Transcript Treatment category - HealthChange Home

Health Change Australia (HCA) Peer Training Level 2
Applying Behaviour Change in Health Services
Using the Health Change Approach
Presented by Health Change Peer Trainers
from [insert name]
[insert name] [insert name]
www.healthchangeaustralia.com
Please switch mobiles to silent
© 2013 Health Change Australia
Slide 1
What is required for patient success?
Without sustained
behaviour change
Initial
diagnosis or
exacerbation
of condition
With sustained
behaviour change
Passive
Treatment
Cycle
Active
Treatment
Cycle
Short term adherence to
recommendations: worse
health outcomes
Long term adherence to
recommendations: better
health outcomes
© 2013 Health Change Australia
Page 2
Health Change generic behaviour change pathway
Knowledge & understanding
Motivation & expectations
Decision
Line
Decision & commitment
Macro View
Planning
Micro View
Action
Self-regulation
Build Motivation
© 2013 Health Change Australia
Build Confidence
(G Inside Front Cover)
Slide 3
The Health Change Australia Model of Behaviour Change
(Health Change Approach)
Integrates patient-centred communication and behaviour
change support into a clinical practice decision framework
Client behaviour change pathway
Knowledge & understanding
Client-centred
Practice Principles
Essential Behaviour
Change Techniques
Motivation & expectations
Decision
Line
Decision & commitment
Decision Framework
Planning
Action
Self-regulation
Build Motivation
Build Confidence
But, it is not a magic pill!
© 2013 Health Change Australia
Slide 4
Health Change practice principles
RICk = Readiness, Importance, Confidence, knowledge
© 2013 Health Change Australia
(G inside Section 2 tab)
Slide 5
How do treatment goals relate to the behaviour change
pathway?
1
Clinical
Targets
Patient behaviour change pathway
Knowledge & understanding
2
Lifestyle &
Treatment
Categories
Motivation & expectations
Decision
Line
Decision & commitment
Macro View
Micro View
Planning
Action
4
Motivational
Drivers
3
Specific
Personalized
Health Goals
Self-regulation
Build Motivation
© 2013 Health Change Australia
(G35)
Page 6
Health Change essential techniques
© 2013 Health Change Australia
(G inside Section 3 tab)
Slide 7
Section 4:
Setting the scene for health change
© 2013 Health Change Australia
(G inside Section 4 tab)
Slide 8
Explain your role:
Set up accurate expectations
Elements:
1. Who I am
2. How I work
3. What I won’t do
4. What’s in it for you (the client))
© 2013 Health Change Australia
(G83)
Slide 9
How does the Health Change Approach apply
to these health service contexts?
• Referring to other clinicians and services
• Providing assessment and treatment advice
• Delivering patient education
• Acute care services
• Short consultations
• Mental health services
© 2013 Health Change Australia
Slide 14
Section 5:
Above the line processes
© 2013 Health Change Australia
Slide 15
Key questions above the decision line
Does the client know and understand the broad lifestyle & treatment
categories applicable to their conditions and risk factors?
Have they been assisted to collaboratively prioritise these?
Are they ready, willing, able and committed to taking action?
Decision
Line
Ready to
Take Action
Build Motivation
© 2013 Health Change Australia
(G inside back cover)
Slide 16
Health Change 10 step decision framework
Above the line processes
Set the Scene & Explain Your Role
 Identify Clinical Issues & Broad Lifestyle & Treatment Categories
 prioritise & Choose a Category to Work on
 Ask RICk   Make a Decision
Decision
Line
Ready to
Take Action
Readiness
Build Motivation
RICk = readiness, importance, confidence, knowledge
© 2013 Health Change Australia
(G inside Section 5 tab)
Slide 17
Step 1: identify clinical issues &
broad lifestyle & treatment categories
1. Identify clinical issues
• Assessment, referral letters, care plans, client information
2. Check client knowledge and understanding of health issues:
1) Health conditions, clinical indicators, risk factors
2) Implications of these and reasons for clinical targets
• Check what they already know before offering information
3. Provide treatment advice, education & guidance:
1) Broad lifestyle and treatment categories for action
2) Reasons for taking action (macro level education)
• Check what they are already doing before offering advice
© 2013 Health Change Australia
(G107)
PSA-b,c,d
Slide 18
Step 2: prioritise and choose a category
to work on
1.
2.
3.
Prioritise broad lifestyle and treatment categories
Balance duty of care with client choice
Prevent the client from becoming overwhelmed
Messy Head Syndrome
© 2013 Health Change Australia
(G113)
Tidy Head
PSA-e
Slide 19
Step 3: ask RICk 
Readiness, Importance, Confidence, knowledge
Use your RICk radar,
but when in doubt, ask the client
PSA-f,g,h
© 2013 Health Change Australia
(G119)
Slide 20
Understanding importance
Why do people say an issue is important when really
they are still above the decision line?
1. Expected responses: playing the patient role or
