Transcript Decision - HealthChange Home

HealthChange® Core Training Part 1
Day 1: HealthChange® Methodology Basics
Day 2: HealthChange® Methodology Decision
Framework
Presented by HealthChange Australia
www.healthchange.com
Please switch your mobile phone to silent
© 2016 HealthChange Australia
Slide 1
Workshop essentials
• Who is HealthChange Australia?
• Housekeeping, OH&S and timings
• HealthChange® Core Training Handouts
• Terminology & Glossary
• Interaction, questions, comments
• PowerPoint and learning styles
• Attendance certificate requirements
• Introductions
© 2016 HealthChange Australia
Slide 2
What themes will we cover?
1. Best practice and the problem of poor adherence to
health, medical, social and other recommendations
for better health and quality of life
2. What health service clients need to follow health,
medical, social or other recommendations
3. What health service providers can do to increase
readiness, willingness and confidence in following
these recommendations using HealthChange®
Methodology
© 2016 HealthChange Australia
Slide 3
Topic 1: Best practice, person-centred
care and adherence to health,
medical, social and other
recommendations
© 2016 HealthChange Australia
Slide 4
Major assumption of the medical, health
and rehabilitation systems
Following evidence-based
recommendations will lead
to better health, quality of
life and functional outcomes
© 2016 HealthChange Australia
Slide 5
How big a problem is adherence?
31%
Patients who fail to fill initial prescriptions
50%
Overall adherence to chronic conditions treatment
50%
Patients who act on physician referrals to other
practitioners and services
50%
Maintenance of new exercise behaviours following
cardiac rehabilitation
The stats haven’t improved - only 1 in 2 people can
usually be expected to take action!
(Barclay 2014; Family practice clinic audit 2010; WHO 2003; Oldridge 1991)
© 2016 HealthChange Australia
Slide 6
Major barriers to following health, medical and
social recommendations exist within the health
and rehabilitation systems
Traditional approaches to clinical practice
can undermine willing adherence to
treatment, lifestyle, rehabilitation and
other recommendations
© 2016 HealthChange Australia
Slide 7
Hot topics in health service delivery
Personcentred Care
Best Practice
Adherence,
Compliance,
Engagement…
Behaviour
Change
Support
© 2016 HealthChange Australia
Integrated
Care
Health
Literacy
Chronic Disease
Selfmanagement
Shared
Decision
Making
Slide 8
Evidence-based Best Practice
Evidence-based assessment,
diagnosis, treatment, advice and care
Evidence-based
person-centred service delivery
© 2016 HealthChange Australia
Slide 9
Is this person-centred?
Coordination
Care
Coordinator
Information
Assessment
Pathology
Observations
Education
Medications
Referrals
Nurse
Psych
Treatment
GP
Patient
or Client
Mental
Health
Health
Service
Allied
Health
Assessment
Treatment
Advice
Patient
Advocates
Health &
Legal Advice
Emotional
buy-in &
Persuasion
© 2016 HealthChange Australia
Family &
Friends
Advice &
Financial
Decisions
Rehab
Program
Education
Assessment
Advice
SelfManagement
Program
Health
System
Navigation
Education
Advice
Attendance
Medical
Specialists
Treatment
& Procedures
Education
Tests
& Skills
Appointments Development
Procedures
Slide 10
Why is person-centred service delivery important?
‘Don’t tell me
what to do!’
‘Yes, Yes, tell me
what to do’
…because it engages clients to do what they need to do
© 2016 HealthChange Australia
Slide 11
Client Reflections
Video - Geoff
• Back injury (medical discharge from Navy)
• Chronic pain
• PTSD, depression & other psychosocial
• Diabetes type 2
• Prostate cancer previously
• High cholesterol
• Weight management issues
• Resistance from previous experiences
© 2016 HealthChange Australia
Slide 12
Activity: Discuss with your neighbour
• In what way is your organisation
already client, patient or personcentred?
• In what way is it not already client,
patient or person-centred?
• What could be done to improve this?
