Training on UTC 6 & 7 for Addiction Treatment Professional of Multan, Pakistan

Training Report

1. Description

Training Name: Universal Treatment Curriculum 6 & 7 Training Multan, Pakistan.

Lead Trainer: Dr. Talat Habib

Co-Trainers: Dr. Azhar Ali Kazmi, Miss Nazia Bashir

Location: Nishan Rehab Multan, Multan, Pakistan

Stakeholder Name (Implementing Agency):  DAP Colombo Plan & Nishan Rehab Pakistan (Training Provider for DAP Colombo Plan)

Training Schedule: September 1-4, 2023

2. Introduction

Nishan Rehab recently hosted a comprehensive training program for addiction treatment practitioners in Pakistan. The training took place from September 1-4, 2023, at Nishan Rehab facility located in Multan, Pakistan. The training focused on two key topics: "Case Management for Drug Addiction Professionals (UTC 6)" and "Crisis Intervention for Addiction Professionals (UTC 7)" Over the course of four days, participants gained valuable knowledge and skills in these areas, enhancing their ability to provide effective treatment and support.

Nishan Rehab generously covered all training expenses, ensuring that participants could attend without any financial burden. In addition, Mr. Bashir Ahmed Naz, the President of ISSUP Pakistan, contributed by providing 60% of the food payment, further facilitating a conducive learning environment for all.

It was truly a collaborative effort to empower addiction treatment practitioners in Pakistan, and Nishan Rehab is proud to have played a role in advancing their professional development.

This training was facilitated by:

 

• Dr. Talat Habib
• Dr. Azhar Ali Kazmi
• Miss. Nazia Bashir

 

3. Objectives of the Training Programme:

The initiative had the following objectives:

 

• To enhance participants' learning experience in UTC 6 and 7, we employ a diverse range of training methodologies.
• To enhance the knowledge, skills, and competence of addiction treatment professionals in Multan and South Punjab. This program aims to improve the quality of treatment services and care for substance users and their families in Pakistan. By equipping these professionals with evidence-based addiction treatment techniques, clients in rural areas will have access to better addiction treatment services locally. Raise standards of treatment and care in the country and to provide the treatment professionals with an opportunity to develop their own Practice Integration Plans

The four-day training initiative covered the following UTC curricula:

• Curriculum 6: Case Management for Addiction Professionals. Professionals gained a comprehensive understanding of the fundamental principles, functions, and models of case management. Discover the concept and significance of case management, and its relevance to your work. Acquire knowledge about how case management facilitates the coordination of services and minimizes fragmentation. Apply the principles of case management to enhance your own professional practice.
• Curriculum 7: Crisis Intervention for addiction Professionals The content aims to give an overview of crisis management and intervention, as well as offer participants the chance to reflect on their personal self-care and safety practices. The objectives of this content include: - Defining crisis and crisis intervention - Describing the steps involved in managing a crisis - Demonstrating awareness of suicide intervention and prevention - Demonstrating awareness of how to handle difficult or hostile clients while prioritizing counselor and client safety.

Description of the Training:

The programme was conducted as per schedule following the UTC Master Agenda. Day one started with the Opening ceremony, followed by the registration and ceremonial welcome. The objectives of this training series were presented by lead trainer, Dr. Talat Habib, and he focused on significance of these trainings in Pakistan. The trainers and participants introduced themselves and their organizations and training was formally started after tea break.

Over the course of the next two days, participants delved into Curriculum 6, a comprehensive program that focused on the models and functions of case management. Through engaging training sessions, the trainers aimed to enlighten the participants about the concept and significance of case management. They effectively demonstrated how case management coordinates services and reduces fragmentation. The participants actively participated in thought-provoking discussions, gaining valuable insights into the current state of case management within their own programs. Furthermore, they explored ways to apply the principles of case management to their own practice. The following topics were covered during the training:

• Introduce participants to ways to implement recovery concepts in case management;

• Familiarize participants with the case management models and what it covers;

• Introduce participants to steps of case management.
• Provide participants an introduction to the domains of case management and its implication in substance use disorder treatment;

During the next 2-days training program, curriculum 7 was covered. Specific objectives include:

• Familiarize participants with the concept of Crisis Intervention;

• Provide an overview of the process and elements of Crisis Intervention and person-centered treatment planning;
• Participants were given details about Suicide and Suicidal Warning Signs;
• Introduce participants to the importance of focusing on Direct & Indirect Warning Signs of suicide and Counselor Safety;
• Concept of Counselor’s Burn Out was also shared with participants and elements of structured recordkeeping.

