1. Adolescent Sexual Health Work Group (ASHWG)
Core Competencies for Adolescent Sexual and Reproductive Health Providers Overview and Resources
Adolescent Sexual Health Work Group (ASHWG)
Introduce yourself
Ask, “How many are familiar with the Core Competencies?”
I am going to introduce you to an important tool.
If I were to ask you “Are you an effective sexual health provider?” you would undoubtedly all say YES.
If I asked “How do you know that you are effective? How do you measure that?” We would probably have different standards or yardsticks for measuring effectiveness:
co-workers tell me I am effective,
clients tell me that I am good,
my supervisor gives me an excellent evaluation
I have a degree or have gone through training
I FEEL competent when I do my job.
What if we had a common standard for measuring and comparing our effectiveness? The Core Competencies do just that and much more.

2. Objectives
What makes an effective adolescent sexual health educator or provider?
How to become more effective through assessment and competency-based learning.
Creating a map for professional growth
What resources are available?
Here is an overview of what we will accomplish during this presentation.
Review the Objectives on the Slide

3. What do you want our youth to Know Feel Do
In relation to their sexuality?
Let’s begin by focusing on adolescents for a moment so we don’t lose sight of the target of our efforts.
Take a moment at your table, or pair up with someone else, and discuss a few of the key things that you think are important for our youth to know, feel, and do. Identify one or two important ones from each category.
Ask some individuals or groups to share examples.
The outcomes for adolescent health have been identified in documents such as the California Health Education Standards and national organization such as SIECUS.

4. Adolescent Reproductive Health Outcomes
Interventions: Curriculum, Counseling, Modeling, Health Care, Immunizations
Here is a map of where we are going in this presentation
The outcomes for adolescents that we just talked about are on the top line.
One of the features that distinguishes sexual health education from other disciplines, at least in the classroom setting, is that the ultimate goal is some type of health behavior. The goal of reading, writing, and arithmetic is not to address behaviors that have strong health implications. In reproductive health we want youth to avoid health compromising behaviors and engage in healthy behaviors. That fact requires a different type of skill set for teachers that can be challenging.
One of the ways that we influence those health outcomes is through a variety of interventions: curriculum, counseling, modeling, health care, immunizations and others.
I want to be clear that the Core Competencies are not associated with the specific interventions that influence outcomes. We are going one level deeper. If you attended a training designed to help you implement an evidence-based curriculum the trainers would assume that you have adequate communication skills, a basic understanding of adolescent development, youth culture, and legal issues.
The Core Competencies address the knowledge, skills, and attitudes providers need to implement effective strategies and interventions to create those outcomes. These skills and attitudes are often ignored when we focus on the intervention, assuming that the provider has the requisite skill set.
Provider Knowledge, Skills, Attitudes

5. What are 5 things that someone who works with adolescents in the area of reproductive health should know or do well?
Knowledge
Skill
Attitude
Think of someone who is an excellent sexual health educator or provider. What does he/she do specifically? In small groups have a discussion and identify 5 things that someone who works with adolescents in the area of reproductive health should know or do well.
Give groups a few minutes to identify. Ask a few groups to share an example.
The set of Core Competencies defines this skill set in a way that is useful and measurable.

6. Core Competencies
The knowledge, skills, and/or attitudes common to all who work with adolescents in the area of reproductive health.
A Competency is defined as knowledge, skills, or an attitude, necessary to perform a particular role or job. A competency provides a benchmark for excellence and is useful in a lot of ways as we shall see.
Core Competencies are the specific competencies that everyone in that profession should possess.

7. NEED for Core Competencies
A variety of reproductive health programs with different standards, training, strategies, and messages targeting the same youth.
Sexual health is an area that draws from many disciplines – public health, nurses and clinic staff, classroom teachers, community health educators, and outreach workers.
Many state and local agencies target adolescents for reproductive health care but do not collaborate or even communicate with each other.
Each discipline has its own traditions, vocabulary. We often focus narrowly on pregnancy prevention, STD, or HIV prevention and ignore other health issues. We may also give slightly different messages. An adolescent could get one message in a health class on Friday afternoon, and a different message from a community health educator the next day.