© 2016 HealthChange Australia
Slide 13
Topicto
2:edit
HealthChange®
Click
master titleMethodology
style
Overview
© 2016 HealthChange Australia
Slide 14
HealthChange® Methodology
A health service delivery methodology
used to provide person-centred care
and promote health literacy, shared
decision making, behaviour change and
self-management to support adherence
to evidence-based recommendations
for improved health and quality of life
outcomes
Visit healthchange.com for short videos
on HealthChange® Methodology and to
download other resources
© 2016 HealthChange Australia
(HCM Mini Guide p. 1)
Slide 15
Layers of HealthChange® Methodology: An integrated suite of tools
PSMP*
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
*PSMP: Personal Self-Management Plan
© 2016 HealthChange Australia
(HCM Mini Guide p. 2)
Slide 16
Australian, Canadian and Danish programs and services
Prevention
•
•
•
Primary Care
Chronic Condition Management
•
•
•
•
•
•
•
•
•
•
•
•
•
•
GP & Allied Health consultations
ACT Health/Medicare Local/Heart Foundation
HeartLink Program
Practice Nurse Care Planning
NSW Get Healthy Telephone Coaching
NSW Live Life Well Diabetes Prevention
VIC WorkSafe WorkHealth Coach
Program
Clinical Research
•
•
NSW CDM Connecting Care
Home & Community Care (HACC)
VIC Early Intervention (EICD)
VIC HARP programs
Heart failure & Cardiac rehab
Diabetes, HIV, Disability, Aged Care
Mental health
QLD Health Call Centre Cardiac Triage
QLD Disease Management Services
TAS Diabetes Services
Care Coordination Services
Deakin University – HIPP/Healthy Pregnancy Study
Melbourne University – Knee Osteoarthritis, Diabetic Retinopathy, Lung Cancer
Alberta Health Services
Alberta Primary Care Networks
Ontario
Denmark - Copenhagen
•
•
Ottawa Regional Cancer
Foundation: Cancer Coaching
© 2016 HealthChange Australia
Metropolitan University College
Health Promotion Degree Course
Slide 17
Typical results using HealthChange® Methodology
Fewer ‘No-Shows’
Diabetes prevention group program: retention at week five was 80% v. 36%
Improved patient access: group program waitlist reduce to zero
Risk reduction program: 382 of 1st 400 recruited attended group education
Community-based healthy lifestyle programs: improved clinical outcomes,
decreased negative affect
Osteoarthritis Chronic Care Program (OACCP) tracked the changes in
outcomes pre and post implementation of HealthChange® Methodology:
• Jan-Mar 2011: 51% of patients had surgery deferred due to poor selfmanagement after being on waitlist for 12 months
• Jan-Mar 2012: 34% of patients were deferred.
• Cardiac-related deferrals alone declined from 29% to 10%
© 2016 HealthChange Australia
Slide 18
For service providers, HealthChange® Methodology
is like an ice cream cone!
© 2016 HealthChange Australia
Slide 19
HealthChange® Methodology uses a
conversational style
‘like a duck gliding on the water…’
© 2016 HealthChange Australia
Slide 20
Topic 3:
The HealthChange® Behaviour Change Pathway
PSMP*
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
© 2016 HealthChange Australia
Slide 21
People’s needs are sequential:
They follow a behaviour change pathway
Knowledge & Understanding
Health Literacy
See healthchange.com
to view video
Motivation & Expectations
Decision & Commitment
Decision Line
Macro view
Ready to take action
Micro view
Planning & Problem Solving
Action
Self-regulation
Build Importance
Build Confidence
© 2016 HealthChange Australia
(HCM Mini Guide p. 3)
Slide 22
HealthChange Health Literacy
What
Why
(Information)
(Motivation)
 
 
Health
Condition
What can be
done to manage
this condition
Elements required to make a fully informed decision
© 2016 HealthChange Australia
Slide 23
Three essential tasks for health service providers to align
conversations with their clients’ or patients’ needs
Knowledge & Understanding
1. Set up a healthy working
alliance (build trust)
Motivation & Expectations
Decision & Commitment
2. Identify and address
motivational barriers to
action (build importance)
Decision Line
Ready to take action
Planning & Problem Solving
Action
Self-regulation
© 2016 HealthChange Australia
3. Identify and address
practical barriers to action
and self-regulation (build
confidence)
From: Gale & Skouteris (2013)
(HCM Mini Guide p. 4)
Slide 24
What service providers need to ask themselves to be able to help clients
Does the client know and understand their health issues and clinical targets?
Do they know and understand the broad treatment, lifestyle and referral
categories applicable to these?
Have they been assisted to collaboratively prioritise these categories?
Are they ready, willing, able and committed to taking action?
Decision Line
Macro view
Ready to take action
Micro view
What options do they have for taking action in particular categories?
What are their personalised goals/plans for achieving category goals?
Are they confident they can do these things? What might stop them?
Will I review the client? What other support might they need?
Build Importance
© 2016 HealthChange Australia
Build Confidence
(HCM Mini Guide p. 5)
Slide 25
Client case demonstration
Video - Terry
•
•
•
•
•
CAD, heart attack
Hypertension
Diabetes T2
Obesity, Lap banding
Gall bladder removed
© 2016 HealthChange Australia
Slide 26
But, won’t a truly person-centred approach
take more time to deliver?
…not if you have an effective consultation system
aligned with the person’s needs
© 2016 HealthChange Australia
Slide 27
How HealthChange® Methodology saves time
1. Targeted and streamlined assessment
2. Targeted and individualised education
3. Targeted and meaningful dialogue
4. Speedy identification and troubleshooting of barriers to
action on referral, treatment and lifestyle recommendations
Quickly builds
rapport and trust
Avoids needless discussion of things
that other clinicians have already
covered
Avoids irrelevant and nonproductive conversations
Avoids unproductive discussion
of things the client does not
want to do
Minimises time discussing
things the client is already doing
Keeps the conversation
focused & on track
© 2016 HealthChange Australia
Slide 28
Topic 4:
HealthChange® Person-Centred Practice Principles
PSMP*
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
RICk = Readiness, Importance, Confidence, knowledge
© 2016 HealthChange Australia
(HCM Mini Guide p. 6)
Slide 29
Activity:
Consider your answers to the following
questions relating to your allocated Practice
Principle:
1. What do you think this principle is
about?
2. How do you think you might already
use it in your workplace?
3. How do you think you might potentially
use it in your workplace?
© 2016 HealthChange Australia
Slide 30
HealthChange® Methodology requires health service providers to
balance their duty of care with their client’s right to make fully
informed, conscious decisions about what they will do.
