Making Every Contact Count

Helen Donovan – Public Health Nursing Adviser, RCN

Sophie Taysom – MECC Policy Lead, DH

Making Every Contact Count

It’s about giving appropriate, timely and

relevant advice on health and wellbeing to

patients, service users, carers, staff and

communities as part of our day to day work.

It can include supporting people to quit

smoking, reduce excessive drinking, improve

their diet and lost weight.

The Sun August 2012

The Daily Mail Feb 2012

MECC – why bother?

‘If every member of staff delivered brief advice on stopping smoking to 10 people in a year a total of 2,880,000 people would benefit. If 1 in 20 of those receiving the brief advice went on to quit smoking a total of 144,000 people would have quit.’

How?

� Giving information about lifestyle and health to people in a neutral way;

� Assisting people to explore the importance of a specific behaviour change and increase their confidence to achieve it;

� Helping the public understand the implications of choosing not to change; and,

� Leaving the responsibility for change and the right to decide whether or not to change, clearly with the person.

By using motivational techniques to influence and support people to

make changes in their own lives by:

Miller WR et al. J Consult Clin Psychol 1993;61:455–61;Miller and Rollnick, 1991

You may have already observed that

direct persuasion is not enough to help people

resolve their ‘ambivalence’ to change

CL1

Slide 5

CL1 Jennifer - do you have the full citation for Miller and Rollnick, 1991?Charlotte Lewis, 06/08/2003

DO YOUALWAYS

FOLLOW GOOD ADVICE?

• It’s tempting to try to be ‘helpful’ by persuading people of the urgency of their problem and the benefits of change

• But these tactics frequently increase client resistance and lessen the probability of change

Miller WR et al. J Consult Clin Psychol 1993;61:455–61;Miller and Rollnick, 1991

GIVING ADVICE TO CHANGE?

THE CHANGE PROCESS

• No-one changes their behaviour without first changing their attitudes and beliefs.

• When a client argues with you it means you have made a wrong assumption.

• Long term behaviour change takes time to consolidate

Current Behaviour

Making Changes

A change I’d like to make:

The Advantages of

The Disadvantages of

Current

behaviour

Making

the Change

Take into consideration:

• Consequences to self

• Consequences to others

• How I feel about myself

• How others feel about me

My Conclusion / Decision / Goal:

PEOPLE ARE MORE LIKELY TO CHANGE WHEN THEY:

� Invest time and thought in the ‘issue’

� Can see a benefit from changing

� Know what to expect when they try to change

� Have developed coping strategies

� Have plans for difficult or unexpected situations

� Have support / encouragement from others

� Can imagine being happy with a new ‘lifestyle’.

STEPS TO CHANGE

1. Deciding

2. Preparing

3. Taking action

4. KEEPING UP THE CHANGE

5. Coping with setbacks

Motivational Interviewing

The four essential principles

� R – RESIST: the urge to attempt to change the

individual through didactic means.

� U – UNDERSTAND: it’s the individuals reasons and

motivations and not the practitioners that will elicit a

change in behaviour.

� L – LISTENING: is vital; the solutions lie with the

individual not the practitioner.

� E – EMPOWER: the individual to understand they

have the ability to change.

(Rollnick et al 2008)

Limiting Questions

Questions that can only be answered by “Yes” or “No”

� “ Do you want to stop smoking?”

� “Do you agree that something needs to

be done?”

� “Are you happy to take these tablets?”

HOW TO HELP - WHAT WORKS?

� Find out what the person already knows about

the risks of the lifestyle or behaviour and

their interest in getting more information.

“What have you heard about the risks of XXX ?” “May I tell you my concerns?”

� Provide the key facts in a neutral fashion -

not as an instruction to change.

� Find out if the person has heard this before

“Has anyone mentioned this to you before?

HOW TO HELP - WHAT WORKS?

� Elicit the persons interpretation of the facts

� Offer additional / up to date information

� Sum up the conversation and link the facts to

their current health status or medical condition

ASK : Have you ever considered changing?

� Explain the short and long term benefits of

change and assess their understanding.

ASK: What do you think might happen ifyou do NOTHING?

Use Open Questions

Seek to understand the person’s frame of reference, attitude and beliefs

� Why do you think that happened to you?

� What have you found to be the most difficult aspect of XXX?

� Have there been other occasions like this?

� What’s stopping you from changing?

Answering open questions encourages

people to think and can plant a seed of change

Change often begins with a new thought

Distorting Questions

Leading

� You won't have any problem with this, will you?

Multiple options

� Tell me about how the job's going - do you like it here?

I know it must seem a bit strange but you'll soon settle

How do you find the work itself and the people you're

working with...?

Rhetorical

� How are you getting on with xxxx? I've always found him

very easy to deal with.

PEOPLE - NOT READY TO CHANGE

Respect this decision

Ask: “What would need to be different for you to consider CHANGING XXX”?

� Explain your medical / social concerns

� Leave the subject open for future discussion

PEOPLE UNSURE ABOUT MAKING A CHANGE

� Ask them about the pros and cons

of making the change

� Discuss their ambivalence

� Explain your future concerns for

their well being if they choose to

stay the same

People Making Plans to change

� Congratulate their decision

� Check their expectations of changing

Ask “What could get in your way?”

“What can you do to avoid that”?

� What help will you need?

� What is the first step you plan to take?

Consolidating the clients plans

� “Who are you going to ask to support you?”

� “What date have you decided to start ---?”

� “What treatment/programme will you use?”

� “Would it help to see me again?”

If Yes..

� “What would you like me to do if you don’t return for your next appointment?”

People need to believe they have the ability

to make a change to even try

� Normally, people only attempt things at which they feel they have a chance of succeeding.

� Try asking how CONFIDENT they feel to attempt the change you want to recommend on a scale of 1 -10

� Then ask how MOTIVATED they feel to make the change on a scale of 1 -10

Relapse preventionAsk:

� What makes this a good time to change?

If they have tried this change before:

� What have you learnt from past attempts?

� Is there something you’d do differently now?

� How would you feel if you relapsed?

� What help and support do you have?

� How will you know its working this time?

Finally ......

It is always worthwhile getting the person to repeat back to you what they heard you say .....

And tell what they actually plan to do next

Otherwise this may happen.......

Communication skills� Listen:

No agenda, advice or judgement

� Ask Questions:

To help speaker delve deeper into the issue and

think of a solution for themselves

� Give Feedback:

Overview of key issues, current options and choices

� Summarise:

Whole situation, Pro’s and Con’s