8. Core Competencies for Adolescent Sexual and Reproductive Health
Developed by a Subcommittee of the California Adolescent Sexual Health Workgroup (ASHWG)
2006—2008
Over 100 professionals gave input into the process
ASHWG was formed to address the differences in approach between state level agencies and large non-governmental agencies.
A subcommittee was formed in 2006 and developed the initial framework and draft of competencies. Over 100 state and national professionals gave input into the process. The Core Competencies were published in June of 2008.

9. NEED for Core Competencies
Need for a common standard that all providers share to measure growth, learning, and determine staff development needs.
Another advantage of having core competencies is that it can create a common standard for measuring growth.
What if each discipline used the same standards of competence and measuring growth?
What if we all went through the same basic core training before specializing in STDs HIV or pregnancy prevention?

10. Other Disciplines That Have Developed Core Competencies
Public Health
Health Education
Public Health Nursing
Addiction Counseling
Professional Development Coordinators
Marriage Family Therapists
Social Work
Adolescent Reproductive Health is not alone in developing a set of Core Competencies to guide our profession. All of these disciplines or professions have developed them, some as far back as the late 1980s.
Adolescent Reproductive Health is unique in that it is multi-disciplinary. We are medical professionals, nurses and clinicians, community health educators, street outreach workers, classroom teachers, and faith-based workers.
This fact makes it all the more important that we have a common standard for guiding the growth and excellence of our profession.

11. Core Competency Domains
A: Professional and Legal Role
B: Adolescent Development
C: Youth Centered Approach and Youth Culture
D: Sexual and Reproductive Health
E: Pregnancy, STIs, HIV
The first Draft of Core Competencies had over 100 items. Throughout the development process the list was reduced – largely based around what was CORE or common to everyone in the profession. If it was not considered common to everyone it was not included in the final list.
Here you will see the way the competencies sifted out into categories or domains.

12. 52 Core Competencies 21 cognitive 31 operative
Cognitive Sub-domain -- Competencies that focus on basic facts and knowledge
Operative Sub-domain -- Competencies that highlight the application of knowledge to performance
There are 52 Core Competencies organized into five domains. The competencies are also divided into 21 cognitive and 31 operative sub-domains.
Competencies in the Cognitive Sub-domain focus on knowledge.
They outline the basic facts a practitioner needs to know. Competencies in the Operative Sub-domain highlight the application of knowledge to performance. They are demonstrated in observable behavior.
There may be some gray area between these two. But the distinction between cognitive and operative was useful.

13. Think of ability as a pyramid
Think of ability as a pyramid. At the bottom is this extensive knowledge base that I have made up of facts information and experience. For example, if I were an HIV test counselor, “Knows” would be the knowledge of the different types of tests, how they are administered, efficacy rates etc.
“Knows How” is a higher level of skill and indicates that I can apply that knowledge. “Knows How” would be the ability to tell you the steps of giving an HIV Test and communicate that in an understandable fashion.
“Shows How” would be that I can model the steps of giving an HIV test that for you and demonstrate the skill.
“Does” means that I actually do it consistently with adolescents in the proper setting.
The top of the pyramid is the focus of competency-based approaches. While everything below it is important, the gold standard is what you can do.

14. Who?
The Core Competencies apply to health clinic workers, test counselors, case managers, clinicians, classroom teachers, community educators, health outreach workers etc.
Each job will demand additional job specific or role specific competencies beyond the “core”.
The Core Competencies are those that apply to all who work with adolescents in the area of reproductive health, including clinic workers, test counselors, case managers, clinicians, classroom teachers, community educators, and health outreach workers. They are the shared body of expertise and knowledge that staff in these roles have in common. Each of these staff will require additional job or role-specific competencies beyond the Core Competencies.

15. PURPOSE of the Core Competencies
Guide hiring, training, & evaluation
Collaboration & cross training
Support consistent health outcomes
Shared body of knowledge & skills
Program Development
Framework for Higher Education and Licensing and Certification bodies
 The Core Competencies are meant to be useful! They can be applied in a variety of ways. But a consistent theme is that they can help unify different aspects of our profession.