If you feel like all your
consultations sound the same, you
are probably not being personcentred
© 2016 HealthChange Australia
(HCM Mini Guide p. 7)
Slide 31
How to turn clients into elks or polar bears…..
• ‘Tell’ people what to do
• Argue the point
• Use scare tactics with people who are low in confidence
• Using judgmental language
• Overwhelm people by expecting them to do too much
• Overwhelm them with too much information/education
Service providers need alternative
strategies to be built into their
consultations and service delivery
© 2016 HealthChange Australia
Slide 32
Use honest and open dialogue to avoid
playing the ‘practitioner-patient’ game!
Acknowledge the
elephant in the room
© 2016 HealthChange Australia
(HCM Mini Guide p. 8)
Slide 33
Macro-level
Performance
Indicators

Clinical
Targets
(Physiological)
Reasons for
actions
Macro-level
Areas for
Action

Micro-level
actions or
strategies
Motivational
Drivers

Treatment,
Lifestyle &
Referral
Categories
© 2016 HealthChange Australia

Specific
Specific
Personalized
Tasks
Health Goals
(HCM Mini Guide p. 9)
Slide 34
How do the four aspects of goal setting relate to
the HealthChange® behaviour change pathway?

Clinical
Targets

2
Decision
Line

Motivational
Drivers
Lifestyle &
Treatment,
Treatment
Lifestyle
&
Categories
Referral
Categories
Macro view

Micro view
Specific
Personalised
Health Goals
© 2016 HealthChange Australia
Slide 35
HealthChange
Health Literacy
 Health
Condition
 What can be
done to manage
this condition
 What I will do
to manage this
condition (How?)
© 2016 HealthChange Australia
What
Why 
(Information)
(Motivation)
 
 
 
Decision
Macro view
Line
Micro view
(HCM Mini Guide p. 9 & 10)
Slide 36
Different clients will have different motivators
What might commonly motivate the following groups
of clients?
• Children or teens?
• Working age adults?
• Seniors?
• People with disabilities?
• People with mental health issues?
• Homeless people?
• Different cultures?
• Others?
© 2016 HealthChange Australia
Slide 37
What is the critical information for people to know
so that they understand enough about their
clinical condition/s to be motivated to take action?
1. Usual course of the condition and treatment over
time and how these can impact on people
2. What makes the symptoms or prognosis better or
worse
3. What is likely to happen if the condition is not
self-managed well
4. Common misconceptions
© 2016 HealthChange Australia
Slide 38
Patient experience of micro advice from multiple sources
Manage Chronic
Health Condition/s
Hospital-based
Procedure
Know and
understand own
medications
Use accurate
dose and timing
Clinical Targets
Receive home
nursing visits
Have pathology
and other tests as
required
Visit General
Practitioner
Recognise and
act on signs of
Speak with Care
improvement
Coordinator
Recognise and
act on signs of
deterioration
Identify and
manage triggers
Manage alcohol
consumption
Do specific
rehabilitation
activities
Manage nutrition
and eating
Avoid infections
and illnesses
Visit medical
Recognise and
specialist/s
act on side effects
Use bracing,
supports and aids
Monitor and
effectively
manage pain
Take care of
Know and use
equipment
emergency action
plan/s
Manage wounds
and dressings
effectively
Use nutritional
supplements
effectively
Seek a
medications
review
© 2016 HealthChange Australia
Manage weight
Other...
and waist
Manage physical circumference
Address
activity
recreational drug
use
See Diabetes
Manage stress
Educator
and mood
Manage fatigue
effectively
and energy
Engage social
support
Go to physio clinic
Reduce or quit
smoking
Monitor and
Receive Social
manage other
Services
symptoms
Attend education
Arrange transport
or assistance
and other access
program/s
to services
Slide 39
HealthChange® self-management menu of options:
to support health literacy, engagement and action
Manage Health
Condition/s
Manage
Medications
Effectively
Engage in
Specific
Treatment
Activities
Monitor and
Act on
Symptoms
Attend
Services and
Appointments
Clinical
Targets
Manage
Triggers and
Risk Factors
Manage
Healthy
Lifestyle
Factors
Group your clients’ or patients’ tasks into overarching
behavioural categories (self-management objectives) in
order to create a person-centred self-management plan
© 2016 HealthChange Australia
(HCM Mini Guide p. 10)
Slide 40
HealthChange®
Manage Diabetes
Menu of Options
Manage
Medications
Effectively
Engage in Diabetes
Treatment
Activities
Manage Diabetes
Effectively
Monitor and Act on
Diabetes
Symptoms
Clinical Targets
HbA1c, BP, Chol, Eye health,
Kidney function etc.
Attend Services
and Appointments
Manage Symptom
Triggers and Risk
Factors
Manage Healthy
Lifestyle Factors
Know and understand
your medications
Know and understand
about diabetes
Monitor blood sugar
levels consistently
Have regular
pathology tests and
checks
Identify what affects
your blood sugars
Manage nutrition and
eating to control
blood sugars
Use accurate dose
and timing
Record blood sugar
levels regularly
Adjust medications in
response to blood
sugar levels
Visit your General
Practitioner regularly
Manage alcohol intake
Manage physical
activity to control
blood sugars
Recognise and act on
side effects
Avoid infections and
illnesses
Know and use your
emergency action plan
Visit your diabetes
team for regular
check-ups
Manage caffeine
intake
Manage stress and
mood to control blood
sugars
Use and take care of
monitoring and
injecting equipment
Manage wounds and
dressings effectively
Recognise and act on
signs of improvement
Register with NDSS
and join Diabetes
Australia
Reduce or quit
smoking
Manage fatigue and
energy
Seek a medications
review
Check feet and legs
daily, manage blisters
or other problems
Recognise and act on
signs of deterioration
Attend a diabetes
education program
Manage weight and
waist circumference
Engage social support
Other...