During the entire training period, the participants actively engaged by asking questions, participating in role-plays, and enthusiastically taking part in other activities (see Annex 5). Upon completion of the four-day training, the participants expressed their satisfaction and anticipation for the next training session, which will cover UTC 8. Dr. Talat Habib, Programe Coordinator at Nishan Rehab Pakistan (Training Provider for Colombo Plan), commended the participants for their keen interest in the training. He also extended his gratitude to Mr. Bashir Ahmed Naz, President of ISSUP Pakistan, for partially funding the meals, and to DAP (Colombo Plan) for their support in this endeavor.

5. Participants:

The training commenced with a group of 24 substance use disorder treatment professionals, predominantly from Multan, Bahawalpur, Lahore, Mailsi, and neighboring areas of South Punjab, Pakistan. The majority of participants were actively involved in drug addiction treatment centers, while a few were engaged in hospital settings. Within the training group, there were 2 Medical Doctors and 22 Psychologists (please refer to Annex 1 for a complete list of participants). It is worth noting that these professionals possessed extensive clinical experience in the field, fostering fruitful discussions throughout the training. The group exhibited excellent rapport and mutual respect, as everyone actively participated, providing each individual an opportunity to voice their ideas and thoughts.

The participants acquired various skills through role-play and demonstrations, displaying an eager interest by posing insightful questions and engaging actively in exercises and interactive presentations.

6. Training Evaluation:

The training was evaluated at 5 levels.

1. The pre and post assessment form, consisting of 20 multiple choice questions, was collaboratively prepared by the lead trainer and co-trainers. Its purpose was to evaluate the knowledge of participants before and after the training sessions, allowing for a comparison of their level of knowledge. The form was administered at the beginning and end of the training and then returned to a staff member of Nishan Rehab Pakistan (Training Provider) for result recording.
2. The pre- and post-tests, which were cooperatively prepared by the trainers, were utilized to evaluate the participants' initial knowledge and their progress in learning. Annex 2A serves as evidence of both their entry-level knowledge and the improvement they achieved through the training. The percentage scores demonstrate a significant increase in good scores, indicating a notable enhancement in the participants' understanding (from 7% to 73%). Furthermore, Annex 2B clearly shows that participants achieved higher scores in the post-test compared to their pre-test results.
3. Evaluation of training components was done at the end of the training days. The daily feedback was shared with all trainers in order to help the trainers identify whether adjustments need to be made during the training. Participant’s daily evaluation forms depicted that they were satisfied with methodology and content of the training (please refer to Annex 3 for details)
4. Overall training evaluation was also done for UTC 6 and 7 separately to know participants’ general feedback regarding training modules, components and trainer’s skills on facilitation (Refer to Annex 4 – Training Evaluation). Annex 4 reveals above average satisfaction with training programme ranging from 84-100 %.  According to participants’ feedback; it was well managed training, a good opportunity to establish professional linkage with each other and to learn in such a good learning environment. 
5. The trainers also evaluated the participants based on their behavior and performance during the training programme as well as the results of the curriculum test assessments. The trainers were able to identify potential candidates who could be a part in bringing this knowledge to a wider audience within Pakistan and become new generation of trainers. They were as follow: 

1. Ms. Maria Tahir, Genius Rehab, Lahore
2. Ms. Shahzeen, Nishan Rehab Multan, Multan
3. Mr. Irfan Ali, Nishan Rehab Multan, Multan
4. Miss Rida Batol, Psychologist, Multan
5. Dr. Aman Ullah, Nishan Rehab Multan, Multan
6. Mr. Zahid Abbas, Director & Psychologist at Nishan Rehab Multan, Multan

7. Challenges:

Few challenges were also faced during the training:

• The attendance of participants during the training was addressed by implementing a system where their attendance was marked both in the morning and in the evening. This helped to address the issue of some participants arriving late or not attending the training for the entire day.
• Some topics were too long given the limited time in the master agenda for presentations. For instance, there were 23 slides to cover in the 20 Guide Lines in Crisis Management, with only 15 minutes allocated for it. To address this, a summarization technique was employed before diving into the exercises, making it possible to explain the topic concisely.
• Participants expressed concerns regarding the repetitive nature of the manual and the instructions given by trainers. They felt that trainers were emphasizing the need for strict adherence to the curriculum content.