pleasing you
2. Intellectualised responses: something I feel I
‘should’ do
3. Wanting outcomes: but not prepared to take the
actions required to get the outcomes
© 2013 Health Change Australia
Page 21
Step 4: make a decision
Client choices:
1. “yes”
2. “no”
3. “maybe”
Clinician choices:
1. Client “yes” - proceed below the
decision line
2. Client “no” – revisit Step 2 or invite
them to opt out
3. Client ambivalence – ask Rick-
focused decisional balance questions
PSA-i
© 2013 Health Change Australia
(G129)
Slide 22
Client case demonstration
Video – Greg
Steps 2-4
 Identify Clinical Issues & Broad Lifestyle & Treatment Categories
 prioritise & Choose a Category to work on First
 Ask RICk   Make a Decision
Decision
Line
© 2013 Health Change Australia
Ready to
Take Action
Greg Above the Line
Slide 23
Beware the Motivation Trap!
Motivation to
reduce pain
lose weight
retain independence
etc.
© 2013 Health Change Australia
(G41)
≠
Motivation to engage in
actions or tasks
required to reduce pain,
lose weight, retain
independence etc.
Slide 24
Signs of shaky commitment (ambivalence)
• Body language or tone of voice contradict RICk
responses
• Statements like ‘I know I should…, but, ….’
• Laughing nervously when talking about a topic
• Strong emotion when discussing condition/s ,
lifestyle/treatment categories or goals and actions
• Weak reasons to take action & strong reasons not to
• Changing the subject during discussion
• Others?
© 2013 Health Change Australia
Slide 25
Common above the line thinking barriers
People will not take action unless they believe:
I have a problem
k
The problem is serious
enough to consider action k
It could adversely affect
things or people that are
important to me
There is an effective course
of action open to me
I am able to pursue this
course of action
I can’t put off making a
decision
© 2013 Health Change Australia
I
Weigh up
expected
costs and
benefits
Decide to
take action
or not
k
C
R
Adapted from the Health Belief Model (Becker & Rosenstock, 1984)
Slide 26
RICk-focused decisional balance
Decision: __________________________________________?
What is the decision that the client is
trying to make?
Is it very clear what the two sides of the
decision are?
Is the decision black and white?
© 2013 Health Change Australia
(Appendix B G77
Slide 27
RICk-focused DB: Client perspective
Alternative A
(Current behaviours)
1.
Positive aspects
of selecting this
alternative
(short term)
2.
Negative aspects
of doing this
(long term)
© 2013 Health Change Australia
(Appendix B G77)
Slide 28
RICk-focused DB: Client perspective
Alternative B
(Health-enhancing behaviours)
3.
Positive aspects
of selecting this
alternative
(long term)
4.
Negative aspects
of doing this
(short term)
© 2013 Health Change Australia
(Appendix B G77)
Slide 29
RICk-focused DB: Client perspective
Pros
Cons
Alternative A
Alternative B
(Current behaviour)
(Health-enhancing behaviour)
1.
Positive aspects
of selecting this
alternative
(short term)
3.
Positive aspects
of selecting this
alternative
(long term)
2.
Negative aspects
of doing this
(long term)
4.
Negative aspects
of doing this
(short term)
© 2013 Health Change Australia
(Appendix B G77)
Slide 30
RICk-focused DB: Clinician objectives
Pros
Cons
Alternative A
Alternative B
1.
Acknowledge
reasons for current
behaviours
(barriers)
3.
Identify possible
benefits to be gained
from taking action
2.
Identify possible
negative
consequences of
inaction
4.
Acknowledge
undesirable
aspects of taking
action (barriers)
Is anything the client has mentioned important enough for them to want to work on this?
© 2013 Health Change Australia
(Appendix B G77)
Slide 31
RICk-focused DB: Equal alternatives
Pros
Cons
Alternative A
Alternative B
1.
Positive aspects of
selecting this
alternative
(short & long term)
3.
Positive aspects of
selecting this
alternative
(short & long term)
2.
Negative aspects of
doing this
(short & long term)
4.
Negative aspects of
doing this
(short & long term)
© 2013 Health Change Australia
(Appendix B G77)
Slide 32
Digging down in the benefits:
Should I give up smoking?
I will look better and not wheeze
I’ll feel better
I’ll be able to be more active (body boarding)
I want to be able to keep enjoying life as I get older
(and this won’t happen if I don’t give up before I get older) *
Therefore, I want to give up now
© 2013 Health Change Australia
(G63)
* Intrinsic motivator
Slide 33
Client case demonstration
Video - Justine
RICk-focused decisional balance
assistance for smoking
Things to consider:
• Why did the clinician ask RICk-focused DB
questions?
• Which RICk-focused DB questions were
asked?
• What were the pros/cons of smoking and
quitting for this client?
© 2013 Health Change Australia
Justine video
Slide 34
Keep Smoking
• It is social – something to do with
friends and partner
• I enjoy it
• I don’t get bored
• It gives me a time out – relaxation
• Wheezing, coughing
• My skin not so good – will get worse,
smokers lips etc.
• I struggle paddling out
