On the following pages you will find all of the supplemental materials necessary to facilitate the
Upstream 3-hour curriculum (curriculum and slide decks are separate).
Find the header in the upper right hand corner that correlated with the “Materials” column on the
curriculum.
Questions? E-mail training@upstream.org
FAQ ACTIVITY
Is it safe not to have a monthly
period with the hormonal IUD?
FAQ ACTIVITY
How do the IUDs work to
prevent pregnancy?
FAQ ACTIVITY
How soon after an IUD is
placed is it effective?
FAQ ACTIVITY
Will my partner feel the IUD
strings during sex?
FAQ ACTIVITY
Will the IUD insertion hurt?
FAQ ACTIVITY
Do IUDs cause infections?
FAQ ACTIVITY
Can I have an IUD if I’ve never
had kids?
FAQ ACTIVITY
Will my IUD move during sex?
FAQ ACTIVITY
Can I still workout with the
implant ?
FAQ ACTIVITY
Will the implant move under
my skin?
FAQ ACTIVITY
Will the insertion of the
implant hurt?
FAQ ACTIVITY
Does everyone have frequent
spotting and bleeding with the
implant?
FAQ ACTIVITY
Will it be hard for me to get
pregnant once I stop using the
shot?
FAQ ACTIVITY
How long will the irregular
bleeding last for with the shot?
FAQ ACTIVITY
What do I do if I miss a pill?
What do I do if I missed two
pills?
FAQ ACTIVITY
When should I change the
patch?
FAQ ACTIVITY
Will I have my normal period
with the pill, patch, or ring?
FAQ ACTIVITY
How do I insert the ring?
How do I know if I inserted it
correctly?
FAQ ACTIVITY
Is the EC pill the same as the
abortion pill?
FAQ ACTIVITY
What is the most effective
method of EC?
FAQ ACTIVITY
What is the most effective
method of contraception?
FAQ ACTIVITY
How do I put on a condom?
Consumerist
Counseling
 Provider shares
information that
patient requests, or
ALL information
 Entire decision left
with patient
Shared
decision
making
SHARED DECISION MAKING- COUNSELING
POSTERS
 Generalizes best outcome
for all women
 May perceive pressure to
use certain methods
Directive
counseling
COUNSELING POSTERS
“A collaborative process that allows
patients and their providers to make
health care decisions together, taking into
account the best scientific evidence
available, as well as the patient’s values
and preferences….This process provides
patients with the support they need to
make the best individualized care
decisions.”
Informed Medical Decisions Foundation
COUNSELING POSTERS
Shared Decision Making in Family
Planning:
- consistent with women’s desires
- provision of decision support,
without pressure
- associated with improved
satisfaction with counseling and
with choice of method
COUNSELING POSTERS
Greet
Ask
Talk
Help
Explain
Return
COUNSELING POSTERS
“Do you intend to
get pregnanT in the
next year?”
THE One Key
Question®
COUNSELING POSTERS
Do you think you would like to have
(more) kids some day?
YES: When do you think that
might be? How important is it to
you to prevent pregnancy until
then?
NO: How important is it to you to
prevent pregnancy until then?
SECONDARY QUESTIONS
What are you hoping to get
out of your birth control
method?
SECONDARY QUESTIONS
What methods have you used
in the past? What did and did
not work for you? Any sideeffects?
SECONDARY QUESTIONS
Do you need a discreet
method of birth control?
SECONDARY QUESTIONS
What is important to you
about your method?
SECONDARY QUESTIONS
How would it be for you if you
didn’t get your period?
COUNSELING TECHNIQUES
Effective Questioning
Using questions to elicit facts or feelings about the
patient’s health. Use closed-ended questions to
quickly gather factual, non-sensitive information,
while open-ended questions are critical for eliciting
feelings and detailed information. Use probing
questions to elicit more in-depth information.
COUNSELING TECHNIQUES
Active Listening
To get the information you need to help a patient,
you must listen actively. This technique involves
communicating, without words, your interest in the
needs the patient expresses.
COUNSELING TECHNIQUES
Paraphrase & Clarify
This technique involves repeating, synthesizing, or
summarizing in other words what the patient has
told you. This helps the counselor clarify what the
patient is saying, and helps the patient feel that
she’s been heard.
