Welcome to module two, public health in the era of COVID-19. By the end of this module, you will be able to describe and explain the role of the US public health system in contact tracing. Describe the main skills required to conduct COVID-19 contact tracing, and list and describe at least six effective communication skills. Let's first begin with a little history. Many of you may be familiar with the core public health functions outlined in the 1988 Institute of Medicine report, The Future of Public Health. The three core functions of public health, our assessment, policy development, and assurance, each of which will be described in this module. In 1994, the Core Functions of Public Health Steering Committee was convened to develop a better definition and description of public health in the United States. The steering committee involved representatives from public health service agency, like the CDC, and key national public health organizations. The committee produced a statement called Public Health in America. The Public Health in America statement provides a vision and mission for public health, as well as the context of what public health should be prepared to do and how public health service is delivered. The vision for public health is broad, healthy people in healthy communities. The mission is to promote physical and mental health, and prevent disease, injury, and disability. The public health department's assess public health threats by monitoring community health status. And investigating health hazards as they emerge through administering health surveys, contact tracing, community health assessments, and investigating environmental health risks. They utilize these resources to monitor and respond to emergencies, such as COVID-19. Surveillance data collected by these entities are used to better understand the pandemic, including transmission rate, incubation period, case fatality rates, and monitoring hot spots. Public health systems are commonly defined as all public, private, and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction. This concept ensures that all contributions to the health and well being of the community or state are recognized in assessing the provisions of public health services. This figure shows the complexity of the public health system in the United States. Essential services, ES 1 addresses what's going on in our state or community. A COVID example would be data dashboards by city and county, do we know how healthy we are? Do we have accurate periodic assessment of the community's health status, including identification of health risks, determinants of health, and determination of health services needed? Do we pay attention to the vital statistics and health status indicators of groups that are at higher risk than the total population? Do we identify community assets that support the local public health system in promoting health and improving quality of life? Use of appropriate methods and technologies, such as geographic information systems, to interpret and communicate data to diverse audience. Collaboration amongst LPHS components, including private providers and health benefit plans to establish and use population health registries, such as disease or immunization registries. A COVID example for ES 2 would be county or city testing, standing up testing centers. ES 2 answers the following questions, are we ready to respond to health problems or threats? How quickly do we find out about the problems? How effective is our response? Epidemiological investigations of disease outbreaks, patterns of infection, chronic diseases, injuries, environmental hazards, and other public health threats and emergencies. Active infectious disease epidemiological programs, access to a public health laboratory capable of conducting rapid screening. And high volume testing. ES 3 answers these questions. How well do we keep all segments of our state and community informed about health issues? Health information, health education, and health promotion activities designed to reduce health risk and promote improved health. Health communication plans and activities such as media advocacy and social marketing. Accessible health information and educational resources. Health education and health promotion program partnerships with schools, faith based communities, worksites, personal care providers, and others to implement and reinforce health promotion programs and messages. ES 4 addresses how well do we truly engage people in state and community health issues? Identifying potential stakeholders to contribute to or benefit from public health and increasing their awareness of the value of public health. Building coalitions, partnerships, and strategic alliances to draw upon the full range of potential human and material resources to improve community health. Convening and facilitating partnerships and strategic alliances among groups and association, including those not typically considered to be health related. In undertaking defined health improvement projects, including preventative screening, rehabilitation, and support programs. A COVID example of ES 5 would be a stay at home order. ES 5 answers these questions. What policies in both the government and private sector promote health in our state and community? How well are we setting health policies? How effective is local public health governance, development of policy, codes, regulations, and legislation to protect the health of the public and to guide the practice of public health? Systematic LPHPS and state level planning for health improvement in all jurisdictions. Alignment of LPHS resources and strategies with community health improvement plans. ES 6 answers this question. When we enforce health regulations, are we technically competent, fair, and effective? Assurance of due process in recognition of individual civil rights and all procedures. Enforcement of laws and regulations and public health emergency actions taken under the Board of Health or other governing bodies or authority must be addressed. Review, evaluation, and revision of laws and regulations designed to protect health and safety, reflect current scientific knowledge, and utilized best practice for achieving