• It is stopping me from doing sports
that I enjoy – my fitness is bad
• It is inhibiting me
• I am losing friendships with nonsmoking friends
© 2013 Health Change Australia
(Appendix B G81)
Try Quitting Again
• My skin will have a ‘glow’
• I will look better, smell better, feel
better
• Confidence
• Won’t be judged as a ‘smoker’
• I will not be labelled with having a
‘dirty habit’
• Greater social acceptance
• Be seen as selfish (but actually my
friends will accept this change and
support me)
• Expectation that I am a smoker (but I
can change this)
• Lose my partner in crime (but he will
support me if I am serious about it)
• Judged as a failure ‘here we go again’
(it takes a number of attempts to
quit)
DB Examples
Slide 35
RICk-focused DB: Common pitfalls
• Not clarifying the category and the
decision that the client is trying to
make
• Not using “digging down” in Box 2 and
3 to identify a personal motivator
• Not using the Practice Principles at all
times during the conversation to keep
it client-centred
© 2013 Health Change Australia
Slide 36
Patient care
plan or
treatment
plan
1
Clinical
targets
(physiological)
4
Motivational
drivers
Personal selfmanagement
plan
2
Broad
lifestyle &
treatment
categories
© 2013 Health Change Australia
(G35)
3
Specific
personalised
health goals
Personal
action plan
Slide 37
Step 1: using care plans to inform behaviour change
Patient problems, needs
& relevant conditions
Clinical goals
Required
treatment &
services
Provider for
treatment & services
Type 2 Diabetes
HbAlc < 7%
3 monthly checks
Diabetes Education
Exercise Program
Foot care
Physician/Nurse
D. Educator/Dietitian
Ex. Physiologist
Podiatrist
Hypercholesterolaemia
TC: < 4mmol/L
LDL < 2.5mmol/L
HDL> 1.0mmol/L
TG < 2.0 mmol/L
Cholesterol meds
10mg
Low saturated fat
diet
Physician/Nurse
Dietitian
Obesity
BMI < 25
Maintain a healthy
diet
Physician/Nurse
Dietitian
Back pain
Reduce pain &
improve mobility
Physiotherapy
Bone density scan
Physiotherapist
Nuclear imaging
© 2013 Health Change Australia
Slide 38
© 2013 Health Change Australia
(G129, Appendix I p.135)
Slide 39
© 2013 Health Change Australia
Video demonstration of using the PSMP
Slide 40
What would you like to say about using a
PSMP?
• General comments?
• Benefits to clinicians?
• Benefits to clients?
• Benefits to organisations?
© 2013 Health Change Australia
(G129)
Slide 41
Create cross-discipline evidence-based menus of options for consistent advice
Reduce
Diabetes Risk
Activity
a. Cardiovascular
b. Strength
Diet
a. Dietary fats
b. Dietary fibre
c. Eat regularly
Healthy body
weight
(reduce by 5%)
Effective
medication
management
Regular
checkups
Healthy body
weight
Effective
medication
management
Manage
Arthritis
Pain
management
Specific
strengthening
exercises
© 2013 Health Change Australia
(G165)
General
physical
activity
Slide 42
Small group exercise – generating
categories
Reduce
risk
Eat
healthily
Be more
active
Reduce
alcohol
© 2013 Health Change Australia
Manage
stress
Manage
medications
Quit
smoking
Visit
specialist
Video demonstration of using category cards
Slide 43
Section 6:
Below the line processes
© 2013 Health Change Australia
Slide 44
Key questions below the decision line
Decision
Line
Ready to
Take Action
What options do they have for taking action in a particular
category?
What is their personal goal and plan?
Are they confident they can do this and what might get in the way ?
Will I review the client and what other support do they need?
Build Confidence
© 2013 Health Change Australia
(G inside back cover)
Slide 45
Health Change 10 step decision framework
Below the line processes
Decision
Line
Ready to
Take Action
 Generate Personal Goal Options
 Choose & Refine an Option  Create an Action Plan
 Identify & Address Barriers  Ask RICk
 Consider Review & Referral
Readiness
Build Confidence
RICk = readiness, importance, confidence, knowledge
© 2013 Health Change Australia
(G inside Section 6 tab)
Slide 46
How do treatment goals relate to the behaviour change
pathway?
1
Clinical
Targets
Patient behaviour change pathway
Knowledge & understanding
2
Lifestyle &
Treatment
Categories
Motivation & expectations
Decision
Line
Decision & commitment
Macro View
Micro View
Planning
Action
4
Motivational
Drivers
3
Specific
Personalized
Health Goals
Self-regulation
Build Motivation
© 2013 Health Change Australia
(G35)
Slide 47
Step 5: generate personal
goal options
Lifestyle/treatment
category
Ways to generate options:
1. Treatment strategies
from assessment
2. Collaborative problem
solving using:
Options
a) Client first technique
b) Menu of options
technique
Personal goal
& action plan
PSA-j
© 2013 Health Change Australia
(G139)
Slide 48
Create goal hierarchies for education, menus of options & consistency of
advice in programs
Reduce diabetes
risk
Increase CV
exercise
Increase muscle
mass
Reduce total
fat/& saturated
fat
Increase fibre
Reduce body
weight by 5%
Water-based
exercise
Gym exercises
Change to low
fat dairy
5 serves
vegetables
Reduce portion
sizes