COUNSELING TECHNIQUES
Reflect and Validate
Feelings
Clarify the feelings the patient expresses in order to
help understand her emotions. It is helpful to
patients to let them know that their reactions to a
situation are normal, and that those feelings are
common to other people in similar situations. You
can communicate that the feelings are valid.
COUNSELING TECHNIQUES
Give Clear Information
Before you give any information, it is helpful to ask
questions to determine how much the patient
already knows. It is important to provide information
using words that the patient can understand. Ask
patients to repeat the information you have given
them to verify that they understood.
COUNSELING TECHNIQUES
Arrive at Agreement
This technique involves clarifying and summarizing
the decisions that a patient has made during the
counseling session.
COUNSELING TECHNIQUES
Small Talk
Ask what kind of work she does or if she is in school
before getting into the content of the visit. Use the
information she gives you to refer back to later in
the visit.
COUNSELING TECHNIQUES
Compliment Healthy
Behavior
Find something about her health-supporting
behavior to compliment. This is so that she will trust
you, and she makes the connection between other
“responsible”, “healthy” behaviors and effective
contracepting behavior
COUNSELING TECHNIQUES
Emphasize Essential
Points
The amount of information presented should be
limited and emphasize essential points. Highlight
important facts by presenting them first. Providers
should focus on the particular needs and knowledge
gaps identified during the conversation. Many clients
immediately forget or remember incorrectly much of
the information provided.
COUNSELING TECHNIQUES
Frame Messages
Positively
In addition to discussing risks, discuss the
advantages and benefits of contraception. Frame
numeric quantities simply and in the positive.
COUNSELING TECHNIQUES
Teach-back
It is important to ensure that clients have processed the
information provided and discussed. One technique for
confirming understanding is to have the client restate the
most important messages in her or his own words. This
teach-back method can increase the likelihood of the client
and provider reaching a shared understanding, and has
improved adherence with treatment plans and health
outcomes. Using the teach-back method early in the
decision-making process will help ensure that a client has the
opportunity to understand her or his options and is making
informed choices.
ROLE PLAYS
Scenario #1
Scenario #2
You are a patient here for a birth control visit. You
need to keep your birth control private from your
boyfriend. You have been using condoms and want
to try something new. Your sister uses pills so you
have heard of those, but you don’t want to think
about your method all the time.
You are a patient here because you have heard
about IUDs and you really want to try one. You don’t
know which one you want, but you already have
heavy periods and want less bleeding.
Scenario #3
Scenario #4
You are a teenage patient. You are using the pill, but
you keep missing pills and missed one yesterday and
the day before.
You are a patient who uses depo and has heard
about the implant and you are interested in not
returning to the clinic every 12 weeks for a shot but
you are scared about the insertion and the side
effects.
Scenario #5
Scenario #6
You are a patient who is only planning on preventing
pregnancy for the next six months to a year when
you plan to get pregnant with your next baby.
You are a teenage patient who is totally unsure
about what method they are interested in.
ROLE PLAYS
Scenario #7
Scenario #8
You are here because you need emergency
contraception, because you had sex without a
condom 3 days ago. You are 17, and have no idea
when you might want to get pregnant, but not until
you are “much older”.
You are in school and work full time. You and your
husband don’t want to get pregnant for several more
years. You have heard of long-term methods, but she
is uncomfortable with the idea of having a method
inside her body.
Scenario #9
Scenario #10
You are a patient who is only planning on preventing
pregnancy for the next six months to a year when
you plan to get pregnant with your next baby.
You are a current pill user and has used the patch in
the past. You have heard there is a shot that you can
get that does the same thing as the pill. You might
want to switch methods. You like the idea of a
method you don’t have to think about often, but
does not like the idea of something placed in your
body.
Scenario #11
Scenario #12
You have been using condoms, but started a new
relationship, and want a lower maintenance method.
You don’t know if you ever want to get pregnant.
You used pills once, but didn’t like them. You have a
friend who uses the nuva ring, and you would be
interested in hearing more about it.
This person is worried she may become pregnant by
accident. She and her husband use the pull out
method. They both have religious beliefs that using
hormones to prevent a pregnancy is not okay, but
they have had a couple of pregnancy scares. They
are new to the area and are worried that if they
become pregnant now they will not be able to
provide for a baby financially.