16. Performance Descriptors
No prior experience 0
Introductory 1
Intermediate 2
Competent 3
Accomplished 4
A basic assumption of competency assessment is that the progression from awareness to knowledge to proficiency is a continuum without distinct boundaries. Learning does not always take place in a linear, step-wise fashion. There may be transitional skills that emerge between stages.
Most evaluations use a rating scale, generally from 1 to 4, or 1 to 5. A rating scale translates the level of competence from a word to a number (Satisfactory = 2), which may be useful in tabulating a more global assessment, or determining trends over time. Defining the terms used in the rating scale can increase both understanding and reliability when more than one person is conducting an assessment. Here is an example:
No prior experience – I have not yet attempted to learn this skill.
Introductory – I am just beginning to learn this competency and have some experience with it.
Intermediate -- I am familiar with the skill and use it frequently in several situations or settings
Competent -- I use this skill consistently with little or no effort. It is automatic.
Accomplished -- I use this skill in creative ways and would be an excellent role model for others.
What is important is that you use your own definition and understanding and remain consistent when conducting an assessment.

17. Rate Yourself Using this Rubric
Domain C:
Rate Yourself Using this Rubric
No prior experience 0
Introductory 1
Intermediate 2
Competent 3
Accomplished 4
For this portion of the presentation, make a copy of Appendix A for participants.
Take a moment to look at the competencies in Domain C: -- just the first page. I will give you a couple of minutes to rate yourself (or someone that you know or supervise)
Process: How was this? What are you learning?
The competencies are broken down further.

18. Core Competency Resources
Core Competencies for Adolescent Sexual and Reproductive Health
Performance Assessment and Human Resources Toolkit
Competency-Based Training
If your presentation is limited to an overview of the Core Competencies, this slide describes additional materials for using and implementing the Core Competencies.
The tools described here are all available for download on the web.
There is a registration for the Core Competencies. We use this to see who is using them and to notify people of new tools.
See your cover sheet.
I have some time for technical assistance either on-site or over the phone. See my contact information.

19. Part II Performance Assessment and Human Resources Toolkit

20. Performance Assessment and Human Resources Toolkit
Everything covered in this section of our presentation is taken from the Performance Assessment and Human Resources Toolkit. This will be a snapshot of what is included in that document. It is available for download.
My goal is to let you know that you have resources. I am not imagining that you will internalize all of this or even use it all.
This section will cover:
Breaking down the core competencies into measurable objectives.
Using the Core competencies for self-assessment and performance assessment
Writing job descriptions
Conducting interviews with potential employees
Writing professional development plans.

21. Performance Assessment and Human Resources Toolkit

22. Assessment of Competence
Complete your own Self-Assessment
Before delving into the details of assessment I want to give you an opportunity to practice with an assessment. Look at Page 2 of your handout. This lists the competencies in Domain C: Youth Centered Approach and Youth Culture with possible indicators listed beneath each one. On the right you will notice two columns one for self-assessment and one for an evaluator.
Decide whether to do an assessment for yourself, or choose someone that you know to conduct an evaluation. Take a few minutes to really reflect on your own level of competence, or that of someone else.
Use the rating scale on the next slide.

23. Performance Descriptors
No prior experience 0
Introductory 1
Intermediate 2
Competent 3
Accomplished 4
The Toolkit discusses a variety of formats to use for performance descriptors and provides samples to choose from. Let’s use the same one that we used earlier.
No prior experience – I have not yet attempted to learn this skill.
Introductory – I am just beginning to learn this competency and have some experience with it.
Intermediate -- I am familiar with the skill and use it frequently in several situations or settings
Competent -- I use this skill consistently with little or no effort. It is automatic.
Accomplished -- I use this skill in creative ways and would be an excellent role model for others.

24. What was it like to conduct a self-assessment?
Share in Dyads
What was it like to conduct a self-assessment?
What are you learning?
Ask participants to pair up with one other person and process the experience of completing the assessment by discussing the two questions on the slide.
Ask a few participants to share some of their discussion.
The assessment that you just completed is part of the Toolkit. The assessment tool is available for all of the competencies.