Walk, jog or
ride
Home exercises
Change cooking
oils
2 serves fruit
Reduce serves
at dinner
Group-based
exercise
Incidental
activities
Select leaner
meat serves
Hi-fibre breads,
pasta and rice
Manage night
time eating
Other...
Other...
Other...
Other...
Other...
© 2013 Health Change Australia
(G Appendix J p.165)
Slide 49
Step 6: choose & refine an option
• Help the client to choose a personal goal
option and state it as a personal goal in
one or two sentences:
• What
• How much
• How often
• When to start
• When to complete or review
PSA-k
© 2013 Health Change Australia
(G145)
Slide 50
Step 7: create an action plan
Include as much detail as necessary for
the client to feel confident:
• Actions or tasks
• Memory prompts
• Support mechanisms
• Thinking strategies
• Emotion management strategies
• Backup plans
• Tracking and monitoring strategies
• Review and referral details
© 2013 Health Change Australia
(G149 & Appendix K p.167)
Action plan video
Slide 51
Step 8: identify & address barriers
Behaviours
Emotions
B
S
E
T
Situations
Thinking
PSA-l
© 2013 Health Change Australia
(G153)
Cathy video
Slide 52
Common below the line barriers
Behaviours & situations
• Not understanding
• Not remembering
• Poor planning
• Strength of old habits vs. creating new ones
• Recurring or cyclical situations: disease episodes,
depression, travel, seasons etc.
• Lack of support from partner/friends/family
• Lack of access to services
• Pain & disability
© 2013 Health Change Australia
Asthma
Slide 53
Common below the line barriers
Thinking & emotions
• Undermining beliefs: Treatments shouldn’t have side effects,
If it hurts, I can’t do it, It’s not fair!, I feel okay so I must be fine
• Unpleasantness of new things: It will hurt, It is too much effort
• Procrastination: I’ll do it later
• Energy levels: It’s all too hard, I am too tired
• Fear/concerns about injury: Exercise may aggravate my
condition, I can’t exercise I have arthritis
PSA-m
© 2013 Health Change Australia
Slide 54
Relapse prevention
• Normalise lapses and emphasise trial & error
• Identify potential triggers for lapses and strategies to get
back on track
• Change ANNTs into PETs (I have busted, I am back at the
beginning again, what’s the point?)
• Use metaphors to stay on track (e.g. going on a journey,
tortoise & hare)
• Average no. of relapses for people changing habits: 5 to 7
• Average days to create habit: 66 (range 18-254)
© 2013 Health Change Australia
(EJSP 2010)
Slide 55
Turning ANNTs into PETs Short method:
Thinking strategies to support action plans
• Do you ever procrastinate or put off doing things you
had planned to do?
• What excuses do you usually give yourself for not
taking action?
• What would you need to say to motivate yourself
instead, to make sure that you do what you are
planning to do?
• How will you remember to say these things to
yourself so that you procrastinate less often?
© 2013 Health Change Australia
(G67)
Slide 56
Step 9: ask RICk again
To check that the client’s personal goal
and action plan are appropriate
RICk tip:
If confidence is low, adjust the personal goal
and/or identify relevant barriers and add
necessary steps into the action plan
PSA-n
© 2013 Health Change Australia
(G157)
Slide 57
Step 10: consider review and
referral
• Follow-up consultation scheduling: the lower the
client’s overall confidence, the sooner the next
consult should be
• Check RICk for attending referral appointments
• Track client actions and clinical indicators to review
progress over time
• Reinforce trial and error
PSA-o ,p
© 2013 Health Change Australia
(G159)
Slide 58
Conducting follow-up consultations
Options:
Develop
personal goal/s
and action
plan/s
1. Continue with the
same personal goal
Extend goals &
add new
categories &
goals when
ready
2. Move to a new
personal goal
Give it a Go!
3. Move on to the next
lifestyle or treatment
category and add
personal goals for
that category
© 2013 Health Change Australia
(G163)
Track your
progress &
review goals
regularly
Keep using the
strategies that
work and
change the
ones that don't
Slide 59
Optional documentation of Steps 6-10
Treatment category: Regain and maintain mobility
Personal goal: Do my rehab exercises 3 times per day starting from tomorrow at
home and continue doing them until I see the physio again
Tick when
completed
Actions required to achieve this goal:
Put my next rehab appointment on my calendar in the hallway
2. Put my rehab exercise handout and rolled up towel on the bedside table
3. Set an alarm to take my pain meds before the exercises
4. Do my exercises before I eat breakfast, lunch and dinner
5. Prepare my meals before I do my exercises
6. Label a pack of frozen peas with a marker pen and use as an ice pack
7. Put a damp towel around the peas & apply to my knee during my meals
8. Make sure I put the packet of peas back in the freezer after use
9. Remind myself that even though it hurts while I do my exercises,
the pain will settle afterward and it’s not causing damage
1.