SAMPLE COUNSELING SCRIPT
MA:
Hi, Shelly, my name is Katy and I am checking you in before you see the provider today. How are you?
PT:
Good, thanks.
MA:
Great. So, I see that you are here for a refill on your birth control. It looks like you are using the NuvaRing, correct?
PT:
That’s right
MA:
Ok. We can definitely get you more rings today. Can I ask- are you satisfied with your method of birth control?
PT:
Oh, yeah. I like the ring, I’ve been using a few years.
MA:
That’s good to hear! Before I set you up with some refills, any questions or concerns about your method?
PT:
Well, yeah. I like using my ring, but sometimes I forget to change it. It’s just hard to
remember, you know.
MA:
Yes, I know it can be hard to remember to change a ring monthly. Are you interested in talking about methods you don’t have to think
about as much?
PT:
Yeah, that’d be great.
MA:
Ok- did you get a chance to look over this in the waiting room (hands patient Bedsider’s Tiers of Effectiveness tear sheet)
PT:
Yes, I looked at it.
MA:
Great- so this lists all of the methods here, in order of effectiveness. Up here, we have our top tier methods, which are 20 times more
effective than the ones here in the second row, and
finally our lowest tier methods including the condoms and other barrier methods. Can I
ask, are
you planning to get pregnant in the next year?
PT:
No way! I am still in school. I am not thinking about that for a long time.
MA:
Ok, so in that case, all of these methods would be available to you. What are you hoping to get out of your method?
PT:
Well, to not get pregnant of course. Also, to not have to think about it as much as the ring. Also, my periods are heavy and crampy so I
would like some help with that.
SAMPLE COUNSELING SCRIPT
MA:
shot-
Ok, that gives me some good info to work with. The methods that you don’t have to think about as much as the ring include the depo
PT:
No, way. I hate getting no shots. I don’t want that one.
MA:
Ok, no problem. Then that leaves our top tier methods, either the IUDs- small t-shaped devices that are inserted into the uterus by a
clinician or the contraceptive implant which is placed under the skin of the arm. Do any of these interest you?
PT:
I don’t want the implant. The IUD seems kind of cool.
MA:
Ok, so we have a few IUD options. Because you said you have heavy, crampy periods we
probably want to avoid the copper IUD
which can sometimes that make that worse. But we
carry the Mirena, a hormonal IUD that lasts for up to 5 years, that is actually
recommended to
help with heavy, crampy periods.
PT:
Really? That’s awesome!
MA:
Yep. Would you like to learn more about the Mirena?
PT:
Yes...
CONTRACEPTIVE TRIVIA
CONTRACEPTIVE TRIVIA
CONTRACEPTIVE TRIVIA
QUESTION BANK
ROUND ONE: SHE SAID…WHAT?
1.
2.
3.
4.
5.
How does the hormonal IUD work to prevent pregnancy?
Does everyone have frequent spotting and bleeding with the implat?
Will the IUD insertion hurt?
Can I have a LARC if I haven’t had kids?
Will the IUD move during sex?
ROUND TWO: COUNSELING RULES
1.
2.
3.
4.
5.
Name at least 4 qualities that make someone a good counselor
Saying “Not so many people your age act so responsibly! You are clearly interested in protecting yourself!” is an example of
“So what I hear you saying is that your boyfriend wants to have a baby, but you aren’t so sure” is an example of...
Identify at least 2 questions you can ask to help facilitate the options counseling session
If someone is experiencing birth control sabotage, we should talk to them about ______methods of birth control.
ROUND THREE: YOU GOTTA KNOW THIS…
1.
2.
3.
4.
5.
This is a model for offering methods from most to least effective
Name 2 barriers to correct and consistent use of contraception
If a hundred women use an IUD or implant for a year, how many may get pregnant?
Name 2 non-contraceptive benefits from a LARC
Name 3 correct names that are used for an IUC
ROUND FOUR: LARC IS JUST THAT AWESOME
1.
2.
3.
4.
5.
This is THE most effective contraceptive method available
LARC have a very high ______________ rate among women who use them
This is the most effective form of emergency contraception
T/F The vast majority of women are good candidates for LARC methods
T/F While LARC may be the most effective and have high satisfaction and continuation rates, they carry slightly higher risks than the 2nd
tier methods
TIERS OF EFFECTIVENESS