Table 3 Learning support techniques

Sharing experiences and telling stories

Providing trainees with examples of previous experiences, including stories about how other sites had addressed challenges or adapted PCMHI to their local context and using this technique with stakeholders to model the power it has for transferring knowledge

Making thinking visible

Explaining why she had acted with or responded to stakeholders in a particular way, suggesting this would help them learn how to facilitate in those circumstances and generalize learning to similar situations.

Using comparisons to clinical skills and activities

Comparing the process of assessing and addressing problems, e.g., destructive interpersonal and organizational dynamics, to clinical processes, e.g., she suggested that the process of facilitating a chaotic meeting was “similar to doing a treatment group”

Using heuristics or rules of thumb

Sharing rules of thumb to provide trainees with generalizable lessons on how to help sites. For example, “You get dealt the cards; make it into the best hand you can” (for dealing with challenges over which they had no control); “work with sites where they are” (for when stakeholders insisted on discussing local issues rather than focusing on the planned agenda); and “don’t plow ahead with your plan” (for when something, e.g., a prepared presentation, was not working)

Psychosocial learning supports

Acceptance, confirmation, and support.

Praising trainees when they had good ideas or applied facilitation appropriately, providing confirmation when they accurately diagnosed problems, supporting their perceptions of what was happening, and providing ongoing support for the learning process

Providing protection.

Protecting trainees from making mistakes by conducting facilitation activities until they were ready or stepping in and taking over, e.g., leading a meeting, when trainees did not know how or were not ready to handle complex problems

Facilitating exposure and visibility and promoting trainee interests.

Calling attention to the role of trainees and deferring to them to ensure that they were seen as “the face of the program” and credible

Promoting self-learning

Encouraging articulation.

Asking questions to encourage them to think aloud to, for example, prepare for meetings (what they planned to accomplish, what obstacles they might encounter, and how they might address these) or process what occurred during a meeting (what they thought about the meeting, who “key allies” might be, potential problems or barriers to implementation, potential next steps)

Encouraging learning from others.

Encouraging trainees to learn from other experts (e.g., by arranging meetings or referring them for consultation) and from similar others (e.g., to obtain materials or learn about what was working for them)

Structural learning supports

Setting up opportunities.

Scheduling meetings with them on a regular or less frequent basis as needed

Using teachable moments.

Taking advantage of “teachable moments,” e.g., to help one of the trainees modify her interpersonal style to be more supportive, the expert took advantage of multiple opportunities to model and coach the trainee on how to more positively reinforce site efforts rather than point out their weaknesses

Encouraging and empowering to take on new roles.

Initially charging trainees with gathering information about sites and current practices while the expert conducted most facilitation activities. Within several months, encouraging, empowering, and sometimes “pushing” trainees to take on other new roles, e.g., leading meetings with site leadership and staff, as well as becoming the expert on site and network interpersonal and political dynamics and how to assess and monitor them

Stepping in and stepping out.

Stepping in (e.g., to say something or assume leadership) and stepping out (e.g., to hand leadership back to the trainee) as a way of protecting facilitation trainees from making mistakes or reinforcing other lessons they were learning; the expert suggested that this process involved “….knowing when you get out of the way and just hold your breath…versus when you continue to kind of keep your hands on and be there standing in the corner to step in if you need to”

Pulling back and fading.

Becoming “increasingly less involved” over time and stepping back and watching trainees; one of the trainees said, “.…instead of her handling it, she would sort of advise me how to handle it”