How much do you want to achieve this goal?
(Not at all) 1 2 3 4 5 6 7 8 9 10 (Very much)
How confident are you that you can achieve this goal?
(Not at all confident) 1 2 3 4 5 6 7 8 9 10 (Very confident)
© 2013 Health Change Australia
X
Page 60
Client case demonstration
Video – Greg
Steps 5-9
Decision
Line
Ready to
Take Action
 Generate Personal Goal Options
 Choose & Refine an Option  Create an Action Plan
 Identify & Address Barriers  Ask RICk
 Consider Review & Referral
© 2013 Health Change Australia
Greg below the line video
Page 61
Practising step 5 – small group exercise
Generate personal goal options within a category
1. Choose a treatment or lifestyle category
2. Generate a list of personal goal options relevant to
that category
• 5 minutes to create a list of 6-10 options
• Which practice principles and techniques would
you use if doing this with a client?
© 2013 Health Change Australia
Slide 62
Practising step 6 – small group exercise
Create a personal goal for a client
1. Choose one option from the list you just created
2. Formulate a client goal in 1 or 2 sentences
including:
• What they are going to do
• When or how often (frequency per
day/week/month) the action will be carried out
• Quantity/duration/intensity of behaviour as
appropriate
• Start date, review date &/or completion date
© 2013 Health Change Australia
(G145)
Slide 63
Phrasing for steps 7-10 – small group exercise
Normalising and addressing barriers to action
Identify barriers
1. How do you raise the
topic that it’s normal
for things to get in the
way of your plans?
2. Create a menu of
barriers from BEST to
help the client to
identify their own
below the line barriers.
© 2013 Health Change Australia
(G154-155)
Address barriers
1. What questions can you
ask to get the client to
come up with the
solutions?
2. How could you use a menu
of options to suggest
strategies to address the
barriers?
Slide 64
Share your phrasing examples:
1.
2.
3.
4.
Normalising and client first for barriers
Menu of options for barriers
Client first for strategies
Menu of options for strategies
© 2013 Health Change Australia
Slide 65
Health Change integrated suite of tools to increase adherence
Knowledge & understanding
Client-centred
Practice Principles
Essential Behaviour
Change Techniques
Motivation & expectations
Decision & commitment
Planning
Change Barriers
& Facilitators
Decision
Framework
Action
Behaviours
Emotions
Situations
Thinking
Self-regulation
Build Motivation
© 2013 Health Change Australia
Build Confidence
Slide 66
Client case demonstration
Video – Young Geoff
Consultation showing the whole
framework in 13 minutes
 Identify Clinical Issues & Broad Lifestyle & Treatment Categories
 prioritise & Choose a Category to work on First
 Ask RICk   Make a Decision
Decision
Line
Ready to
Take Action
 Generate Personal Goal Options
 Choose & Refine an Option  Create an Action Plan
 Identify & Address Barriers  Ask RICk
 Consider Review & Referral
© 2013 Health Change Australia
Young Geoff 13 minute video
Slide 67
Troubleshooting with clients
Difficult clients: client is above the decision line
Chronic and complex clients:
• client is above the decision line
• client has significant BEST barriers
• messy head syndrome for clinicians and clients
When you are feeling stuck, ask yourself:
• Is the client above or below the decision line?
• What is the sticking point?
• Which course of action is appropriate?
© 2013 Health Change Australia
Slide 68
Who should we spend behaviour change time on?
1. Clients who receive passive treatment only?

