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Skills Workshop Session
- 1. Making Every Contact Count Skills Workshop Session <Insert session facilitator name and date> Developed by Tony Connell Learning and Development Consultant and the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County
- 2. What are we going to cover? • Delivering MECC • Where and when do you make contact • Which lifestyle issues do you deal with • How do you signpost and provide information • How do you know you are having an impact.
- 3. By the end of the session • Feel confident that raising lifestyle issues is part of your role • Be aware of the importance of client self confidence and motivation in making lifestyle changes • Examine basic health messages in relation to alcohol, healthy eating and weight management, smoking, physical activity, mental wellbeing and sexual health • Explore arrangements for access and maintenance of signposting information • Practice raising and responding to wellbeing issues.
- 4. What is MECC? MECC means making the best of every appropriate opportunity to raise the issue of healthy lifestyle •Systematically promoting the benefits of healthy living across the organisation •Asking individuals about their lifestyle and changes they may wish to make •Responding appropriately to the lifestyle issue/s once raised •Taking the appropriate action to either give information, signpost or refer service users to the support they need.
- 5. What MECC is not • It is not about adding another job to your already busy working day • It is not about you becoming a specialist in a certain lifestyle area • It is not about you becoming a counsellor or providing ongoing support to particular individuals • It is not about you telling somebody what to do and how to live their live • It is about you helping other people to know how they can improve their own health and wellbeing.
- 6. An example of MECC Impact In East Midlands • 288,000 staff • Millions of patient contacts a year • If staff MECC with just ten people • Less than one hour a year for each staff member = 2.88 million opportunities to influence behaviour change.
- 7. Pre Session Survey I feel knowledgeable about
- 8. Where are we now? Where do we want to be? • What is the teams/ departments vision about providing health promotion messages?
- 9. Making Every Contact Count
- 10. Health Inequalities Unhealthy lifestyles ‘…people living in the poorest areas will, on average, die 7 years earlier than people living in the richer areas and spend 17 years more living with ill health.’ ‘…the commitment to reduce health inequalities is a priority for ...the health system, drawing upon the Marmot review to address the wider determinants of health…’ Healthy Lives, Healthy People: update and way forward. July 2011
- 11. Discussion • What is the profile of your client group? • What are their lifestyle and information needs? • What influences their lifestyle choices? • Does the issue differ for each stage of life?
- 12. Client Contact – Who? • Providing information and support on health and wellbeing issues need not be confined to clients • Your colleagues may appreciate your support to tackle a lifestyle issue • There may also be opportunities to signpost members of the public (friends, family, carers) who
- 13. When can you raise an issue? • During any day to day contact with the client • When you hear them mention a lifestyle problem • When you can see that support with a lifestyle issue may be of help • As part of existing information gathering arrangements • Consider making a list of when you have contact with clients – face to face, phone, forms etc.
- 14. Client Contact Example ‘Amending the Active Together registration was a simple but very effective way of widening the reach of our physical activity programmes to include a broader health promotion message The impact of this small change has enabled many participants to access a wider range of information and services’ Quote from a pilot site
- 15. Discussion What are the points of contact with clients which provide the opportunity to promote positive health messages and behaviours?
- 16. What to say? Discussion Examples: • Our own behaviours and lifestyle influence how good we feel, so things like smoking, alcohol, diet and exercise make a difference. What areas about your lifestyle would you be interested in talking about? • You can make changes if you would like to. Are you interested in talking to someone? • Use the prompt card
- 17. Responding to a lifestyle issue
- 18. Making Effective Contacts Use the prompt card to help you judge the client’s: •Awareness of their general health and wellbeing •Motivation •Information needs.
- 19. Making contacts more effective We can’t make other people change… but we can: • talk to people you meet at work and give them information which can help them live a healthier life • encourage them to change to more healthy behaviours, which is an important step in reducing health inequalities • provide an environment where you feel confident in promoting healthy behaviours with colleagues and clients.
- 20. Making Effective Contacts I’ve been told to move around more, lose weight, quit smoking and eat the carrot! Listen to what the client is saying
- 21. Making Effective Contacts Look interested Involve yourself by responding Stay focussed on information giving Test your understanding Evaluate what is not being said Neutralise your feelings.
- 22. Making Effective Contacts Clients have a crucial role in ensuring services are relevant to their needs Look for opportunities to maximise the client’s experience and incorporate them at every possible stage of planning and implementation.
- 23. Making Effective Contacts • Self confidence is often referred to as ‘self efficacy’ as this is concerned with people’s self confidence and self worth • Enhancing these aspects of ‘self’ will motivate them to achieve set goals and in turn improve their general health and well-being • Being positive and leaving people feeling good about themselves are motivational and will build self efficacy • If you see the client again ask if they have used the information you gave.