Manage other health
conditions effectively
Other...
Compile and maintain
personal medical
records
Other...
Other...
©2016 HealthChange Australia
www.healthchange.com
This is a principle,
not a rule!
© 2016 HealthChange Australia
(HCM Mini Guide p. 11)
Slide 42
Readiness
Importance
Confidence
knowledge
}
Action
Listen to your
intuition, but when in
doubt, ask the client!
© 2016 HealthChange Australia
(HCM Mini Guide p. 12)
RICk Relations
Slide 43
Beware the Motivation Trap!
Motivation to
reduce pain,
lose weight,
retain independence
etc.
© 2016 HealthChange Australia
≠
Motivation to engage in
actions or tasks
required to reduce pain,
lose weight, retain
independence etc.
Slide 44
Elicit information from the client prior to offering your
own information, education or suggestions to find out:
Prior knowledge,
knowledge gaps,
misinformation
1. What do they already know?
2. What don’t they know?
3. What misinformation do they have?
4. What are they already doing?
© 2016 HealthChange Australia
(HCM Mini Guide p. 13)
Slide 45
WAIT for a response
8 seconds is a
common
response time
Why
Why
Am
Am
I
I
Talking? Taking Notes?
© 2016 HealthChange Australia
(HCM Mini Guide p. 14)
Slide 46
Provide pens and paper and invite every
client to write themselves some notes during
your conversation if they wish to
It’s a very practical
way to help patients
and clients!
© 2016 HealthChange Australia
(HCM Mini Guide p. 15)
Literacy
Slide 47
When you don’t succeed…
...try a different strategy!
Discuss trial and error
and reduce the
number of your ‘no
show’ clients
© 2016 HealthChange Australia
(HCM Mini Guide p. 16)
Slide 48
Activity: Consider your use of the HealthChange®
Person-Centred Practice Principles
RICk = Readiness, Importance, Confidence, knowledge
© 2016 HealthChange Australia
Slide 49
Topic 5:
BEST barriers to action and facilitators for change:
Behaviours
Emotions
Situations
Thinking
PSMP*
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
© 2016 HealthChange Australia
Slide 50
BEST barriers to action and facilitators for change
Behaviours
• Actions, everyday habits, planning or lack of
planning
Emotions
• Emotional reactions to things that happen to
us, mood states
Situations
• Medical, physical, cognitive, social, cultural,
access, $, changes in circumstance, clinicians
Thinking
• Beliefs, attitudes, expectations & habitual
thinking patterns, readiness, importance,
confidence, knowledge (RICk)
© 2016 HealthChange Australia
(HCM Mini Guide p. 17)
Slide 51
Common everyday thinking barriers…
© 2016 HealthChange Australia
What gets in the way for you?
What are the recommended activity levels for adults?
Does your own activity level meet the guidelines?
If No: What stops you from achieving this?
If Yes: How do you manage to achieve this?
What gets in the way for your clients?
© 2016 HealthChange Australia
Slide 53
People need to believe:
I have a problem
k
Understanding how people
need to be thinking to get to
the decision line
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
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)
© 2016 HealthChange Australia
Slide 54
How above the line thinking barriers can
manifest in conversations:
“Can’t you just do something to fix this for me?”
“I really want to get rid of this weight! Tell me what to do!”
“I will do the exercises once I get the pain under control”
“I tried to do what you said, but I just didn’t have time…the
kids come first/my work has been really busy”
“I’m too old to change now – I have been like this all my
life”
© 2016 HealthChange Australia
Slide 55
What causes clients to go into denial?
High emotion + low confidence → denial or avoidance
© 2016 HealthChange Australia
Slide 56
Common below the line practical barriers:
• Lack of support from partner/friends/family
• Poor access to services
• Not understanding advice
• Forgetting what to do
• Poor planning
• Effects of pain & disability
• Strength of old habits v. difficulty creating new ones
• Recurring situations: disease episodes, depression,
travel, seasons etc.
© 2016 HealthChange Australia
Slide 57
Common below the line thinking barriers:
“I don’t have time today, I have other responsibilities!”
“I feel okay, I don’t need to take medication/do
treatment activities today”
“If it hurts I should avoid it”
“I couldn’t be bothered”, “I am too tired”, “It’s all too
hard!”
“I’ll do it later, I’ll do it tomorrow”
“A little bit more food/alcohol/TV/sleep won’t hurt…”
© 2016 HealthChange Australia
Slide 58
Activity: Small group discussion
Applying BEST in your daily
work
Behaviours
Emotions
Situations
Thinking
Consider a challenging client or staff member who is not
progressing as expected:
1. Where is the person on their behaviour change
pathway?
2. What types of BEST barriers might be getting in the
way of their progress?