2. Clients who are clearly not interested in your
advice? 
3. Clients who are undecided (ambivalent) or
couldn’t be bothered? 
4. Clients who are motivated but lack confidence?
5. Clients who are clearly motivated and confident?
© 2013 Health Change Australia


Page 69
Benefits for clinicians, services and referrers
• Flexible delivery modes: f-2-f, group and telephone or
teleconferencing
• Shared information and common language
• Fewer ‘fail to show’ patients
• Shorter waiting lists and better retention for programs
• Measureable processes for QA, evaluation and
tracking skills development
• Better work satisfaction, greater confidence and
transferrable skills for clinicians
© 2013 Health Change Australia
Page 70
How can you adapt your practice?
Tasks
Description
Set-up & introduction
Assessment
Lifestyle & treatment recommendations
Passive treatment
Broad macro level education
Prioritisation of recommendations
Targeted micro level education
Personal goal setting
Personal action planning
Treatment planning/referral/other
© 2013 Health Change Australia
(G Appendix A, p. 29-30)
Slide 71
Group applications
How can you build the Health Change
Approach into group education
sessions?
© 2013 Health Change Australia
Group Applications
Slide 72
What is required for clinician success?
Without behaviour change
Passive
Learning
Cycle
Exposure to
new
information
Short term improvement
of practice
© 2013 Health Change Australia
With behaviour change
Active
Learning
Cycle
Long term improvement of
practice and integration of
new knowledge
Page 73
Skills development exercise:
Group exercise
Discussion topic: Will you work on developing your
skills to apply the Health Change Approach in your
workplace?
• Work through RICk-focused DB as a group
• If you cross the decision line write down strategies
that might help you to address any challenges and
implement the approach
• Consider using the Personal Goal and Action Plan to
document your goal and strategies
© 2013 Health Change Australia
Slide 74
Skills development menu of options
• Schedule time to plan practice change and develop skills
• Use the Health Change PPETs self-audit tool to track your
use of the practice principles and essential techniques
• Listen to audio-recorded consultations for feedback
• Use the Health Change process skills self-audit tool to track
your use of the decision framework
• Ask your patients/clients for feedback after your
consults/interviews
• Collect data and track changes in waiting list numbers,
recruitment and retention in programs plus client outcome
data
• Visit the Health Change Australia website for more ideas
© 2013 Health Change Australia
Slide 75
© 2013 Health Change Australia
Page 76
© 2013 Health Change Australia
Slide 77
How confident are you that you can use the Health
Change Approach in your work?
1. Practice principles
2. Essential techniques:
a. For use with all clients:
1) Client first technique
2) Menu of options technique
3) Using your RICk radar
b. Optional use to identify & address barriers:
1) Asking RICk
2) Rick-focused DB technique
3) Turning ANNTs into PETs
4) Tracking and monitoring strategies
3. 10 step decision framework
© 2013 Health Change Australia
Slide 78
Thank you for your participation!
Download case studies, session records,
practice guides & worksheets at
www.healthchangeaustralia.com
HCA tools can be used freely in clinical practice
and programs as long as HCA intellectual property
is visibly acknowledged
© 2013 Health Change Australia
Slide 79
Group education programs
• How can you set the scene to make the physical and
social group environment pleasant?
• How will you explain your role and the program
nature and purpose to set up accurate expectations?
• What will the group do and not do? Group rules?
• How does each of the practice principles fit into your
group program?
• What treatment and lifestyle categories will your
program address? Use goal hierarchies to create
menus of options
© 2013 Health Change Australia
Page 80
Group education programs continued…
• Cut down on non-critical health education : 50/50
clinical education / behaviour change content
• Include health behaviour change tips and tools:
messy head, trial and error, 10% tip, BEST barriers
and facilitators, arm folding exercise etc.
• Include group-based behaviour change techniques:
menus of options, RICk-focused DB, co-coaching…
• Consider creating individual ‘survival kits’ for
managing lapses after the program finishes
© 2013 Health Change Australia
Page 81
Create goal hierarchies for education, menus of options & consistency of
advice in programs
Reduce diabetes
risk
Increase CV
exercise
Increase muscle
mass
Reduce total
fat/& saturated
fat
Increase fibre
Reduce body
weight by 5%
Water-based
exercise
Gym exercises
Change to low
fat dairy
5 serves
vegetables
Reduce portion
sizes
Walk, jog or
ride
Home exercises
Change cooking
oils
2 serves fruit
Reduce serves
at dinner
Group-based
exercise
Incidental
activities
Select leaner
meat serves
Hi-fibre breads,
pasta and rice
Manage night
time eating
Other...
Other...
Other...
Other...
Other...
© 2013 Health Change Australia
Page 82
Assessing current actions, gaps & options
Healthy Nutrition Menu of Options