- 24. Building self efficacy We only see behaviours... ‘
- 25. Building self efficacy B B e h a v io u r T F Tho u g hts F e e lin g s
- 26. Building self efficacy Avoidance of B change Low self efficacy T F I fail at everything I do Inadequate
- 27. Building self efficacy P rog re s s to w a rd g o a l B Higher self efficacy T F I w a nt to c ha ng e a n d I b e lie v e I C o n f id c an e nt
- 28. Physical Activity Why is it important? Regular physical activity can reduce: • Coronary heart disease • Strokes • Type 2 diabetes • Musculoskeletal disorders • Mental illness • Some cancers.
- 29. Physical Activity Suggestions you could make: • Take the stairs instead of the lift or escalator • Get off the bus or train one stop earlier and walk the rest of the way • Walk to the shops instead of taking the car • Take a walk at lunch rime • Take up an active hobby such as cycling or walking • Jobs around the house e.g. gardening and DIY.
- 30. Alcohol Why is it important? Drinking to much alcohol increases the risk of developing: • Serious liver disease • Stomach and pancreas disorders • Anxiety and depression • Accidents • Cancers (mouth, liver, colon and breast) • Muscle and heart disease.
- 31. Alcohol Suggestions you could make: • Don’t binge drink • Consider drinking a non-alcoholic drink to quench your thirst before having alcohol • Pace yourself – set a limit and stick to it • Try to eat when you drink as you’ll drink less • Reduce the number of days when you drink more than 1-2 units • Go out to the pub or club later in the evening • Resist pressures to drink more.
- 32. Mental wellbeing Why is it important? Mental health problems can cause: • Panic attacks • Loss of interest in social activities • Feelings of sadness or loneliness • Low self esteem or persistent guilt • Heavy or frequent alcohol consumption • Smoking excessively to relieve stress • Difficulty in sleeping.
- 33. Mental Wellbeing Suggestions you could make: • Keep active (ideally 30 minutes exercise a day) • Eat healthily do not smoke and only drink alcohol in moderation • Enjoy nature (try gardening or have a pet) • Keep in touch with friends • Accept the person you are and avoid harmful emotions • Do something creative and learn new skills • Talk about your feelings.
- 34. Smoking Why is it important? Smoking can cause a range of illness, but the most serious are: • Cancers – especially lung cancer but also of the bladder, kidney, stomach and pancreas • Respiratory disease – especially lung disease and pneumonia • Circulatory disease – especially heart disease (including strokes and heart attacks) • Digestive disease – especially stomach or duodenal ulcers.
- 35. Smoking Suggestions you could make: • Contact a stop smoking service • Use stop smoking medicines • Avoid situations which you associate with smoking • Gain support from friends and family • Undertake activities • Take your favourite clothes to the cleaners to prepare for their new smoke free life
- 36. Sexual Health Why is it important? A healthy sex life is an important part of a persons wellbeing. The consequences of poor sexual health include: • Unintended pregnancy • Sexually transmitted infections • Low self esteem, anxiety or depression • Passing infections on to others • Relationship problems.
- 37. Sexual Health Suggestions you could make: • Hugging and kissing can be as rewarding as sex • Sex should be fun and not harmful to anyone • Intimacy results from awareness of your partners needs as well as your own • Discuss any problems away from the bedroom • Ask for professional advice if necessary or seek advice from the NHS Choices website www.nhs.uk • Be honest about what you want from your partner.
- 38. Healthy Eating & Weight Management Why is it important? Being overweight can seriously affect a persons health and may result in the following conditions and diseases: • Type 2 diabetes • High blood pressure • Cardiovascular disease • Cancers • Osteoarthritis, gallstones, pregnancy complications sleeping problems and changes in liver function • Decreased life expectancy.
- 39. Healthy Eating & Weight Management Suggestions you could make: • Eat a balanced diet • Eat at least five portions of fruit and vegetables • Check for fat and sugar content on food labels • Choose lean cuts of meat, trim off the fat • Boil, steam, grill or poach rather than fry and roast • Stick to three meals at the same time each day • Choose low sugar food and drink • Cut down on alcohol.
- 40. Making Every Contact Count
- 41. Agree on action What is your role after discussing a lifestyle issue? • Provide information • Signpost • Make a referral Always wish the client well.
- 42. Information gaps What information gaps are there (if any) to support you in MECC? • How will these be addressed? • Who will do this? • By when?
- 43. External sources of information Physical activity www.activeplaces.com Sexual health www.nhs.uk/worthtalkingabout www.brook.org.uk www.fpa.org.uk Alcohol www.units.nhs.uk www.alcoholstakeholders.nhs.uk Smoking NHS Smoking Helpline: 0800 169 0 169, http://smokefree.nhs.uk/ Healthy eating and weight management www.nhs.uk/change4life Mental health and wellbeing British Association for Counselling and Psychotherapy ww.bacp.co.uk ‘
- 44. Your own sources of information • Developing and maintaining your own personal contacts with the services you are signposting too can enhance the quality of information you provide • An awareness of another organisation can facilitate the client making contact with the service you signposting too • Working with colleagues within your organisation allows for colleagues to benefit from your experience and expertise.
- 45. Monitoring the impact of MECC • How do you know you have had an impact? • How do you monitor? • Getting feedback from the form and how do you use that feedback to get better? • Discuss how you can monitor your contacts and the impact MECC may have had.