compliance. Education of persons and entities obligated to obey agencies, to enforce laws and regulations and to encourage compliance. Enforcement activities in a wide variety of areas of public health concern under authority granted by local, state, and federal rule or law, including but not limited to. Abatement of nuisances, animal control, childhood immunizations and other vaccinations. Food safety, housing code, local sanitary codes, on site wastewater disposal, septic systems. Protection of drinking water, school environment. Solid waste disposal, swimming and bathing, area safety and water quality. Tobacco control, enforcement activity during emergency situations, and vector control. ES 7 answers are people in my state community receiving the health services they need? Assuring the identification of populations with barriers to personal health services. Assuring identification of personal health service needs of populations with limited access to a coordinated system of clinical care. Assuring the linkage of people to appropriate personnel health services through coordination of provider services and development of interventions that address barriers to care. Examples, culturally and linguistically appropriate staff and materials. Transportation services provided. ES 8, do we have competent public health staff? How can we be sure that our staff stays current? Education, training, and assessment of personnel, including volunteers and other lay community health workers to meet community needs for public and personal health services. Efficient processes for licensure of professionals. Adoption of continuous. Quality improvement and lifelong learning programs that include determinants of health. Active partnerships and strategic alliances with professional training programs to assure community relevant learning experiences for all students. Continuing education in management and leadership development and programs for those charged with administrative or executive roles. ES 9 addresses are we meeting the needs of the population we serve, are we doing things right? Are we doing the right things? Assurance of ongoing evaluation in critical review of health program effectiveness based on analysis of health status and service utilization data. Assurance of the provision of information necessary for allocating resources and reshaping programs. ES 10, are we discovering and using new ways to get the job done? Public health research activities include initiating research, participating in research by others, reporting results and implementing policy based on these results. Contact tracing is an essential component of Public Health Essential Function 2 which focuses on diagnosing and investigating health problems and hazards in the community. During an infectious disease outbreak, like COVID-19, one of the best tools public health experts have is old-school detective work. Finding each sick person and then figuring out who they recently interacted with. The technique called contact-tracing helps get outbreaks of diseases like COVID-19 under control the verge 4/10/2020. Successful contact tracing requires an expansive workforce of individuals who are empathetic, possess excellent interpersonal skills, and work effectively with diverse populations. These skills include building repport, risk communication skills, demonstrating cultural competence, sensitivity, and empathy. Let's discuss the communication skills needed for contact tracers. We discussed the importance of a contact being able to trust a contact tracer. Another word for trust is rapport, rapport is a relation of trust between people. A feeling of sympathetic understanding or mutual understanding. Another word for it might be harmony or connection. So how can a contact tracer ensure that they develop rapport with a patient or a contact? There are three components that we're going to discuss today to building rapport. The first is using effective communication skills. Second, finding common ground with the individual. Third, displaying respect and empathy. We're going to spend the majority of this video talking about five effective communication skills for contact tracers. They are active listening, an appropriate level of information, using an appropriate tone, giving factual information and reinforcing information. The first skill is active listening, we're going to discuss two techniques that factor into active listening. First, let's define active listening. Active listening is simply the way of communicating the fact that you are listening to the person you are speaking with. I'm sure we've all experienced in active listening when we can't tell if someone is actually paying attention to us. Growing up my mom used to say that if I can't see your eyes, then I don't know you're listening. Similarly, active listening is a way of responding to someone without interrupting them. Or making the conversation about us and letting them know that we are hearing them and that we are processing what they're telling us. The first technique we can use to display active listening is paraphrasing or summarizing. These are two words that mean essentially the same thing. Rewording or re-phrasing a statement in our own words as a way to verify information. So you may hear phrases like what I'm hearing is, or it sounds like you were saying. The important thing here is that we don't repeat people's exact words. We want them to know that we are processing their information. And we can't be expected to remember exactly what they said word for word. However, we do want to avoid Phrases like I know what you mean because this implies a certain level of similarity between you and the patient or the contact. While that similarity may exist, it can also be frustrating to people who are trying to explain their experience, to have someone suggest that they don't need to do that because they already understand what they're going through. This is a way of demonstrating engagement in the conversation, which is the essence of active listening. Let's look at an example of paraphrasing or summarizing. Let's imagine that a PUI says the following. I can't tell you the names of all my contacts, I just hang out at the pool Hall and there's a guy there