© 2016 HealthChange Australia
Slide 59
Topic 6:
HealthChange® Essential Behaviour Change Techniques
PSMP*
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
© 2016 HealthChange Australia
(HCM Mini Guide p. 18)
Slide 60
Elicit information from the person prior to
offering your own information and suggestions:
Prior knowledge,
knowledge gaps,
misinformation
• What do they already know?
• What are they already doing?
• What would help them?
• What could they do to address a
particular problem?
© 2016 HealthChange Australia
(HCM Mini Guide p. 22)
Slide 61
Offering a Menu of Options:
1) Explain why multiple strategies can be useful
2) Check client agreement (ask permission)
3) Provide multiple strategies where possible
4) Invite the client to think of things that may suit
them better
5) Ask the client if they think any of the ideas might
be suitable for them
© 2016 HealthChange Australia
Slide 62
Offering a menu of options: Sample phrasing
• It often helps to have a number of different ideas of how you
can tackle an issue, so that if one strategy doesn’t work, you
can try one of the others.
• I can offer some suggestions if you like, based on what has
worked for other people. However, ultimately you will be the
best judge of what will work for you and what won’t.
• Would you like to hear my ideas or are you confident that
you already have your own solutions?
© 2016 HealthChange Australia
(HCM Mini Guide p. 35)
Slide 63
Using your RICk Radar (intuition)
Observe body language, tone of voice and other
verbal and non-verbal cues to pick up low RICk or
ambivalence
© 2016 HealthChange Australia
(HCM Mini Guide p. 29)
Slide 64
When in doubt… Ask the client!
But, be careful how you ask your questions
Don’t fall into the
Motivation Trap!
© 2016 HealthChange Australia
(HCM Mini Guide p. 29)
Slide 65
Activity:
How many different ways can you think of to ask
about importance and confidence without
actually using these words?
Words related to Importance:
• Value, priority, desire, motivated, committed, reasons, outcomes, benefits
you hope to achieve, personally important, want to do, feel you need to
do, happy to do...
Words related to Confidence:
• Ability, able, capable, manageable, comfortable, comfort zone, likelihood
of being able to, think you can do, will do successfully...
© 2016 HealthChange Australia
(HCM Mini Guide p. 30)
Slide 66
Signs of shaky commitment (ambivalence)
• Body language or tone of voice contradicts RICk
responses
• ‘I know I should…, but, ….’
• Laughing nervously
• Strong emotional reactions
• Weak reasons to take action & strong reasons not to
• Changing the subject during discussion
• Others?
© 2016 HealthChange Australia
Slide 67
Decision Making
Assistance
Alternative A
Alternative B
Pros
1.
Acknowledge
reasons for current
behaviours
(barriers)
Cons
2.
Identify possible
negative
consequences of
inaction
3.
Identify possible
benefits to be gained
from taking action
4.
Acknowledge
undesirable
aspects of taking
action (barriers)
Is anything mentioned important enough for the client to want to work on this?
© 2016 HealthChange Australia
[Mini Guide p. 31]
Slide 68
RICk-focused decisional balance sample questions
• What are the benefits of what you are currently doing?
• What’s the downside of what you are currently doing? What are the
possible long-term consequences for you and the things/people that
are important to you? *
• Why might you consider doing things differently? What benefits
could you expect from this? *
• What is unappealing about doing things differently? What might stop
you from taking action?
• From what you have said, the reasons why you have not taken action
before are [mention barriers], but if you did take action then you
may be able to avoid [negative consequences] and gain [benefits]. *
• Is anything that you have mentioned important enough to make you
want to work on this issue?
* Questions and reflections that may increase Importance
© 2016 HealthChange Australia
[Mini Guide p. 32]
Slide 69
Digging down in the benefits:
Should I do strength exercises regularly or not?
I’ll have greater strength and mobility in my arms
It will be easier to reach up to cupboards, lift things,
and do things around the house
I’ll be able to do my daily activities more easily and
with more confidence
I’ll be able to live independently, stay in my home for
longer and enjoy my life more*
© 2016 HealthChange Australia
* Intrinsic motivator
Slide 70
Digging down in the Consequences:
Should I go to bed early or not?
I will be tired in the morning
I’ll have a worse start to the day (less organised/feel worse)
I’ll have a worse day at work (less productive, more grumpy)
I’ll get home in a bad mood
I’ll be grumpy at home and
likely to fight with my wife *
© 2016 HealthChange Australia
* Intrinsic motivator
Slide 71
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?
© 2016 HealthChange Australia
Slide 72
Pairs Activity:
RICk-focused decisional balance
• Talk each other through the questions one at a time
• 10 minutes each
• Pick an action or topic that you are ambivalent about working on:
Importance 50/50
• There is no need to write anything down – use a conversational
approach:
1. Clarify beginning level of importance
2. Use the key questions on page 32 of the Mini Guide
3. Finish by asking if the things you have discussed have helped your partner to
make a decision to take action or not on their issue, or
4. Ask whether the benefits or consequences to themselves or others are
important enough for them to want to work on this issue further
5. Clarify RICk to see if any of it changed
© 2016 HealthChange Australia
Slide 73
How did you go?
Who decided to make a change and who didn’t?
Who would you use this technique for?
When would you use it?
© 2016 HealthChange Australia
Slide 74
Possible outcomes from RICk-focused
decisional balance
a) Client decides not to work on chosen
category
b) Client decides to take action within the
category
c) Client needs more information to make
the decision
d) Client remains ambivalent
© 2016 HealthChange Australia
RFDB Examples
Slide 75
1. Do you ever procrastinate or talk yourself out of
doing things you had planned to do?