- 46. What have we covered so far? • What issues we are likely to come across • Where we can make contact with service users • How to make our contacts more effective • How we respond when we make contact • How do we measure what impact we have had • What haven’t we covered!! The elephant!
- 47. The elephant in the room We might find it difficult to raise a lifestyle issue with a client if we… • smoke • drink too much • eat an unhealthy diet • don’t exercise enough • have sexual health issues • have emotional health problems … ourselves! Making Every Contact Count 2010 (NHS West Midlands. Adapted)
- 48. The elephant in the room • We have a responsibility to convey healthy lifestyle messages to our clients • Providing information provides choice • Proving information and support about unhealthy behaviours may lead to us considering lifestyle changes ourselves. Making Every Contact Count 2010 (NHS West Midlands. Adapted)
- 49. Clients may: • Be really appreciative that you encouraged them to make changes they had been considering for some time • Be grateful you have taken the time to talk to them and have experience with the same issue • Make connections between their lifestyle and what they want from life • Live longer and healthier lives because of what you did.
- 50. Examples of prompts • Is there anything else I can help you with today? • You know you shouldn’t always be in pain. Have you ever seen a… • You sound quite stressed… Have you ever thought about talking to someone about it? • Would you like some more information or a phone number of someone who can help you with_____?
- 51. Another elephant • We all want to help improve people’s health • What will stop us Making Contacts Count? • Discuss what barriers may get in the way? • What can we do about them? Making Every Contact Count 2010 (NHS West Midlands. Adapted)
- 52. Time to Practice
- 53. Discussion How did you raise the lifestyle issue? How did it go?
- 54. What have we covered? • Asking individuals about their lifestyle and changes they may wish to make • Responding appropriately to the lifestyle issue/s once raised • Taking the appropriate action to either give information, signpost or refer service users to the support they need.
- 55. What have we covered? • An awareness of the general nature of local organisations can facilitate the client making contact with the service you are signposting them too • It is important to keep signposting information readily available and up to date • We might find it personally difficult to raise a lifestyle issue with a client but it is our responsibility • Providing the right information and support provides choices.
- 56. Post session surveys I feel knowledgeable about How confident do you feel about raising a lifestyle issue with a colleague? 1 = not confident at all 2 = a little confident 3 = fairly confident 4 = very confident
- 57. Any questions?
- 58. Finally If you think you are too small to have an impact, try going to bed with a mosquito in the room! Author Unknown
- 59. Quotes Using a team approach to training enabled us to get a huge amount of information from experienced teams. It also provided a chance for managers to know where their teams are at in terms of confidence and explore that… any individualised development work can then take place’ QUOTES ‘Being involved in the briefing and training of the MECC initiative, I felt as a line manager, was vital in helping the integration of the pilot into our services. I had a clear understanding of outcomes and could therefore offer the support to the team of staff I manage. It made me aware of the underpinning principles of the MECC initiative and to see where, as a team, could integrate it into the current provision. Although the team of staff I manage undertook signposting and information giving on other health services, the MECC training / pilot provided a platform for best practise not only with direct staff but with other partner organisations. As a result of the MECC initiative and the success of the pilot, we have embedded it within our physical activity provision. We have improved relationships with partner organisations and are continuing to offer a consistent approach to improving lifestyles’. ‘During implementation of the framework it was vital to have the input and support of my Lead Nurse who recognised the importance of the pilot and therefore was able to not only co-ordinate support to the staff involved, through their Matron’s, but also spread the health promotion message and details of the pilot to the wider audience within the Trust’ ‘Met with the team managers to inform them of the work and get their ideas on the approach as strategic leadership is essential for anything you want to implement. The managers welcomed that information would be given to staff along with resources to help them implement MECC. The managers gave time us time to discuss MECC and deliver training in their
- 60. Contact:
- 61. Reproduction of materials These materials may be reproduced for educational or training purposes. Tony Connell, Learning and Development Consultant and the East Midlands Health Trainer Hub should be acknowledged.
Hinweis der Redaktion
- Trainer notes – the notes accompanying the slides are to provide guidance in how to run this session. The slides are designed to be adaptable. The session should take approximately 2 – 2.5 hours to deliver Prior to delivery of the session you should consider how best to tailor the slides to make them relevant to your organisation and the team you are delivering the session too. You may use some or all of the slides or even add your own. However you tailor the training it is important you meet the learning outcomes and ensure staff and competent and confidence to deliver MECC in their role after the session. Please amend any images etc make the presentation as relevant as possible to your audience. The session is designed to be delivered with a team or department who have had the orientation session and are looking to implement MECC. If an orientation session (or a version of it to introduce MECC) has not been delivered to the team you are training you may wish to include some introductory slides on what MECC is etc
- Outline the course for the day. Again this outline should be altered depending on what you think is required for the particular department or team.