we call Slim and another one called JD. Pause the video for a minute and think about what you might like to respond to the statement with a paraphrase or a summary in your own words. This response is only one example of how you might paraphrase or summarize. If you did this slightly differently or even drastically differently, that doesn't necessarily mean you are wrong. So when the PUI says I can't tell you the names of all my contacts, I just hang out at the pool hall. There's a guy that we call slim and another one called JD. One example response, may be what I hear you saying is that you just know the nicknames of the folks at the pool hall. Is that correct? This let's the contact know that we've been listening and also benefits us because as contact tracers, we need to know the actual names or simply the nicknames of the people at the pool hall. The second active listening technique is reflection. At first glance, this may seem similar to summary or paraphrase, but it essentially means putting words to a contact's emotional reaction. It acknowledges their reactions and helps build rapport by checking to make sure that your assumptions are correct rather than moving forward on incorrect assumptions. This may include phrases like. It sounds like you are feeling worried, or I understand that you're having trouble with. Let's look at an example. The PUI might say I'm feeling tired in this whole interview is making me nervous. You're asking me too many questions. Pause the video here and think about how you might reflect back. This patient what you understand they are feeling. Again, this is just one example, so if you came up with a different way to do this, that's perfectly acceptable. So if the PUI says I'm feeling tired and this whole interview is making me nervous. You're asking me too many questions. One possible response is, I can tell that this process is worrying you. Is there something in particular that you're nervous about? The second effective communication skill will discuss today is providing an appropriate level of information. The first thing to think about is that there's a difference between need to know and nice to know information. That's true in general, but it's especially true with something like COVID-19. When someone has just found out that they're sick or that they have may have been exposed to the virus. They may want not want to know all of the details about the science of the virus, how it works, how it infects people even though that information may be factual and maybe even helpful at a certain point in the process. It's important to be able to understand what someone needs to know in a moment as opposed to what is simply nice to know. Next, we want to avoid technical terms and jargon. In the medical field, there is a lot of fancy words that are used to describe disease processes, anatomical landmarks, etc. For instance, one of the types of swabs that is done to test for COVID-19 is a nasal pharyngeal swab. Now that is a pretty big word, but it essentially means inserting a cotton tip swab all the way back through the nasal cavity to the back of the throat. This is an uncomfortable process, maybe even painful, but it's necessary and perhaps the most effective way that we have for testing for COVID-19 right now. If I was going to have root use a phrase like nasal pharyngeal swab when talking with the patient or a contact it will be important to define and clearly explain that term so that they understand what it means. Otherwise, jargon can be incredibly confusing and frustrating for patients. It is necessary sometimes, so when it is necessary, we want to make sure that they understand it clearly. Finally, when providing the appropriate level of information, it's important to know that we can and should repeat information. We're going to talk more about this when we talk about follow up later. However, it is important to recognize that it's okay to repeat information. When someone's experiencing emotion, as someone might be when finding out that they're sick, or that they might have been exposed, they might experience emotion like fear, sadness, concern, worry. But when they're experiencing that emotion, it can be hard for them to remember information, so repeating information throughout the course of the conversation can be valuable, especially if it's incredibly and critical information. The third effective communication skill we're going to talk about today is using appropriate tone. So tone can mean a couple of different things, but in this context we mean an inflection that can express mood or emotion. You may have heard this term used when you think about someone's tone of voice. Well, tone can be affected through three different things. It can be affected through your voice, the sound of your voice, the quality of your voice, but it can also be affected through your choice of words and your general attitude. In the context of contact tracing, there are three tones that we want to discuss. The first is a passive tone that gives up one's right in deference to others. The second is an aggressive tone, which demands one's rights at the expense of others. And the last is an assertive tone which maintains ones rights without compromising the rights of others. Let's look at some examples. An example of a passive tone might be, when you have the opportunity, it will be helpful to get the names of people you spend time with. An example of an aggressive tone might be, you must give me the names of all your contacts now. Whereas an assertive tone might be, it is important to identify your contacts, so let's start with making a list of the people you spend the most time with. Which of these tones do you think is most important for a contact tracer to maintain? If you answered an assertive tone, you're correct. Being assertive is important as a contact tracer, because the work that you're doing is not only benefiting the people that you were talking to, but also the people that they may or may not have come in contact with if they were not notified by you. You are not only asserting your rights for protecting the rights of other people who may have been exposed to this illness. The important thing to remember is that what you are doing