25. Assessment Principles
The more accurate the assessment, the better the professional development plan.
Assessment of competence is best accomplished through a comprehensive approach that uses multiple methods
It is difficult to overestimate the importance of assessment to everything that we do in adolescent reproductive health. It is a type of diagnosis. If you went to a physician for an illness, he or she would first “diagnose” your ailments and everything would flow from there.
Assessment drives learning and training. It is critical for good performance and improvement.
There is no single “best” method for assessing competence. An ideal approach is to develop multiple assessment methods tailored to the competency being measured.
A combination of assessment methods creates a richer profile of the individual practitioner.
Competency assessments should not be done in isolation from the real and complex world of performance. They should allow staff to reveal as many dimensions of knowledge, skills, and attitudes as possible.

26. Assessment Principles
Assessment should be designed to capture the complexity of learning and performance.
How well do staff:
Integrate and transfer learning over time
Apply knowledge to new settings and contexts
Engage in problem solving strategies
Create, express and interpret meaning
There multiple ways to undertake an assessment.
Be willing to think creatively and “outside of the box”.
Assessment should accommodate different learning styles.
Involve staff in the design of their own assessment.
If your agency requires a specific evaluation instrument you can always add additional ones related to domains of competence.

27. Applications of the Competency Assessment and Evaluation Tool
Self Assessment
Performance Evaluation
Compare Strength of Team Members
Assess Training Needs
Here are some of the uses and applications of the instrument.
Practitioners can evaluate their strengths in all domains by completing the tool as a self-assessment. The results can be compared to an assessment by a peer, a supervisor, or several supervisors to form a complete picture of practitioner competence and performance.
Supervisors can use this tool to independently rate the competence and performance of practitioners. The results can be organized by individual competency or by domains.
Conducting a performance evaluation on several practitioners can provide a picture of the range of competence embodied in a team. Comparing the results of several practitioners provides a mosaic that allows a manager to better match skill level to the demands of the organization, strategize on-the-job mentoring for increased competence, assess training needs, and develop a training or mentoring plan.
The Competency Assessment and Evaluation Tool can be applied as a guide for determining training needs of the organization. This assessment can also surface those practitioners who might be able to share their expertise as trainers or mentors.

28. Multiple Choice Questions Short Answer Pre – Post Tests
Knowledge Assessment
Multiple Choice Questions
Short Answer
Pre – Post Tests
Oral Questioning
Essays
Oral Presentation
See Pages 9 & 10 of the Toolkit for examples and a discussion of each of the Knowledge Assessments.
Assessments of knowledge are undoubtedly the most familiar. Anyone who has spent time in an education institution has been bombarded with a variety of assessments of knowledge.
Courses of education, beginning in elementary school, rely heavily on these objective, pencil-and-paper measures of knowledge. They are easily administered and scored, and have the advantage of being standardized.
On the downside, such measures may only elicit understanding of a narrow slice of cognitive knowledge.

29. Performance Assessment
Generally involves methods of direct observation by clients, peers, supervisors,
Or practitioner generated records and products
In competency-based approaches the focus is on what someone can DO, rather than what they KNOW.
In general, performance must be measured by direct methods requiring observation of a practitioner’s behavior over time or products produced by the practitioner. Indirect methods, such as self-assessment and client reports can supplement the more direct methods but cannot substitute for observation.

30. Performance Assessment Instruments
Pages 12-15
Global Assessments
Supervisor Assessments
Client Surveys
Self-Assessment
Role Play Simulations
Direct Observation
Pages 12 to 15 of the Toolkit describe a variety of strategies and instruments for measuring performance.
The ideal strategy for performance assessment is direct observation of a practitioner. This can be accomplished by supervisors, peers, or even clients through the process of client surveys.
A practitioner’s self-assessment can be an important contribution to performance assessment. Role play simulations can be opportunities for evaluation when direct observation is not practical. Roleplay can be formal or informal. Finally, video-taping a practitioner in a variety of settings creates a rich opportunity for shared observation and evaluation.

31. Performance Assessment Instruments
Practitioner Products
Client Record Audits
Portfolio – practitioner generated
Two additional performance assessments involve products produced by the practitioner. These include an auditing of client records or other files. This can yield a lot of information about performance.
Finally, the Portfolio is a collection of products prepared by the practitioner that documents progress toward mastery of a competency or skill-set. Here the responsibility lies with the practitioner to demonstrate competence. Portfolios accommodate a variety of learning styles and encourage high levels of creativity. They can be used for both cognitive and operative competencies.