- Review the learning objectives and also ask delegates what they would like from the session. Again you may want to review these objectives and tailor them according to the team/department’s needs
- Trainers should provide delegates with a reminder from the orientation session about What MECC is. If delegates have not attended the orientation session then you may want to use more slides from the orientation presentation (or your own slides) to explain the purpose of MECC in the context of the organisaton. This may include links to national and regional strategies and drivers, local examples and data (number of staff and opportunities to influence in the local area) Success for MECC will not always be a referral into a service. The success of MECC is engaging your service users. The outcome of that engagement could be providing them with information, signposting them to further support, referring them into a lifestyle service or even just listening to whether or not they are ready to make a change. Most commonly a lifestyle issue will be about encouraging people to: Stop Smoking Eat Healthily Maintain a Healthy Weight Drink alcohol within the recommended daily limits Undertake the recommended amount of physical activity However, if a contact is to truly COUNT the focus should be on the service user and their needs. This may involve lifestyle areas such as sexual health, or being immunised. It may also involve ensuring service users can access services to support wider health determinants such as housing or financial support, which may preventing someone from making a healthy lifestyle choice. These will be determined by the team / organisation the training is being delivered
- Staff may have a concern that MECC will add to their workload and involve them lecturing people. This slide could be adapted to include other barriers identified by staff that may prevent MECC being implemented. This session should encourage staff to think about how they add MECC into their daily role
- There are over 288,00 staff employed in the NHS across the Midlands and East SHA Cluster. If Every member of staff Made Every Contact Count with just 10 people a year that is 2.88 million opportunities to influence behaviour change. The potential impact for MECC is great – in the E midlands if all did a little have a big impact as Tesco says You should consider adapting slide using data and an example more local and relevant to your organisation
- You need to decide what baseline you can use to assess the impact of the training on staff’s ability to raise a lifestyle issue. These questions (and you may want to use others) could be sent before the session so people can rate themselves in private. You could then relate the groups score back to the attendees and begin discussion about how confident they feel about discussing health and wellbeing, possible barriers they face and what they can do to get better. You should use the best mechanisms to capture this pre and post session survey information i.e. workshop method and discussion hands up approach or individual sheets completed and returned. The questions can also used as a baseline to evaluate the impact of the training and to assess staff’s confidence 1,3 or 6 months after MECC has been implemented. A paper version is available from Section 7 of the Implementation Guide and Toolkit tools and resources within the NHS Midlands and East metrics. Pre and post session survey data from NHS organisations should be collated and submitted to the SHA. NHS Midlands and East organisatons will be asked to provide responses to these pre and post session surveys as part of monitoring performance against the ambition. Your organisation will have to determine how this is done. The full survey is available in the NHS Midlands and East metrics resource with the implementation guide and toolkit
- The questionnaire on the previous slide shows where people are now – but where do they want to get to? This exercise is designed to increase shared ownership of the project and specifically making every contact count principles. The ‘vision’ need not be a statement it could be a picture. If written it should ideally be one line of text. If the group size allows it is preferable to have the whole group work on the statement. If this is not possible several statements (one from each group) are acceptable as it is the process of understanding the outcomes and principles of MECC that is more important than the detailed wording of the statement Already have lots of times where you are in contact with service users – how do you make it more effective?
- The diagram shows what MECC involves. An individual will come into contact with an organisation and member of staff, that individual may have lifestyles behaviours they would benefit from changing but may or may not know this and/or have the motivation and opportunity to change. The staff member raises a lifestyle issue if appropriate, or responds to the service user that has raised. How staff raise a lifestyle issue will vary according to their role and how the opportunity arising, for example someone asking specific questions as part of a form will raise and respond differently to an issue raised opportunistically. Once the issue is raised the staff member needs to listen and consider how they should respond to the issue – whether they provide information, signpost or refer to another support service. The service user may then decide to act or not decide to act or need further support to understand their lifestyle. Emphasise that many staff will be undertaking signposting and information giving activity already. The project provides an opportunity for this work to form an integral component of organisational activity as well as providing a platform for best practice to be shared with colleagues more widely. The slide also acknowledges that some service users may not act on any contact or conversation you have with them – they may not even want to enter into conversation about a health issue. You should draw upon other local training and mechanisms that may really help to bring this to life or put in context of other training staff may have received, for example brief advice training for smoking and use of ask, advise, assist. These next slides we will consider our client group and we might raise a lifestyle issue
- The importance of promoting healthy behaviours was highlighted in the Government’s White paper, Healthy Lives, Healthy People and reinforced in the update of this document in July 2011. Check with participants their knowledge of local health data and make the link between individual need, client group need and the health profile of the local community. Essentially, information giving should reflect need at several levels You could amend this slide with local data and examples to make it more relevant to you team or department – who are their client group and what are the likely influences on their lifestyle choices Staff need to understand the impact of social and economic influences on health, with the result that if you are poorer you are more likely to experience worse health and to die younger. Both material and psychosocial causes contribute to these differences in health and mental health. Poverty and disadvantage may impact on physical health by affecting emotional health - the experience of disadvantage and exclusion fed by feelings of hopelessness, anxiety and powerlessness can lead to physical health consequences. Gender, age, sexuality, ethnicity, housing, literacy, geography and socio-economic status are all significant influences on health status. Health inequality is a product of multiple influences as illustrated in this slide. Each of the concentric rings represents a layer of health determinants. These are added to the biological and genetic factors that individuals are born with so that lifestyle, social and community influences, employment and cultural factors all combine to determine an individual’s health. The Whitehead and Dahlgren model is based on the notion that health is only one component, albeit a major one, among many that contribute to a person’s wellbeing
- Generate some discussion with the group about their service users. What is the health profile of their services users and the extent of the health inequalities. Consider how this will impact on their lifestyle and the choices they make and how staff might approach MECC. Staff can’t be expected to know about every service for every lifestyle area but what are the most common ones or the priorities. Staff should be able to manage a contact with a client on this issue and know where to look/find info for any other issue they don’t normally come into contact with
- In addition to mapping when you have contact with service users – you may also want to work with delegates to discuss contacts they have with colleagues and other members of the public and mapping out these opportunities.