is a public service, and you have a responsibility and an obligation to elicit information that will reduce COVID-19 transmission in our communities. The fourth affective communication skill is giving factual information. This may seem relatively straightforward, but it's important to recognize that you are acting in the official capacity as a contact tracer, so you may want to make sure that the information that you are giving is factual. Now factual in this context usually refers to coming from some sort of official source, such as the Health Department or the CDC. It may also refer to what are called peer review journals, which are academic journals that have a rigorous review process to ensure that the information they are publishing is scientifically accurate. It's important to correct people's misconceptions an provide appropriate and accurate information about COVID-19. If at any point you are not sure if information you are prepared to share is factually accurate, don't share that information. Instead, tell the patient or contact that you'll look it up and get back to them. It's also helpful to avoid irrelevant information, or information that doesn't have any bearing on the conversation that you are having with the patient or the contact. You are not responsible to educate them all about things related to COVID. Simply their responsibilities as a PUI or a contact, and the information that you need to perform the contact race. The fifth and final affective communication skill we will discuss today is reinforcing information. Reinforcement, much like repetition, which is one of the ways we can reinforce, ensures That information sticks in the patients or the contacts mind. So repetition is one of those skills that you can use to reinforce. Repeating something a few times throughout the course of the conversation may be particularly helpful, especially when that information is crucial to the patients understanding. We'll show an example in a moment. The second type of reinforcing that we can do is eliciting understanding. This is when we ask a patient not just simply, do they understand, but what is it that they understand? Finally, summarizing or paraphrasing which remember is also an active listening skill. Summarizing, in this context often occurs at the end of a conversation or the end of a section of the conversation and is used to reinforce information that you have already told the patient. It's essentially like active listening, but to the things that you've said. Let's look at some examples. If you are practicing repetition as a way of reinforcing, you might say, I mentioned this earlier, but I want to review it again. You will need to remain quarantined for a full 14 days. If you were using a eliciting understanding, you might ask a question like, we've covered a lot today and I want to be sure I was clear. In your own words please tell me what you understand. In summarizing, we might say something like,so, to summarize, here's what we have discussed today. As you see on your screen, there are two phrases that we want to avoid when reinforcing at the end of a conversation. First, we want to avoid asking do you have any questions. This can put pressure on the patient to rack their brain and try to come up with some questions to make sure that they don't look silly or stupid. The second is do you understand for similar reasons, patients often say yes to this question because they don't want to look silly or stupid, even if they don't understand. Instead, we can ask someone what questions do you have, which implies that of course they have questions. Of course they're engaged and they don't have to give you an answer to those questions. Instead, we might ask questions like, what questions do you have or can tell me in your own words what you understand, which encourages patients to participate in the conversation. Now that we've discussed 5 effective communication techniques, we are going to discuss some communication pitfalls or things to avoid. First, we want to avoid being defensive or distant. It's important to remember that any emotion that someone is experiencing is not personal to you. That will help prevent us from becoming defensive's contact tracers. It's also very important that we do not interrupt the patient or the contact, but allow them to speak freely. This can be challenging sometimes, especially if you're communicating with someone who likes to talk a lot, but it's important for the sake of building report that they feel that they can be fully heard. It's important that we don't give false assurances. Promising someone that everything is going to workout and you won't get sick enough to end up in the hospital, are not things that we can promise. Additionally, promising certain actions in a certain period of time is also an unwise idea. The flip side of providing factual information to a patient might be providing personal opinion and advice. As contact tracers, we are not medical professionals and we don't want to behave as such, providing advice that comes purely from our own minds as problematic. It is perfectly acceptable to point someone to official resource is that may be helpful to them as they navigate the questions or whether or not they've been exposed to COVID-19. But it's important that those come from those official sources an that we don't insinuate or suggest that we are anything other than what we are, contact tracers. The next two pitfalls are related. Overpowering the listener can be done with loud voices, but it can also be done with a significant amount of speech or interrupting the patient. We want to make sure that the person we're talking to feels like they are he center of the conversation. Yes, ultimately we have a job to do, but that job is going to be incredibly difficult if they don't trust us. So we need to make sure that they know that they are the most important part of the conversation. In that same vein, we want to make sure that we avoid condescending statements. These might come about because the patient or the contact is expressing anger and we are lashing out in response. But we also want to be mindful of other statements that might be perceived as being condescending. Sending, especially if the