Healthy Eating Patterns

Comfort Eating or Stress Eating




Healthy breakfast

X
Manage emotions
Healthy lunch

Eat mindfully

Healthy dinner/supper

Limit tempting snacks

Healthy snacks

Find substitute activities

Other _______________

Other _______________

Fats, Fibre, Salt & Sugar
Limit portion size
_____________________

Home cooked meals
_____________________

_____________________

_____________________

_____________________

_____________________

_____________________
Stay hydrated

_____________________
Reduce juices and sodas

_____________________

Beverage Choices
Reduce sugar intake


X




Other _______________

Other _______________
Reduce fat intake

Increase fibre intake

Reduce salt intake



© 2013 Health Change Australia

Other

Reduce caffeine


Reduce alcohol
Return
Slide 83
© 2013 Health Change Australia
Slide 84
Steps 1-4: Case coordination example
Documenting priorities to create a personal self-management plan
Lifestyle/Treatment
Categories
Priority
1. Medications
(see Physician)
2
2. Rehabilitation
exercises
(already provided)
2
3. Wound care
1
4. Dietary changes
(see dietitian)
3
5. Tests (bone density
scan & bloods)
4
6. Home assessment
(see OT)
2
© 2013 Health Change Australia
Readiness
X
Importance
X
Moderate Moderate
High
High
(G129, Appendix I p.135)
Confidence
Knowledge
Moderate
Moderate
X
Low
Moderate
Good
Date
##/##

Slide 85
Steps 1-4: profession-specific example – managing arthritis
Documenting priorities to create a personal self-management plan
Lifestyle/Treatment
Categories
1. Medications
Priority
Readiness
-
Taking
action
2. Specific
exercises
1
3. General activity
2
4. Pain management
strategies
1
5. Weight management
2
© 2013 Health Change Australia
Importance
X
X
High
High
Moderate Moderate
High
High
Confidence
Knowledge
Date


##/##
X
Low
Moderate
X
Low
Moderate
Good
##/##
after educ
Pacing
activity
Video demonstration of using the PSMP
##/##
Slide 86