2. What excuses do you usually give yourself for not
taking action?
3. What do you need to say to motivate yourself
instead, to make sure you do what you are
planning to do?
4. How will you practise these thoughts so that you
can say them to yourself when you need them?
© 2016 HealthChange Australia
(HCM Mini Guide p. 40)
Slide 76
Client case demonstration
Video – Terry
Identifying and addressing
thinking barriers
© 2016 HealthChange Australia
Slide 77
What is the purpose of tracking
and monitoring?
Why do we monitor physiological outcomes?
What’s the problem with only monitoring
physiological outcomes?
What are the benefits of tracking actions also?
© 2016 HealthChange Australia
(HCM Mini Guide p. 38)
Slide 78
What you track is what you get
Family blocks of chocolate
Week
Starting
(date)
28/4
Mon
5/5
Wed
3
squares
Chocolate
Exercise
Tue
15
mins
Thur
Fri
2
squares
20 mins
10 mins
Sat
Sun
2
squares
Total days
goals met
Ex
hours
total
3!
3!
45
mins!
Chocolate
Exercise
12/5
Chocolate
Exercise
(HealthChange® Habit Change Diary is available from healthchange.com)
© 2016 HealthChange Australia
Slide 79
Activity: Consider your use of the HealthChange®
Essential Behaviour Change Techniques
ET Questions
© 2016 HealthChange Australia
Slide 80
Layers of HealthChange® Methodology: An integrated suite of tools
PSMP*
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-centred Practice Principles
HealthChange® Behaviour Change Pathway
*PSMP: Personal Self-Management Plan
© 2016 HealthChange Australia
(HCM Mini Guide p. 2)
Slide 81
From what we have covered today, what are
you going to do to refine your service delivery?
Write down 3 things that you
are going to do as a result!
© 2016 HealthChange Australia
Slide 82
Thank you for your participation!
Find videos, case studies and practice tools at
www.healthchange.com
HealthChange® tools can be used freely in clinical practice
and programs as long as HealthChange® Australia intellectual property
is visibly acknowledged by displaying the HealthChange® Inspired logo
Contact us for more information
Use of any of the content contained in this workbook for training
purposes outside of HealthChange® workshops and without written
permission from HealthChange® Australia is a breach of Copyright and
Intellectual Property Laws and legal action may be taken against
persons or organisations that engage in this activity
© 2016 HealthChange Australia
Slide 83
© 2016 HealthChange Australia
Slide 84
Getting to know you
1. Your name
2. Your role
3. The common conditions your team/you
help patients to manage
4. The biggest challenges that you face in
working with your patients, clients or
service users
• Managers or administrators may like to consider the service
users associated with their organisation and/or their other
stakeholders (staff, management, colleagues etc.)
© 2016 HealthChange Australia
Return
Slide 85
© 2016 HealthChange Australia
Slide 86
Client case – ‘toxic wasteland’
• Male, mid-30’s, BMI = 34 (96 kg), elevated BP, BGLs & Chol.,
married, 2 children, manager in hospitality industry
• Told to: change diet, lose weight, start exercising, reduce alcohol
and caffeine dramatically, quit smoking
• 18-24 shots per day espresso per day
• 1 bottle of wine per night, plus multiple martinis
• 15 cigarettes/day
• Low energy, poor sleep, frequent waking, needed naps on
days off
• Very little water – doesn’t like it
• No exercise, poor diet, hardly any fruit and vegetables
© 2016 HealthChange Australia
Slide 87
1 x 20 minute intervention
Reaction to Dr’s advice: “What can I do? I would have to quit my job!”
• Main barrier: completely overwhelmed and didn’t know how to take
action
• Key principle to overcome barriers: One thing at a time, one step at
a time, adding up over time
• Prioritized category: alcohol reduction
• Strategies: eat dinner early with the children and don’t have chilled
wine available
• No review consultation
© 2016 HealthChange Australia
Slide 88
Behaviours at 1.5 years:
• 5 alcohol free days/week, 1 bottle of wine over 2 nights, no martinis
• No more than 2 x skinny latte’s per day
• 2-3 cigarettes per day, work days only
• 1.9ℓ jug of water/day (hot water + ice + touch of cordial)
• 1 x vegetarian meal per week, aims for daily vegetables + 2 x fruit per day
• 3 x per week on exercise bike, plus conscious use of (many) stairs at work
• No longer takes naps on days off
Behaviours at 2.5 years:
• 5 serves vegetables plus 2 serves of fruit per day
• 5 x exercise sessions per week
© 2016 HealthChange Australia
Slide 89
Results at 1 & 1.5 years:
• BMI 29 (82 kg) - previously 34 (96 kg)
• BP, BGLs and Chol. in normal range – previously all elevated
• No longer gets daily headaches
• Sleeps through the night and reports increased energy
Results at 2.5 years:
• 76 kg
• Waist circumference 88 cm (previously 110 cm)
• BP, BGLs and Chol. All in normal range
© 2016 HealthChange Australia
Slide 90
Client’s reflection
“What the Dr told me to do was impossible”
“I am thankful that she told me (about the critical nature of
my health issues) but I expected more help with how to do it”
“The Dr doesn’t know why I do what I do and why it is hard
to change. Health professionals need to know why!”
