Using Teen Actors to Teach How to Communicate with Adolescents

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Using Teen Actors to Teach How to Communicate
with Adolescents

• Anisha Abraham, MD, MPHAssociate Professor,
  Department of Pediatrics
• Chief, Section of Adolescent Medicine
• Georgetown University Hospital
• Washington, DC

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Objectives

• To review two programs involving teen actors from
  local community organizations Teens Against the
  Spread of AIDS (TASA) and Teens and Theater/Duke
  Ellington School of Arts
• To discuss the benefits of programs using role
  play with teen actors in teaching trainees how to
  communicate with adolescents

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Teen Actors-TASA

• TASA-group of DC high school students who use
  theater techniques to educate youth/families
  about health issues and based at Childrens
  National Medical Center
• In 1997, workshop developed to improve trainee
  violence screening skills at CNMC
• Workshop used TASA members as teen actors and
  educators

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Screening Teens for Violence Risks Workshop

• Participants
• Medical students pediatric residents rotating
  thru the adolescent clinic at CNMC
• Content
• Trainees received a brief didactic lecture on
  violence among teens including FISTS screening
  tool (Fights, Injuries, Sexual Violence and
  Self-Defense Strategies)
• Did one-on-one role play w/ teen actors on
  violence related scenarios
• Engaged in a panel discussion w/ teens regarding
  violence risks at home, school and the community

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Screening for Teen Violence Risks Workshop

• Teen Actors
• TASA members developed their own violence
  scenarios including date rape, domestic violence,
  etc
• Performed 20 min role play w/ trainees, then gave
  feedback to trainees on establishing
  confidentiality, use of FISTS screen,
  identification and management of problem
• Engaged in an interactive panel discussion
  addressing violence issues at home, school, and
  community

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Screening for Teen Violence Risks Workshop

• Led to study assessing impact of workshop on
  trainee violence screening skills
• Abraham A, Cheng T, Wright J , et al. Assessing
  an Educational Intervention to Improve Physician
  Violence Screening Skills Pediatrics 2001 107 p
  63-73

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Study An Educational Intervention to Improve
Physician Violence Screening

• Purpose- To evaluate a violence prevention
  program targeted at health care personnel
• Setting- Adolescent clinic of a tertiary care
  hospital
• Participants- Med students and peds residents
  assigned to an adolescent rotation
• Intervention- On alternate months, trainees
  received 3 hr workshop on violence prevention
  including use of FIST screening tool role play
  w/ teen actors

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Study An Educational Intervention to Improve
Physician Violence Screening

• Evaluation Methods
• All participants interviewed a standardized
  patient (teen actor) c/o a persistent headache w/
  an underlying violence- related issue during
  their clinical rotation
• Participants were not aware that the standardized
  patient was an actor and not a real patient
• Participants completed pre and post rotation
  questionnaires. Teen actors completed an
  evaluation of the encounter

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Study Design

• Beginning of rotation End of
  rotation
• Intervention Group-?Violence Workshop--?Standardiz
  ed patient
• Pre-rotation questionnaire
  Post-rotation
  questionnaire
  Standardized patient evaluation
• Control Group-------------------------------------
  ----?Standardized patient
• Pre-rotation questionnaire
  Post-rotation
  questionnaire
  Standardized patient evaluation

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Study An Educational Intervention to Improve
Physician Violence Screening

• Results- Post-rotation intervention subjects
  reported
• More screening of fighting history (p lt .003)
• Perceived importance in asking about access/ use
  of weapons (plt .02)
• More screening of violence in school/neighborhood
  (plt .01)

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Standardized Patient Evaluation
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Study An Educational Intervention to Improve
Physician Violence Screening

• Conclusion
• A violence prevention education program using
  teen actors improved participants violence
  questioning and perceived comfort and importance
  in violence screening
• Improved identification and management of a
  standardized violence-related scenario

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Screening for Teen Violence Risks Workshop

• Taking it on the road
• Conducted workshops with TASA at the National AAP
  conference in DC (1999), National ER conference
  in DC, the International Adolescent Health
  Conference in Lisbon, Portugal (2005), Georgetown
  University Hospital, National Naval Medical
  Center, etc.

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Duke Ellington/Teens and Theater

• Communicating with Teens Workshop at GUH
  started in 2006 involves teen actors from
• The Improvisation Group/Theater Program at the
  Duke Ellington School of the Arts
• The only DC public high school providing
  professional arts training college preparation
• Teens and Theater
• A group of home-schooled high school students
  from the DC area that are involved in
  improvisational theater

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Communicating with Teens Workshop at GUH

• Participants
• 3rd yr med students in pediatric clerkship
  peds residents in adolescent rotation
• Workshop Content
• Overview of SSHADESS assessment (Strengths,
  School, Home, Activities, Diet, Drugs, Emotions,
  Sexuality, Suicidality and Safety)
• Tips on talking to teens establishing
  confidentiality
• Interactive role play w/ teen actors

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Communicating with Teens Workshop

• Teen Actors
• Create scenarios/perform 20 min role plays with
  groups of med students residents
• Scenarios topics involve drug use, depression,
  gender identity, eating disorders,etc
• Give feedback on use of confidentiality,body
  language, SSHADESS screen, ability to identify
  chief complaint manage issue
• Facilitators
• Attending and pediatric residents give feedback
  regarding communication techniques and management
  of issue

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Communicating with Teens Workshop

• (Video clip)

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Communicating with Teens Workshop

• 2007-2008 Study
• An Educational Intervention to Improve Physician
  Interviewing Skills of Adolescent Patients during
  the Pediatric Clerkship involving 150 medical
  students
• Study conclusion
• Students report increased confidence skills in
  communicating w/ teens when participating in
  interactive workshop as compared to lecture alone
• Workshop as curriculum
• As a result of positive evaluations by trainees
  and results of study showing benefit, workshop
  has become regular part of pediatric medical
  student curriculum conducted every 6 weeks

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Communicating with Teens Workshop

• Reaching larger audiences
• Conducted workshop at 2009 American Academy of
  Pediatrics National Conference (DC)
• Created sexual history-taking pod cast with teen
  actor available at AAP website
• Received invitations to take workshop to area
  hospitals organizations

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Costs

• Teen and Theater/Duke Ellington Funding
• Initially from 25,000 hospital education grant
  to enhance medical student teaching
• Under grant, 600/workshop for coordinator/school
• Currently 150/ workshop for approx 8 teens/
  coordinator- paid by Pediatric Department
• At National conference-teen actors received 50/
  workshop from AAP
• TASA Funding
• Received primary funding from grants including
  Washington AIDS Partnership , GEICO, CNMCs Child
  Health Center and Board of Visitors

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Using Teen Actors Lessons Learned

• Scheduling student actors can be challenging
• to avoid missing classes, tests, performances
• Initial development of scenarios requires time
  and extensive training
• Workshops can be dependent on scenarios and
  actors and experience of facilitator
• Funding necessary but costs are reasonable

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Using Teen Actors Lessons Learned

• Using teen actors from the community can be a
  very rewarding experience for actors,
  facilitators and trainees!
• Model is easily adaptable
• Pilot studies show interactive role play improves
  trainees educational experience
• Teen actors can also train medical faculty, non
  medical personnel
• Actors once trained can be used for many other
  adolescent health topics i.e. substance use,
  pregnancy prevention, etc.