32. Multi-Stage Assessment
Combines self-assessment, written examination, and direct observation of performance skill.
Accommodates different learning styles
Captures cognitive and operative sub- domains
Creates a complete, integrated picture
Multi-Stage Assessment is a model that combines self-assessment, written examinations, and direct observation of performance skills. This approach captures both cognitive and operative sub-domains of the Core Competencies. The results of these individual assessments are then combined to create an integrated picture of employee competence.

33. Human Resources Toolkit
Job Description
Structured Interview Guide
Performance Descriptors
Professional Development Plan
Competency Assessment and Evaluation
What follows next is an overview of the Human Resources Toolkit. This section, found on page 17, includes several instruments to assist with performance assessment and human resources management. It includes sample language for job descriptions, structured interviews, ideas for generating performance descriptors, a framework for a professional development plan and a complete Competency Assessment and Evaluation Instrument. These tools are easily modified to fit the specific demands of your organization.

34. Job Description
The Core Competencies can reframe a job description from a list of tasks to a performance profile.
Identify the most salient skills, knowledge and attitudes that relate to job performance.
Job descriptions are designed to attract the best-qualified and competent candidates. The Core Competencies can be used to identify the most relevant skills, knowledge, and attitudes that relate to job performance. They help transform the job requirements into clearly defined and tangible skills. Consider using the list of Core Competencies as a checklist for defining those skills.

35. Job Description Samples
Comfort and confidence discussing topics related to adolescent sexuality
The ability to apply theories/models of behavior change as they relate to adolescents
Communication skills that emphasize a strength-based approach to youth development
Offer additional examples as needed from Page 18 ff.
The sample language in the section on Job Descriptions on page 18 is organized according to the five domains of the Core Competencies. Identify the domains and competencies that most closely match the requirements for the job. Alter the language as needed or design additional requirements using the Core Competencies as a guide.

36. Structured Interview Guide
Page 20
How would you respond to an adolescent who discloses sexual behavior that conflicts with your personal morality.
Pretend that I am a 15 year-old adolescent. Explain the protection of confidentiality and the limits of confidentiality to me.
Describe some of the common behavioral factors linking pregnancy, STIs and HIV.
Offer additional examples as needed from Page 20 ff.
Interviewing potential candidates for a position provides a brief but important window in the assessment of competence. Having clearly defined the knowledge, skills, and attitudes required by a position, the interview is an opportunity for someone to demonstrate those competencies. The sample questions in the Structured Interview Guide on page 20, suggest wording that allow each candidate to reveal their knowledge, skills, and attitudes. Some of the competencies related to comfort and skill in communication are implicit and need to be discerned in the quality of the responses. Again, use the entire list of competencies as a checklist and modify the language according to your needs.

37. Part III Training and Learning for Competence

38. Training and Learning for Competence
Everything covered in this section of our presentation is taken from the Competency Based Training document. This will be a snapshot of what is included in that document. It is available for download.
The goals of this section are
to understand the basic elements of competency-based training
to review the steps of training design
to share resources.

39. How did you learn to become a skillful provider of sexual and reproductive health?
Pair up with one other person. Take a moment to think about all of the ways that you learned to develop the skill that you have right now and share some of those with your partner.
Ask a few people to share their responses.

40. All the Ways We Learn Academic Coursework Workshops Books Journals
Television
Conferences
Informal conversations
Direct Observation
Input from Peers
Input from supervisors
Working with a mentor
Doing
Making mistakes
Online courses
YouTube
Learning is not a linear process. In fact, it can seem like a random and chaotic process at times. By acknowledging that learning is complex we can begin to take advantage of all of the ways that we learn and use those to improve level of competence.