person that we're talking to comes from a different cultural background than we do. We want to avoid asking several questions at once. That is what we call compounding questions. And it might sound something like this, can you tell me everyone that you've interacted with in the last 14 days and also do you remember standing particularly close to anyone? These two questions are lumped together as though they're one question. When we do this, it makes it harder for the patient to keep track of what has been asked. And sometimes it makes it harder for the listener to keep track of what has been answered. Breaking these two questions out into two separate questions, asking one, getting the answer and then asking the other and getting the answer is far more effective strategy. And then finally, at no point do we want to be aggressive. Aggression can make someone feel small, condescended to or aggravated emotionally. Remember, you are doing public health work to protect not only them, but people within the community. Being confident is necessary. Being aggressive is not. There may be some calls that are particularly challenging. We're going to talk more about this in the third video. But in general the things you need to remember to do, are first of all remain calm. This isn't personal. If someone is upset or sad, it's not because of you or anything you did. Second, it's important to listen to what they're saying. Remember, we talked about non interrupting. That's why this is important. Then you want to reassure them and acknowledge their concerns. Sometimes it's helpful to let people know that an emotional reaction to finding out that they may have been exposed to a pandemic is understandably upsetting. And they shouldn't feel bad for being upset or feeling sad. In some cases, difficult calls may necessitate that you find another contact tracer to handle the interaction. If you are tracing for an organization such as the Health Department or a nonprofit, they will likely have someone that you can speak to, to reassign or refer out the interaction. In the additional readings for this module you will see some additional resources for deescalating difficult situations. Finally, protecting privacy is incredibly important as a contact tracer. There is an entire module on privacy, so we won't spend a lot of time on this. But remember, one of the most important things you can do is to reassure patients that you are going to do the utmost to protect their privacy. There are ways that you might do that by referencing HIPAA or referencing the agreement that you made when you became a contact tracer. By reassuring them, but this is a very big concern for a lot of patience. As we discussed, sometimes you will have difficult calls as a contact tracer. Most of that difficulty will stem from emotion, distress or crisis that the person is experiencing. Some contacts or PUIs may accept the information very matter of factly, while others may be much more emotional. They may be angry, upset, distressed, sad, or in denial. Each of these states of being is a stage in what we call a crisis reaction. We'll talk about more of that in just a minute. But the important thing here is to recognize that these people are not being irrational or purposefully difficult. But instead they are wrestling with a lot of their own emotions and may not know how to handle that well. So we can use the communication skills that we have covered in the previous video and help the person move through these crisis states to a place of reconciliation. So what is it that causes a crisis or crisis state? Well, first, let's talk about what a threat is. We perceive something as a threat when the demands that that experience presents outweighs the resource is we have to manage it. In a biological sense, this might mean that when we are concerned by an angry mountain lion. We recognize that they are a threat because we don't have a way to defend effectively against their claws. However, in an emotional sense, it usually refers to not having the emotional resources. The support system or coping mechanisms to handle the emotion of the given situation. When someone experiences too many threats too quickly or too much threat to quickly, they become unable to manage that event. And that leads to a crisis state and being overwhelmed. So let's talk about the crises phases, the important thing to remember about the phases of crises is that they are not linear, which means that they don't necessarily happen in this order or in any given order. It's entirely possible that someone spends their entire time in the denial state before moving to reconciliation. While it's also possible that someone bounces back and forth between two or three of them and never touches all of them. But let's look at them each in turn and discuss ways that we might help support patients or contacts through these crises phases. The first one we'll discuss is anxiety. Now, in person, we can often pick up on anxiety by hand wringing or hearing or seeing tapping of fingers or bouncing leg. Over the phone or video chat that can sometimes be harder to spot. But when we know that someone is affected by anxiety and crises, one of the first things that we can do to help is to remove them from that situation or direct their activity or attention away from the situation. This might come in the form of encouraging them to take a few deep breaths or changing the topic for a moment. It's also important to reassure them if we were in person with them, we might reach out and touch them gently on the shoulder or on the arm to let them know that we are there for them and support them. That's obviously not something that we can do in our current context but sometimes it can also be helpful to problem solve to help identify and address the source of the anxiety. The second phase is denial. Attribution is the sign here, and attribution simply means making excuses. For instance, someone who's being told that they may have been exposed to COVID-19 might express denial by saying, no, I couldn't have been impacted. I was only standing around them for 10 minutes and I was keeping my distance. I wasn't breathing on him, he wasn't breathing on me, I'm sure I'm fine. That's an example