
Level 2
Recognition (1) (It is-(Recall of
information)-
Differentiation
(It is an x, not a
y-Interpret
information in
one’s own
words)
Align
Arrange
Brief
DefineDepict
Duplicate
Label
List
Match
Memorize
Classify
Describe
Discuss
Explain
Express
Identify
Indicate
Itemize
Locate
Recognize
Level 3
Level 4
Level 5
Problem-solving
(What can one do with an x or how does an x)
Application
(Use knowledge or
generalization in a
new situation)
Adjust
Advise
Apply
Choose
Coordinate
Demonstrate
Draw
Employ
Facilitate
Illustrate
© 2003 EPower &Associates, Inc. Please use and distribute freely.
Analysis
(Break down knowledge
into parts and show
relationships among
parts)
Analyze
Appraise
Calculate
Compare
Contrast
Criticize
Diagram
Differentiate
Distinguish
Examine
Synthesis
(Bring together parts of
knowledge form a whole,
build relationships for new
situations)
Align
Arrange
Collect
Connect
Construct
Create
Design
Develop
Devise
Level 6
Evaluation
(Make judgments
on basis of given
criteria)
Advocate
Appraise
Appreciate
Argue
Assess
Choose
Commit
Compare
Decide
Design / Develop: Provide Content To Be Acquired
• Divide into units by treatment goals
– Supports measurement of outcomes
• Contain background information to one area
– Represents “know” versus “do”
• Provide the same information at the beginning of each unit
– Reduces acquisition time through visual consistency
Design / Develop: Subdivide Content Into Learning
Units
• Logical divisions for what the learner can take in
• Available time for learning
– Attention span (20 minutes!)
• Building block for the knowledge to be acquired
• Attend to the learning taxonomy
Design / Develop:
Consider Learning Styles
• VAK: Visual, Auditory, Kinesthetic
– How to identify learning style?
– How might auditory lesson impact kinesthetic or visual
learner?
– How to adapt training?
Design / Develop:
Consider Learning Styles
Design / Develop: Select Appropriate Instructional
Strategy
Design / Develop: Select Appropriate Instructional
Strategy
• Different learning styles require different methods of
instruction
• Different types of content require different methods
of instruction
The Basics
If activity goal is to..
• Disseminate knowledge
Use…
 lecture (if they have no
knowledge), guided
discussion
• Learn and apply a step
by step process,

demo and practice
• Apply a thought process

case study, story
problem
• Apply new interpersonal
skill

skill practice
Develop: Sample Typical Unit
• Provide unit or session plans in consistent format
– Title / name of content
– Appropriate audience (age, gender, trauma, demographics, etc)
– Theoretical orientation / clinician knowledge requirements—not the
content, only the reference
– Time required to prepare, assess, deliver, evaluate
– Materials: verify titles listed match titles used, cite location
– Sequence of instructions along with need to know notes, cautions
Include Assessments as Appropriate
• How will you know the intervention is appropriate to
the situation?
• How will you avoid misapplication, e.g., the impact of
illusory correlation?
• How will you know the outcome has been attained?
Assessment Techniques
• Knowledge—assess through use of open-ended
questions, story problems, what-ifs, quizzes and tests
• Skill—demonstration of competency through
simulation, role play, application and observation
• Attitudes—demonstration over time through exposure
to triggering situations
Assessing Effectiveness
•
•
•
•
•
•
What is the symptom for which relief is sought?
What would the client experience if relief were obtained?
How will the intervention provide relief?
Under what circumstances will the client apply it?
What performance supports are necessary for application?
How will client feedback be obtained about application and
effectiveness?
How Should the Material Be Laid Out or Presented?
•
•
•
•
•
Make it readable!
Use your grammar checker
Write in active voice instead of passive
Write clearly and simply
Use bullets, avoid layered sub-bullets (hard on the
eyes)
• Avoid using multiple fonts, follow a consistent style in
terms of font size
The !@#!! Computer
• Font, header and document styles are unique to each computer user’s
settings
• As the file is opened on each user’s machine, file adjusts to settings
and preferences
• “Machine code” for each set of preferences adds to document each
time
• The more machine code, the more fragile the document
• Standardization is one solution, so is saving the file in RTF format
Clinicians with limited time, high stress read at lower levels than when they
have ample time and low stress
How might the reading levels of childhood traumatic stress survivors be
impacted during treatment?
Readability
• Aim for readability scores over 50%, grade level 6-8
• Recognize words with more syllables are higher
grade level, may skew readability scores
How to Check Readability Statistics
From Microsoft
Word:
1. Select tools
2. Select spelling and
grammar
3. Select options
4. Check settings
5. Select “Show
readability
statistics”
6. Select “Recheck
document”
7. Select “OK”
8. Recheck…
Sample Readability Statistics
What are implications
of :
--word per sentence
count?
--passive sentences?
--reading ease?
--grade level?
Readability / Grade level
The quick brown fox jumped over the log.
• Readability – 100%
• Grade level – 0.8
The swift auburn fox leapt over the fallen tree.
• Readability – 84.9%
• Grade level – 3.6
Be Kind to the Eyes
• 12 point font, Times Roman or Arial for print
– 3 points above and below each line, single spaced
• 25% “white space” free from text per page
– Room for notes
• Headers, footers tell the reader where they are
• Convert downloadable documents to PDF files
Sample
Font: Times-Roman
12 point
Normal
Spacing: Single line,
0 above / below
Font: Times-Roman
12 point
Expanded 1.5
Spacing: Single line,
6 above / below
PDF: Portable Document Format
• Acrobat reader is a free download used to open PDF
files
• Readers cannot edit these files
• Supports downloading from the Web
• Shifts costs of production to users (printing, paper,
postage, binders)
• “Pull” instead of “push” delivery
Revising Existing Manuals
• Begin by identifying logical learning units—where do
the ideas separate naturally?
• Construct a consistent cover sheet for each learning
unit
• Craft an outline for the entire manual before tackling
it
• Tease out objectives, check sequencing
• “Fix” one unit at a time