41. Competency Based Training
Specific goals and outcomes to be demonstrated by the targeted audience
Performance-oriented, highlighting outcomes over methods used to attain training goals
Demonstration of knowledge and performance of skill
Competency-based training takes a different focus than many traditional methods of education and training.
If you take an academic course, the emphasis is on demonstrating that you have absorbed the knowledge. You will be assessed on that.
Earning a degree documents that you put in the time, but there is no guarantee that you can do anything. How many high school graduates cannot count out change from a register?
At an inservice, you are assessed on a pre/post test of how effectively you can feed back someone else’s understanding of what is important.
Training for competency is different. It says as long as you get to the outcome, the methods used are not as important. In competency based training the focus is strictly on the outcome. In traditional methods, the focus is on the method.

42. Adolescent Reproductive Health Outcomes
Interventions: Curriculum, Counseling, Modeling, Health Care, Immunizations
I want to return to this slide as a reminder. We are talking about the competencies on the bottom line. This is not about a training for a specific evidence-based curriculum.
We are going one level deeper. What knowledge, skills and attitudes do providers need to have to implement effective strategies to create those outcomes?
Sometimes these get ignored and we focus on the intervention, assuming that the provider has the requisite skill set.
Provider Knowledge, Skills, Attitudes

43. Developing Competency-Based Training
Identify and Assess the Audience
Develop Measurable Learning Objectives
Develop an Assessment for Each Objective
Select Content and Teaching Methods
Develop a Curriculum or Course of Study
Ongoing Evaluation and Support
These are the steps to developing competency based training programs. Some of these may be familiar.
Ask participants to look at the final handout: Competency Based Training and Staff Development
Ask them to complete this form individually or by pairing up with another participant to complete together.
You will be using this form to design a training for a particular group.

44. Developing Competency-Based Training
Identify and Assess the Audience
The first question is to decide who is the target audience for your training. It could be an individual, a small group, or a large group. Take a moment to reflect and write down the audience and some things that you know about the audience.
How will you determine what they already know? In the previous section we discussed a variety of ways to assess an audience.
Do you know what type of learners they’re? Are they visual, auditory, or kinesthetic? Do they have any learning challenges?

45. Developing Competency-Based Training
Develop Measurable
Learning Objectives
Having identified and assessed the audience, you will now develop measurable learning objectives.
Objectives should be modest enough to be accomplished within your available time frame. You can’t do it all in one day.
The Core Competencies are condensed. They need to be broken down into more manageable objectives and outcomes. Look at the second page of your handout. Here each competency is broken down into Possible Indicators. We completed this handout as an assessment. Each Possible Indicator can also serve as an objective for training or a learning experience. You can use these as they are written or write your own.
Creating objectives that are measurable makes them easier to assess.

46. Developing Competency-Based Training
Develop an Assessment for
Each Objective
Next, you will design some type of assessment for each objective. Remember that knowledge assessment and performance assessment may involve different types. Do you need to actually observe the learning?
If the objective is written in a measurable form, it will be easier to create a set of assessments for each.

47. Developing Competency-Based Training
Select Content and
Teaching Methods
Now think about learning or teaching methods.
Match the teaching methods to the learners. Are they visual, auditory, or kinesthetic?
Go back to the list of ways that we learn. Be creative. Remember that you focus is to have people be able to demonstrate competence.

48. Developing Competency-Based Training
Develop a Curriculum or
Course of Study
Think about an appropriate course of study for this audience to reach the measurable objective.
Will this learning roll out over a long period of time, or will it be brief and time limited?

49. Developing Competency-Based Training
Ongoing Evaluation and Support
One area that makes staff development so ineffective, is the absence of ongoing support and follow-up training.
How will you continue to support learners after your training?
Ask some member of the audience to share the training design that they created. Use this as an opportunity for discussion.

50. Training for Competence
Cognitive Competencies – trainings, workshops, online courses, independent work and investigations,
Operative Competencies – on the job training, mentoring by peers or supervisors, teaching or modeling for others,
A key facet of competency based training is that you can be creative with methods. As long as the outcome improves competence. Think outside the box of traditional methods.
During difficult financial times, the training budget may be non-existent so we have to look for other methods.

51. Competency-Based Training Toolkit
Description of Competency Based Training
Matrix with an analysis of trainings that address specific core competencies.
Matrix – see your handout with the matrix for current programs that can be accessed.
Closure: Encourage participants to share their thoughts about the presentation and how they intend to use the Core Competencies. Encourage them to download the resources.