- First element to review it the Client Contacts – where are the opportunities in your team to raise a lifestyle issue. This slide and the next slide are introductions as to when and with whom you make contact with. This is essentially a ‘mapping exercise’ which can be a simple or as complex as the need requires. Generate discussion among the group. The role of participants will affect the degree of detail that it is possible to extract from the exercise. When taking feedback try and make connections between the points of contact a client has and the pathway of treatment/intervention. For example - receptionist – initial assessment – consultation – treatment – receptionist (for further appointment). Ask: are some points in the intervention pathway likely to be more effective than others to engage the client? Providing information and support on health and wellbeing issues need not be confined to clients. Your colleagues may appreciate your support to tackle a lifestyle issue. There may also be opportunities to signpost members of the public (friends, family, carers) who access your workplace Discuss the implications of the responses for the MECC approach in the workplace.
- This example from a pilot site highlights that not all contacts are verbal and face to face – there maybe lots of other opportunities with written contacts where you have the opportunity to influence service users.
- First element to review it the Client Contacts – where are the opportunities in your team This is essentially a ‘mapping exercise’ which can be a simple or as complex as the need requires. The role of participants will affect the degree of detail that it is possible to extract from the exercise. When taking feedback try and make connections between the points of contact a client has and the pathway of treatment/intervention. For example - receptionist – initial assessment – consultation – treatment – receptionist (for further appointment). Ask: are some points in the intervention pathway likely to be more effective than others to engage the client? Discuss the implications of the responses for the MECC approach in the workplace.
- Generate some discussion on how the group might raise a lifestyle issue. This will vary and there will be time to practice later. Things to consider: Is it a legitimate opportunity to ask the question? Has the individual already been approached about these issues? What are the trigger points in a person’s life that may make them more open to change e.g. birth of child Are you the right person to be asking at that particular time? If the client has raised the issue ensure you listen and respond to what they have said specifically
- We know the types of issues and when we can raise the issue – the next step is how we respond – we need to listen, understand the service user and consider what the most suitable response is – provide information, signpost, refer or even do nothing)
- 1 click (text comes in automatically) This slide reminds participants of the prompt card. It should be acknowledged that some staff will not need to use the card as the questions may feature within the client assessment process. The use of this slide should therefore be at the discretion of the trainer.
- This is the fundamental principle of making every contact count. Offering advice and encouragement is undoubtedly something that participants will have done on many occasions with their friends or family. Making every contact count encourages the same approach and skills within the work context, with the clients the staff member comes into contact with on a day to day basis. The first bullet point makes reference to promoting healthy behaviours with colleagues. This will be expanded upon in the subsequent making every contact count training. ‘ Whilst the health of all groups in England is improving, over the last ten years health inequalities between the social classes have widened—the gap has increased by 4% amongst men, and by 11% amongst women - because the health of the rich is improving more quickly than that of the poor. Health inequalities are not only apparent between people of different socio-economic groups - they exist between different genders, different ethnic groups, and the elderly and people suffering from mental health problems or learning disabilities also have worse health than the rest of the population. The causes of health inequalities are complex, and include lifestyle factors—smoking, nutrition, exercise to name only a few - and also wider determinants such as poverty, housing and education.’ House of Commons Health Committee H ealth Inequalities Third Report of Session 2008–09 The final bullet point refers to ‘providing a suitable environment’. The environment surrounding the individual is important and it’s essential that this doesn’t deviate from the message being given. A patient’s right to a safe and confidential environment must be respected.
- Providing information that is relevant and meets the needs of clients is crucial. This requires listening skills. We also need to understand what benefit they would get from changing their behaviour – People are more likely to change if they perceive a benefit
- 6 clicks. Everyone thinks they are a good listener – but good (or active) listening is a skill. To ensure the information you offer meets the clients needs you have to be a ‘good listener’. Line 1 . Look interested. To know how to listen to someone else, think about how you would want to be listened too. Be attentive and try to avoid distractions. Line 2. Involve yourself by responding. Respond appropriately to show that you understand. Murmur (“uh-huh” and “um-hmm”) and nod. Raise your eyebrows. Say words such as “really,” “that’s interesting”. People feel valued if they sense you are genuinely interested in what they are saying. Line 3. S tay focussed on information giving. Your role is to signpost, not to engage in a therapeutic relationship! Line 4. T est your understanding. Check with the client the information you are providing is what they need, as you may have misinterpreted what they are saying to you. Line 5. E valuate what is not being said. 80% of communication is non verbal, so try to fully understand what is being said to you by being aware of the clients body language and what isn't being said as much as what is. Line 6. N eutralise your feelings. You may have an emotional response to what you are being told. Don’t let your personal feelings influence the discussion. Essentially, stay professional and objective and remember your role is to signpost only.