of denial. When we identify that someone is experiencing denial, it's important we allow them to express the denial that we don't argue with them or tell them, no that wasn't your experience. They may truly believe that this is the truth and what they experienced. However, it's important to gently remind them of the facts and repeat those facts if necessary. In this context, we might remind the individual that insists that he could not have been exposed, what it is that we know about exposure. Additionally, it's important that we don't promise anything, especially to people that are denying that they may or may not have been exposed. And that we show compassion to them, to let them know that we understand why they might be expressing denial. Third, let's talk about anger. Anger is often expressed through things like facial expressions, such as glaring eyes, closed fist, or a tone of voice that tends to be a little more tight or loud. The important thing to remember when talking with someone who is expressing anger is not to personalize it, which means not to take it on yourself. They're likely not actually, angry at you, but rather at the situation or the institution. It's important to allow people who are angry a chance to express that anger. But it's also important to separate from the source of their anger as much as possible. Confront them if necessary. Now, confronting does not necessarily mean becoming angry or aggressive yourself but simply letting them know that you understand that they're angry. But it's important that you move forward regardless. Be as confident as you can when you're addressing anger. Oftentimes, people who are angry will look for other reasons to remain angry as a coping mechanism for not having to face the crises that they're in. If you come across as too passive or too aggressive, then that can be food for them to continue to build on their anger. Remorse is another phase of crises. Oftentimes we might refer to this as a pity party or self-pity but it can be a valid, important phrase of dealing with a crisis. The important thing is that we don't linger here or allow the patient or contact to linger here. So we want to listen to them very carefully. We want them to know that we hear their concerns and we hear their regrets. We want to avoid judgment. Often this means that we don't agree with them. We don't say yes, you shouldn't have gone to that party or else you probably wouldn't have gotten sick. That can be a very judgmental thing to say. Instead, we might say, honestly, there's no telling that that's for sure where you. Contracted this. And at the end of the day, we all have to make the decisions that feel right for us. We want them to be able to express their remorse, acknowledge it, not judge it, and move them through it. When experiencing the grief phase of crisis, oftentimes we will hear sadness. Maybe some crying or solving. Much like with remorse it is important that we allow the patient to express their sadness. If you've ever seen the Pixar movie inside out, it doesn't excellent job of explaining how sadness relates to our emotions and how valuable important it is to recognize when we are sad. Often times were sad because whatever is going on affecting something that is important to us and that we value. It can also be helpful to normalize those feelings to let people know that it's okay to be sad. In fact it's kind of normal to be sad or frustrated. Think back to when everything became cancelled in the face of COVID-19, graduations, weddings, conferences, events like sports and concerts. Many people were sad when that happened, and that's perfectly natural and reasonable and rational to be sad in that moment. By showing patients or contacts who are sad or experiencing grief that we care, and that we empathize with them it can help them to move through the grief. The last phase of crisis is reconciliation, and this is the point where someone kind of comes out of the crisis process and says okay. I have found the resource is that I need to face these threats and thus they are no longer threats to me. We want to make sure that we have validate patients or contacts that are at this point or that have reached this point. Let them know that we're glad that they've gotten to this point and that we can continue to encourage them to dress this confidently as possible. The important thing to remember is that while each stage of crisis is valid in and of itself, we don't want to linger or languish in any particular phase. So what we're looking to do is essentially help a person move through whatever phase of crises there in so that hopefully they can reach reconciliation sooner rather than later. It's important that we ask them for their perspective and concerns whenever talking with them about crises or other resource is that they may or may not have. We want to empathize with difficulties and make sure to connect with them whatever networks they have already, as well as other support networks and resources that we could provide. We can also be a beacon of hope and enthusiasm, not by making false promises and telling them everything is going to be okay. But by reassuring them that we are confident and capable in our skills as contact tracers. And we're going to do everything we can to minimize the impact of this on them and on anyone that may have come in contact with them. So this is a summary of what to do when you are coming with someone that may be a distressed contact. Might be anxious, depressed, angry, sad. You'll notice that all these draw on the communication skills that we have addressed already. Those communication skills and avoid the pitfalls effective contact tracer. Again in review at the end of the session, give the case an opportunity to summarize the conversation for you, by using phrases such as we have covered a lot today. In your own words review for me what we have discussed. Please tell me what you heard me say. This will help me provide you with additional information you need, and always remember to avoid the phrases. Do you have any questions or do you understand? In summary contact tracing has the potential to protect health and avert preventable deaths by reducing the incidence of COVID-19 cases.