“I was in a nasty evil cycle”
© 2016 HealthChange Australia
Slide 92
Return
© 2016 HealthChange Australia
Slide 94
Client Reflections
Audio - Dorothy
• Health Professional
• Cancer treatment
© 2015 HealthChange Australia
Return
Slide 95
© 2016 HealthChange Australia
Slide 96
Working with low literacy
• Use visual tools
• Ask clients how they usually remember
• Visual and auditory memory aides
• Tactile tracking strategies
(marbles/buttons/strokes of a pen)
• Rehearse action plans verbally
© 2016 HealthChange Australia
Slide 97
Working through interpreters
• Invite interpreters to brief you on culture
• Brief interpreters on your practice style
• Learn how to say hello, goodbye, yes and no in each language.
• Use as little speech as possible
• Promote client choice - use visual tools
• Break dialogue into small chunks – to avoid interpreters
summarising and oversimplifying
• Ask clients to paraphrase information to check accuracy
• Use appropriate eye contact
• Allow extra time
© 2016 HealthChange Australia
Slide 98
Working with cognitive impairment
•
•
•
•
Identify who the decision-maker is
Work with the client and/or carers
Work with client idiosyncrasies, likes and dislikes
Incorporate reminders/visual cues and aids to
comprehension
• Adapt pace and style of language to client
• Check comprehension
© 2016 HealthChange Australia
Return
Slide 99
© 2016 HealthChange Australia
Slide 100
Use your RICk Radar
“I’m desperate to lose this weight and I’m willing to
do whatever it takes because I know it’s the only
thing holding me back from getting into the police
force. But every time I’ve tried I can only keep it off
for a few months then I end up back here.”
© 2016 HealthChange Australia
Slide 101
Use your RICk Radar
“Well, the doctor sent me to you because I have to
manage my diabetes. But my diet is pretty good and,
anyway, there is a lot of diabetes in my family so it
was just a matter of time really.”
© 2016 HealthChange Australia
Slide 102
Use your RICk Radar
“I need to do this because my kids are young and I
want to be around and healthy for them. The thing is
I’m a single parent and I’m caring for my sick mother,
and I just can’t see how I’m going to fit this all in!”
© 2016 HealthChange Australia
Slide 103
Use your RICk Radar
“Can’t you just give me some medication or
treatment to fix this?”
© 2016 HealthChange Australia
Slide 104
© 2016 HealthChange Australia
Slide 105
RICk Relations
Importance
knowledge
Timing
Readiness
Confidence
© 2016 HealthChange Australia
Return
Slide 106
© 2016 HealthChange Australia
Slide 107
HealthChange®
Manage Diabetes
Menu of Options
Manage
Medications
Effectively
Engage in Diabetes
Treatment
Activities
Manage Diabetes
Effectively
Monitor and Act on
Diabetes
Symptoms
Clinical Targets
HbA1c, BP, Chol, Eye health,
Kidney function etc.
Attend Services
and Appointments
Manage Symptom
Triggers and Risk
Factors
Manage Healthy
Lifestyle Factors
Know and understand
your medications
Know and understand
about diabetes
Monitor blood sugar
levels consistently
Have regular
pathology tests and
checks
Identify what affects
your blood sugars
Manage nutrition and
eating to control
blood sugars
Use accurate dose
and timing
Record blood sugar
levels regularly
Adjust medications in
response to blood
sugar levels
Visit your General
Practitioner regularly
Manage alcohol intake
Manage physical
activity to control
blood sugars
Recognise and act on
side effects
Avoid infections and
illnesses
Know and use your
emergency action plan
Visit your diabetes
team for regular
check-ups
Manage caffeine
intake
Manage stress and
mood to control blood
sugars
Use and take care of
monitoring and
injecting equipment
Manage wounds and
dressings effectively
Recognise and act on
signs of improvement
Register with NDSS
and join Diabetes
Australia
Reduce or quit
smoking
Manage fatigue and
energy
Seek a medications
review
Check feet and legs
daily, manage blisters
or other problems
Recognise and act on
signs of deterioration
Attend a diabetes
education program
Manage weight and
waist circumference
Engage social support
Other...
Manage other health
conditions effectively
Other...
Compile and maintain
personal medical
records
Other...
Other...
©2016 HealthChange Australia
www.healthchange.com
HealthChange®
Manage COPD
Menu of Options
Manage
Medications
Effectively
Manage COPD
Engage in COPD
Treatment
Activities
Monitor and Act
on COPD
Symptoms
Attend Services
and
Appointments
Manage COPD
Triggers and Risk
Factors
Manage Healthy
Lifestyle Factors
Know and
understand your
medications
Know and
understand about
COPD
Know and use a
flare-up action
plan
Have pathology
and other tests as
required
Identify and
manage triggers
and irritants
Manage nutrition
and eating
Use accurate dose
and timing
Do specific
rehabilitation
activities
Recognise and act
on signs of
improvement
Visit your General
Practitioner
Quit or reduce
smoking
Manage physical
activity
Recognise and act
on side effects
Avoid and manage
infections and
illnesses
Recognise and act
on signs of
deterioration
Visit other health
or medical
specialist/s
Keep up to date
with vaccinations
Manage stress
and mood
effectively
Use and take care
of inhaler
equipment
properly
Do breathing
exercises regularly
Know when to
seek medical help
or call an
ambulance
Attend a
pulmonary
rehabilitation
program
Manage alcohol
consumption
Manage fatigue
and energy
Seek a
medications
review
Do sputum
clearance
exercises regularly
Monitor and
manage other
symptoms
See a Speech
Pathologist for
swallowing
problems
Avoid contact
with people with
infectious illness
Engage social
support
Manage oxygen
use effectively
Do pelvic floor
exercises regularly
Other...