.8. Comments and Suggestions about Training by Participants:

The comments and feedback provided by the participants included the following statements:

• Thanks to trainers from Colombo Plan, Nishan Rehab Pakistan, and Nishan Rehab Multan for organizing this training in an exceptional manner. The training was highly structured, organized, and informative, leaving no doubt about its effectiveness. The training environment and arrangements were of top-notch quality.
• Due to the high temperatures in Multan during September, participants have suggested that it would be more comfortable to have the trainings in winter. The current weather is quite hot, making it difficult for individuals to fully focus and engage during the sessions.
• Consider providing hard copy manuals before the next training session to enhance attention and retention. Save valuable time for meaningful discussions on the topics by avoiding irrelevant ice breakers.
• To ensure the integrity of feedback forms, Colombo Plan or Nishan Rehab Pakistan can provide coding/stamping services, preventing any tampering by trainers.

9 . Recommendations by Trainers

Following are few recommendations by trainers:

• Trainers are advised to strictly adhere to the agenda's time frame. It is essential for them to come fully prepared to effectively facilitate the training session, with a focus on addressing real-world problems. Additionally, trainers should emphasize the practical application of the information provided.

• It is highly recommended to involve and consider potential participants (Ms. Rida Batol, Miss Shahzeen, Miss Maryam, Mr. Irfan Ali, and Mr. Zahid Abbas) in the Training of Trainers (TOT) for the Universal Treatment Curriculum.
• Only a small number of participants faced genuine issues and were unable to join the training programme. To address this, it is recommended to arrange shadow trainings on UTC, led by a team of new-generation trainers.
• Consider planning monitoring visits to various SUD treatment centers, where the Colombo Plan, DAP or Nishan Rehab Pakistan (As Training Provider) can observe how training participants are effectively integrating their learning into their clinical practice.

 

Annexures

Annex 1 – List of participants

 

S.#	Name	Gender	Location	Organization	Designation
1	Naghmana Rasheed	Female	Multan	Nishan Rehab Multan	Psychologist
2	Samia Noreen	Female	Multan	Nishan Rehab Multan	Psychologist
3	Rida Batool	Female	Multan	Nishan Rehab Multan	Psychologist
4	Kainat Fatima	Female	Multan	Nishan Rehab Multan	Psychologist
5	Nida Arshad	Female	Multan	Nishan Rehab Multan	Psychologist
6	Maryam Fiaz	Female	Mailsi	Nishan Rehab Multan	Psychologist
7	Anam Asghar	Female	Multan	Nishan Rehab Multan	Psychologist
8	Hina Khadim	Female	Multan	Nishan Rehab Multan	Psychologist
9	Mashwa Malik	Female	Multan	Nishan Rehab Multan	Psychologist
10	Samina Nazim	Female	Multan	Samina Clinic	Psychologist
11	Maria Tahir	Female	Lahore	Genius Rehab Lahore	Psychologist
12	Shahzeen Ali	Female	Multan	Nishan Rehab Multan	Psychologist
13	Iqra Qamar	Female	Multan	Nishan Rehab Multan	Psychologist
14	Sehrish Ameen	Female	Multan	Nishan Rehab Multan	Psychologist
15	Aroosa Muneer	Female	Multan	Nishan Rehab Multan	Psychologist
16	Alina Zulfiqar	Female	Khaniwal	Khaniwal HealthCare	Psychologist
17	Aiman Kanwal	Female	Multan	Nishan Rehab Multan	Psychologist
18	Uzma Nawaz	Female	Multan	Nishan Rehab Multan	Psychologist
19	Syed Irfan Ali	Female	Multan	Nishan Rehab Multan	Psychologist
20	Dr. Hashim Khan	Male	Multan	Multan Medical Center	Doctor
21	Maryam Jamil-ur-Rehman	Female	Bahawalpur	Psyche Help	Psychologist
22	Samman Rukhsar	Female	Multan	Nishan Rehab Multan	Psychologist
23	Zahid Abbas	Male	Multan	Nishan Rehab Multan	Psychologist
24	Dr. Aman Ullah	Male	Multan	Nishtar Hospital	Doctor