- The degree to which this is possible will depend on the setting and nature of the information giving arrangements, but as a general principle the client perspective should be incorporated into service design and delivery. A set of useful case studies examining client led provision can be found at: www.institute.nhs.uk/safer_care/mrsa/what_we_learned.html
- You can’t make a person change, but you can give them the sense that change is desirable and achievable. Ask for examples of motivational statements participants have used with others. It may be desirable (or an organisational requirement) to record that information has been given to an individual. The trainer may wish to clarify with the group local recording expectations.
- Ask the group what they see – ask what the person on the shore may be thinking, feeling and what behaviours is he undertaking, and about to undertake. Following brief feedback on these points click again to reveal the whole image. This cartoon illustrates that underlying thoughts and feelings are ‘hidden’ and that it is only behaviour which ‘is seen’. The shark thinks that a good way of getting its lunch is through deception. The shark may be feeling exited at the prospect. The behaviour is the act of shaking the pole with the hand on it. As was illustrated on the cartoon we can only observe behaviours. Like an iceberg most of its existence is below the surface and unseen. One way to understand and change behaviour is to influence the thoughts and feelings that are taking place ‘beneath the surface’. Providing the client with words of encouragement and support can replace existing negative thoughts and feelings with more positive ones; this, in turn, implants thoughts that change is both possible and desirable. The man on the shore, however, is making judgements only on what is ‘seen’ – the behaviour of the shark. The mans thoughts are ‘there is someone in danger, I need to rescue them’. The feelings may be anxiety, the behaviour is to leap in the water. Self efficacy is concerned with the way in which thoughts and feelings you have affect behaviours.
- Slide builds. 6 clicks. Thoughts, feelings and behaviours can be illustrated as the three points of a triangle. The origin of all behaviours is with a thought or a belief – this may be conscious or unconscious. Feelings result from this thought or belief. The behaviours are then a consequence of these thoughts and feelings. As was illustrated on the cartoon we can only observe behaviours. Like an iceberg most of its existence is below the surface and unseen. To understand and change behaviour there is need to influence the thoughts and feelings that are taking place ‘beneath the surface’. Providing the client with words of encouragement and support can replace existing negative thoughts and feelings with more positive ones; this, in turn, implants thoughts that change is both possible and desirable.
- Slide builds 4 clicks This is a scenario where someone avoids behaviour change. Ask the group if they have worked with anyone that fits this profile. What was their level of self efficacy – how did this translate into their behaviour/attitudes? As was illustrated on the cartoon we can only observe behaviours. Like an iceberg most of its existence is below the surface and unseen. To understand and change behaviour there is need to influence the thoughts and feelings that are taking place ‘beneath the surface’. Providing the client with words of encouragement and support can replace existing negative thoughts and feelings with more positive ones; this, in turn, implants thoughts that change is both possible and desirable.
- Slide builds - 3 clicks . In contrast this person self efficacy is higher with a consequent change in their feelings and behaviour.
- The information conveyed in the following slides is drawn from Pharmacy Link publications: http://www.pharmacymeetspublichealth.org.uk/publichealthresources.html You may not wwant to use all of these slides but the slidews are designed to give staff core information on aspects of health and wellbeing. These should be taliored accordingly. There may also be opportunity to generate discussion from staff on suggestions they might make. Inactivity is a problem in both adults and children as there is a clear link between physical inactivity and ill health - however, despite the evidence, only 40% of men and 28% of women are sufficiently active to gain any general health benefits. The remainder fail to meet the Chief Medical Officer’s recommendations for physical activity (DoH 2004 At least live a week, evidence on the impact of physical activity and its relationship to health). Recommendations for physical activity: Adults should be moderately active for a minimum of 150 minutes on 5 (or more) days of the week. Children should be moderately active for a minimum of one hour every day. A person who is doing moderate intensity activity will feel: • An increase in breathing rate. • An increase in heart rate, to the level where the pulse can be felt. • A feeling of increased warmth, possibly accompanied by sweating. It is best to build-up physical activity gradually to the recommended level. Advising people to gradually become more active in their daily lives is vital to reduce any risks and optimise the benefits. People should be advised to avoid sudden vigorous physical activity if they are not used to it, and always warm-up, warm-down and stretch after any physical activity that is moderately intensive. There will also be occasions when you will need to advise people to consult their GP or other healthcare professional before they take part in physical activity; for example, people with long-term conditions, people with existing musculoskeletal disease and/or those who are taking medicines which may affect blood pressure.
