Study finds outreach workers need more training
Communication skills lacking most
Outreach workers have become increasingly important to the treatment success of tuberculosis patients. And yet those who assist people at highest risk for the disease often lack basic information about the disease and may need incentives to expand their knowledge, says the author of a recent study on the educational needs of outreach workers in Atlanta.
"Outreach workers are an extremely important group because they are out in the trenches, and yet they are often overlooked," says Marcia McDonnell, DSN, RN, assistant professor of nursing at Emory University.
Since directly observed therapy became the standard of care several years ago, hundreds of outreach workers have been recruited nationwide to make sure patients comply with treatment. Several states, as well as the Centers for Disease Control and Prevention, recently have developed training curricula geared specifically to outreach workers, but evaluations of workers’ education needs have been few and far between, McDonnell says.
As part of her dissertation for a doctorate in nursing, McDonnell developed a comprehensive needs assessment of outreach workers by evaluating training programs, interviewing health administrators, and conducting focus groups with three different groups of outreach workers those who work with clients at high risk for TB, such as prisoners and the homeless, street outreach workers who work with substance abusers, and outreach workers who work solely with TB patients.
Combining understanding with communication
What she found was that workers who deal with high-risk clients lacked a basic understanding of TB. On the other hand, TB workers were well educated in the disease but often lacked more advanced communication and interpersonal skills needed to motivate and assist patients in taking their medications.
The outreach workers who work with high-risk clients relayed a need for detailed knowledge about TB, reflecting the fact that TB was not their primary focus. And yet their clients frequently asked about TB, she says. "Until I saw the numbers, I wouldn’t have expected it, especially since supervisors said they had inservices on TB," she says. "Some identified a continued education course during orientation programs, but others apparently didn’t get that course."
In addition to motivating clients to take their TB medications, outreach workers who work with high-risk clients should, at minimum, be trained in providing TB education and referrals, she says.
"These workers are some of the best persons to get the message to the people," she says. "Consequently, the information should be presented in a way so that they can use it to educate their target population."
Because there is no career track for outreach workers, one option might be to offer training certificates to motivate them to seek additional training, she adds.
Outreach workers solely hired to treat TB patients showed proficiency in basic TB knowledge. Many of those interviewed, however, were aware they lacked communication and interpersonal skills to deal with the multifaceted problems often confronting their patients.
"They have to deal with a lot of problem patients," McDonnell says, "and need training in how to motivate and establish trust. A lot of their patients have been treated badly by the system, and the outreach workers represent that system."
Different communities, different needs
In addition to knowledge about the medical side of TB treatment, outreach workers need training to deal with substance abuse, physical abuse, and sexually transmitted diseases, McDonnell points out, adding that stress management also is needed to avoid burnout.
The CDC is currently evaluating outreach worker training to determine if it is adequate, says Ann Lanner, acting chief of the communication and education branch for the division of TB elimination. Different communities, however, have different needs, and training is not uniform across the country, she adds.
"Public health administrators need to do an individual assessment in each state as to whether they have a good grasp on their TB training situation," she says. "There are some basic skills, but it depends on the population being served New York City may have one type of outreach and New Mexico, another."
Recognizing that better cooperation is needed among different disciplines, cross-training in HIV, TB, and sexually transmitted diseases has become a priority in Georgia, says Betty DeVoe, MHS, TB program director for Georgia.
"It is crucial that they have that [diverse] education, and they don’t get enough of it," she tells TB Monitor. "Even in the metro area of Atlanta you have a wide range of expertise in outreach workers. In some counties they are college graduates, and in others they have only a basic high school education."
In efforts to provide a basic, more uniform grounding in TB knowledge, the CDC recently completed five self-study modules designed for entry-level TB control workers. The TB primer is administered through the CDC’s public health training network distance learning program and includes an introduction, glossary of terms, and videotape. Workers can be signed up by calling (800) 41-TRAIN.
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