Annex 2A – Pre and Post Assessment Scores of UTC 6

		UTC 6
S.No	Name	Pre test	Post test	% Improvement
1	Naghmana Rasheed	6	16	167%
2	Samia Noreen	7	17	143%
3	Rida Batool	8	19	138%
4	Kainat Fatima	6	16	167%
5	Nida Arshad	4	10	150%
6	Maryam Fiaz	8	17	113%
7	Anam Asghar	10	14	40%
8	Hina Khadim	8	15	88%
9	Mashwa Malik	6	13	117%
10	Samina Nazim	10	19	90%
11	Maria Tahir	13	18	38%
12	Shahzeen Ali	9	17	89%
13	Iqra Qamar	9	16	78%
14	Sehrish Ameen	5	17	240%
15	Aroosa Muneer	6	14	133%
16	Alina Zulfiqar	6	13	117%
17	Aiman Kanwal	5	12	140%
18	Uzma Nawaz	9	16	78%
19	Syed Irfan Ali	9	15	67%
20	Dr. Muhammad Hashim Khan	11	18	64%
21	Maryam Jamil-ur-Rehman	7	14	100%
22	Samman Rukhsar	8	13	63%
23	Zahid Abbas	8	18	70%
24	Dr. Aman Ullah	11	17	55%

*Total score for UTC 6 was 20.

Annex 2B – Pre and Post Assessment Scores of UTC 7

 

		UTC 7
S.No	Name	Pre test	Post test	% Improvement
1	Naghmana Rasheed	8	14	75%
2	Samia Noreen	9	15	67%
3	Rida Batool	9	16	78%
4	Kainat Fatima	7	18	157%
5	Nida Arshad	5	13	160%
6	Maryam Fiaz	6	14	133%
7	Anam Asghar	9	15	67%
8	Hina Khadim	7	18	157%
9	Mashwa Malik	8	14	75%
10	Samina Nazim	6	13	117%
11	Maria Tahir	8	19	138%
12	Shahzeen Ali	8	15	88%
13	Iqra Qamar	9	18	100%
14	Sehrish Ameen	7	17	143%
15	Aroosa Muneer	5	15	200%
16	Alina Zulfiqar	6	13	117%
17	Aiman Kanwal	9	18	100%
18	Uzma Nawaz	7	14	100%
19	Syed Irfan Ali	17	19	12%
20	Dr. Muhammad Hashim Khan	8	15	88%
21	Maryam Jamil-ur-Rehman	7	14	100%
22	Samman Rukhsar	4	14	250%
23	Zahid Abbas	10	18	80%
24	Dr. Aman Ullah	11	19	73%

*Total score for UTC 7 was 20.

Annex 3 – Daily Evaluations

 

Day 1-2nd September 2023:

Trainers’ feedback

Training commenced at 9am with the lead trainer, with the co-trainers joining in at approximately 10:30am. To enhance the training experience, it is recommended to have a minimum of two trainers present simultaneously.

Participants’ Feedback

Participants were highly satisfied with the training session, particularly expressing their appreciation for the engaging discussions on Crisis Intervention and Suicide topics.

Day 2-4th September 2023:

Trainers’ feedback

The available modules provided ample coverage for subject training. The majority of the participants already had practical experience in the field and were familiar with the topics, making it easy for trainers to explain and elaborate on the topics.

Participants’ Feedback

Participants highly praised the trainers for their positive and friendly demeanor. They also expressed their gratitude for the trainers' excellent time management skills during the training sessions. In terms of the training content, participants found the detailed information about the 20 Guidelines for Case Management, Crisis Intervention, and Counselor Safety to be particularly valuable. However, some participants expressed a desire for more information about TAP-Series and ISSUP goals and objectives. 

Annex 4 – End of Course Evaluation

Table 4A. Evaluation Summary for  UTC 6 (24 participants)
Training Topics	Poor (1-2)	Average(3)	High  (4-5)
Training objectives were clearly stated.		2	22
Objectives of Training were Achieved		2	22
Material was clearly presented.		3	21
The training activities/exercise allowed the practice of important concepts.		3	21
The training provided balance among presentations, activities, participant questions and discussions.	1	2	21
The training topics(s) were relevant to my work		0	24
I expect to use information gained from this training		3	21
I would recommend this training to a colleague		2	22
Overall rating of Trainer 1- Dr. Talat Habib		4	20
Overall rating of Trainer 2-Dr. Azhar Ali		6	18
Table 4B.Evaluation Summary for UTC 7 (24 participants)
Training Topics	Poor (1-2)	Average (3)	High (4-5)
Training was well organized	2	1	21
Trainers were knowledgeable about the subject	0	3	21
Trainers were well prepared for the course	0	2	22
Trainers were open to participants' comments and questions	1	1	22
Training topics were relevant to my work	2	2	20
I expect to use information gained from this training	2	0	22
I would recommend this training to a colleague	2	1	21
Overall rating of Trainer 1-Dr. Talat Habib	0	0	24
Overall rating of Trainer 2-Miss Nazia Bashir	1	2	21