- Problems arising from alcohol misuse have risen steeply over the past 10 years and between 15,000 and 22,000 people in the UK die every year from stroke, cancer, liver disease, accidental death and suicide linked to alcohol. In the same period alcohol related admissions to hospital have risen by 80% and alcoholic liver disease has more than doubled. Individuals vary in how they process alcohol, for example by gender and body weight, but the general recommendations for drinking alcohol are: • Men – should not regularly drink more than 3-4 units a day. • Women – should not regularly drink more than 2-3 units a day. Pregnant women, or women trying to become pregnant, should be advised to avoid alcohol altogether. However if they choose to drink, then advise them to drink no more than 1-2 units once or twice a week, and avoid getting drunk
- Ask the group for any other suggestions they may have.
- This is clearly not an exhaustive list and symptoms can be highly variable between individuals and in the same individual over time. All mental health disorders can seriously affect a person’s physical health as well as their ability to engage with social networks and employment opportunities. Some indicators of more serious illness: • Hallucinations, hearing voices or strange conversations. • Fear of persecution or threats of violence. • Suicidal thoughts or attempts. • Signs of recent self-harm, e.g. injuries on forearms.
- Ask the group for any other suggestions they may have. Five daily habits for mental wellbeing: • Look after your body – keep physically active, eat healthily, do not smoke and drink alcohol in moderation. • Engage with nature – walk in a park, try gardening, stroke a pet. • Ensure positive social contacts – talk with someone you like, smile. • Limit harmful emotions – acknowledge them and let them go, don’t harm others with your frustrations • Reflect and learn – reflect on problems and try to learn something new every day.
- Tobacco smoking is the main avoidable cause of premature death in England and is responsible for more than 80,000 deaths per year amongst adults aged 35 and over. Smoking also puts other people at risk if they inhale the smoke regularly. Exposure to second-hand smoke is linked to strokes, respiratory problems (such as asthma attacks) and infections – especially ear and chest infections in children, and also cot death. In addition, smoking is responsible for over 3000 house fires a year in the UK, typically resulting in around 100 deaths (Dept of Communities and Local Development, Fire statistics 2007).
- Ask the group for any other suggestions they may have. All staff have a major role to play in helping reduce the impact of tobacco on health. Their main contribution will be through identifying smokers who want to stop and referring them to sources of support - principally the NHS Stop Smoking Services.
- Whilst sexual activity has many positive aspects, the consequences of poor sexual health may be serious and have long-lasting effects on a person’s physical and mental wellbeing.
- Ask for any suggestions
- Being overweight is having a BMI between 25 and 30kg/m2, being obese is having a BMI of 30kg/m2 or more. Waist measurement can also provide a good guide to a person’s health risk (particularly cardiovascular disease, diabetes and stroke). In general: • A healthy waist measurement for an average adult male is less than 37 inches (94 cm). If their waist circumference is 40 inches (102 cm) or more, even at a healthy weight (BMI 18.5 – 25 kg/m2) they are at increased risk. • A healthy waist measurement for an average adult female is less than 32 inches (80 cm). If their waist circumference is 35 inches (88 cm) or more, even at a healthy weight (BMI 18.5 – 25 kg/m2) they are at increased risk. Taking 30 minutes activity on 5 or more days of the week will have general health benefits and improve fitness.
- We have looked at what unhealthy lifestyle issues you may come across, we have looked at how to raise the issue and how to respond to the issue – now we need to consider the action we will take and how we might know if we have had an impact
- This slide provides the opportunity to clarify and action any information needs the group may have ; for example, what information leaflets/resources are required, where will they be stored, whose responsibility is it to obtain these etc? Input/discussion links to the next slide. The previous exercise identified what the most common lifestyle issues are that staff are likely to come across. Do staff know how to provide information or refer service users on these issues? DO they know where to go if they don’t know what to do about a lifestyle issue? It is important to stress to teams that need to give the right information at the right time in the right way to the right people in order to have an impact. The local health data should be able to clarify what the main issues staff should focus on
- This slide provides the opportunity to clarify and action any information needs the group may have ; for example, what information leaflets/resources are required, where will they be stored, whose responsibility is it to obtain these etc? Input/discussion links to the next slide. The previous exercise identified what the most common lifestyle issues are that staff are likely to come across. Do staff know how to provide information or refer service users on these issues? DO they know where to go if they don’t know what to do about a lifestyle issue? It is important to stress to teams that need to give the right information at the right time in the right way to the right people in order to have an impact. The local health data should be able to clarify what the main issues staff should focus on
- Signposting examples – As well as the organisation’s own resources, services and information, staff should know about other organisation’s resources that they can refer people to
- Points 1 and 2 Clearly the extent to which a staff member can network will depend on the amount of time the member of staff has and the freedom within their role to undertake this activity. Having a personal contact can keep you up to date with service information . You may also be able to inform the client to ‘ask for ‘x’ as they are very helpful and friendly’. The client may feel more comfortable contacting the service if they have a personal contact to ask for. Of course this may not always be practical or possible. The team may want to consider having a contact person to network with services by lifestyle issue i.e. one person takes the lead for maintaining contact with the local smoking cessation service. Point 3. We can often fall into the trap of thinking that ‘expertise lies out there somewhere’, when frequently it is our own immediate work colleagues that hold a vast array of information and experience we can draw upon. Not only is it highly efficient to use the skills that exist within our immediate environment, but valuing and validating this knowledge empowers staff. A climate where information and knowledge is shared also provides the platform to promote healthy lifestyle behaviours among colleagues.
- How can you monitor the impact of MECC and possibly use existing monitoring processes. It’s important to highlight that monitoring needs to adhere to data and patient confidentiality regulations.
- The slide provides a summary of what the session has covered to date before moving onto the sometimes sensitive subject of staff’s own healthy lifestyles. Addressing the elephant in the room is still an aspect of making contacts more effective and follows on from the previous section
- 2 clicks – slide builds automatically. It is a rare person that doesn't have at least one, and maybe several of the issues listed at some point in their life - that is normal! Trainers could re-assure participants that ‘perfection’ isn't a pre-requisite for information giving by providing a personal example.
- 3 clicks. If you share the same lifestyle issue with a client it may increase your credibility to acknowledge that it is an issue you also need to deal with yourself. It can be helpful to say to the client how hard it has been for you to tackle the same issue. This is a good normalising statement to make (slide 28 – normalising statements). Essentially there is a ‘duty of care’ to pass on information about health improvement issues, but acknowledging you are human and need to work on an issue yourself can be reassuring for the client and motivate them to change their behaviour.
- 4 clicks This slide coveys the potential benefits of signposting and information giving from the clients perspective. Remind participants that many clients expect health professionals to raise lifestyle issue.
- There are a number of ways in which you can raise the issue of health and wellbeing with a service user or a colleague. We have provided a few examples but there maybe others you want to suggest more relevant to your team
- Getting staff to identify barriers will help you assess where staff are in support of MCC and help you identify ways in which those barriers could be overcome. You may not be able to overcome all the barriers (eg hours of work) but you may be able to work round them One barrier could be worried about the client’s response – which has been partly answered in the email above
- 1 click – slide builds automatically. Divide the group into pairs (or one group of three if there is an odd number). One person plays the role of the client, the other the staff member. Ask the group to think of a situation where they can raise a lifestyle issue with a client. Each person will rehearse raising one of the lifestyle issues discussed in the training with their pair. The roles are then reversed. Suggest participants shouldn’t make life too hard for the staff member – the exercise is about building everyone's confidence to undertake information giving. Each role play should note take more than 2-3 minutes before the roles are reversed. Make the point that information giving and encouragement may be very brief for some clients and others an ongoing process. If time allows ask participants to undertake the exercise again using a different lifestyle issue (maybe one they feel less comfortable in raising). See next slide trainer notes for possible prompts. indirect questions to start with. E.g. Do you have any concerns about…… Have you thought about….. How do you feel….. What do you think….. Are you aware of risks…. • Or more directly Do you know…….. Tell me about……..
- The feedback will allow the group to share the group experience of what worked well and maybe what didn’t work so well. It may be useful to record the different ways in which the lifestyle issue was raised and circulate these suggestions after the event. This training deliberately avoids suggesting scripted statements or questions as staff may become focussed on ‘memorising lines’ as opposed to being their natural self. The former could induce anxiety and therefore avoidance – the latter should create the sense that information giving is within their skill set and a normal part of their day to day activity. If you feel participants need some prompts, the following may be useful examples: “ A lot of people I’ve seen say they feel much fitter and happier once they quit smoking.” “ People who cut down on alcohol also tend to find they loose weight.” “ Joining the … group will mean that you not only get help and support but you will meet new people too.” “ Think about all the money you will save if you quit smoking.” “ I know lots of people who….(for example give up smoking). “ A little bit of exercise a day can make us feel better.” “ Here’s a leaflet, I’ll leave it for you to read.” “ Maybe now isn’t the right time to think about change, but the door is always open” Source: Making Every Contact Count 2010 (NHS West Midlands)
- Review what you covered on the course
- Review what you covered on the course
- Repeat session survey to assess the impact of the session. Try not to forget a paper version is available from Section 7 of the Implementation Guide and Toolkit tools and resources within the Midlands and East SHA metrics. Pre and post session survey data from NHS organisations should be collated and submitted to the SHA.
- Additional training resource: You may want to use these quotes from some of the sites who piloted Making Every Contact Count to help illustrate how organisations have started to Make their Contacts Count The quotes cover, the importance of management support, endorsement of the MECC approach, example of staff changing their behaviour and the example of contacts through written communication which has already been used in the presentation
- These materials may be reproduced for educational or training purposes. Tony Connell, Learning and Development Consultant and the East Midlands Health Trainer Hub should be acknowledged. This permission is limited to the reproduction of materials for educational or training events. Systematic or large scale reproduction or distribution, or inclusion of material intended for sale, may only be done with prior written permission.