Compile and
maintain personal
medical records
Avoid using
sedatives
Pace your activity
levels
©2016 HealthChange Australia
www.healthchange.com
HealthChange®
Manage Knee OA
Menu of Options
Consistently do
recommended
treatment
exercises and
activities
Manage Knee
Osteoarthritis
Effectively
Manage
medications
effectively
Attend relevant
services and
appointments
Monitor and
manage pain and
other symptoms
Know and manage
pain and other
symptom triggers
and risk factors
Manage other
general healthy
lifestyle factors
Know and understand
about osteoarthritis
Know and understand
your medications
Visit your General
Practitioner
Recognise and act on
signs of
deterioration
Identify and manage
flare-up triggers
Manage nutrition and
eating
Do specific
strengthening
exercises
Understand different
types of pain
medication
Have radiology and
other tests as
required
Recognise and act on
signs of
Improvement
Plan and pace
activities
Manage physical
activity
Do aerobic exercise
Use accurate dose and
timing
Visit other health or
medical specialist/s
Manage symptoms
using non-medication
strategies
Protect joints from
stress and pain
Manage stress and
mood effectively
Engage in other
treatments/specific
rehabilitation activities
Recognise and act on
side effects
Participate in a selfmanagement program
See a professional for
assistance when
symptoms cannot be
effectively managed
Manage weight and
waist circumference
Manage fatigue and
energy
Use bracing, supports
and aids effectively
Seek a medications
review
Compile and maintain
personal medical
records
Other…
Other…
Engage social support
Other…
Other…
Other…
©2016 HealthChange Australia
Other…
www.healthchange.com
HealthChange®
Manage CHF
Menu of Options
Manage
Medications
Effectively
Manage Chronic
Heart Failure
(CHF)
Engage in CHF
Treatment
Activities
Monitor and Act
on CHF
Symptoms
Attend Services
and
Appointments
Manage
Symptom
Triggers and
Risk Factors
Manage Healthy
Lifestyle Factors
Know and
understand your
medications
Know and
understand about
heart failure
Know and use your
emergency action
plan
Have pathology
and other tests as
required
Identify and
manage symptom
triggers
Manage nutrition
and eating
Use accurate dose
and timing
Do activities to
manage fluid
retention
Recognise and act
on signs of
improvement
Visit your General
Practitioner
regularly
Avoid activities that
put strain on your
heart
Plan and pace
physical activity
Recognise and act
on side effects
Avoid infections
and illnesses
Recognise and act
on signs of
deterioration
Visit your medical
management team
regularly
Manage caffeine,
alcohol and fluid
intake
Manage stress and
mood effectively
Take care of
medical devices
Manage wounds
and dressings
effectively
Monitor, record
and manage fluid
balance
Attend an
education or
activity program
Manage salt intake
Manage fatigue
and energy
Seek a medications
review
Manage other
health conditions
effectively
Monitor, record
and manage body
weight
Compile and
maintain personal
medical records
Reduce or quit
smoking
Engage social
support
Other...
Other…
Other...
Other...
Other...
Other...
©2016 HealthChange Australia
www.healthchange.com
HealthChange®
Manage Heart Disease
Menu of Options
Manage
Medications
Effectively
Engage in Heart
Disease
Treatment
Activities
Manage Heart
Disease
Monitor and Act
on Heart Disease
Symptoms
Attend Services
and
Appointments
Manage
Symptom
Triggers and Risk
Factors
Manage Healthy
Lifestyle Factors
Know and
understand your
medications
Know and
understand about
heart disease
Know and use
emergency heart
attack action plan
Have pathology
and other tests as
required
Identify and
manage symptom
triggers
Manage nutrition
and eating for
heart health
Use accurate dose
and timing
Do cardiac
rehabilitation
activities
Recognise and act
on signs of
improvement
Visit your General
Practitioner
regularly
Manage alcohol
consumption
Manage physical
activity for heart
health
Recognise and act
on side effects
Avoid infections
and illnesses
Recognise and act
on signs of
deterioration
Visit your medical
team for regular
check-ups
Address
recreational drug
use
Manage stress and
mood effectively
Take care of
devices and
equipment
Manage wounds
and dressings
effectively
Monitor and
manage pain
Attend a cardiac
rehabilitation
program
Reduce or quit
smoking
Manage fatigue
and energy
Seek a medications
review
Manage angina
effectively
Monitor and
manage other
symptoms
Compile and
maintain personal
medical records
Manage weight
and waist
circumference
Engage social
support
Other...
Use nutritional
supplements
effectively
Other...
Other...
Other...
Other...
©2016 HealthChange Australia
www.healthchange.com
HealthChange®
Manage Chronic Pain
Menu of Options
Manage
Medications
Effectively
Engage in Pain
Treatment
Activities
Manage Chronic
Pain
Monitor and Act
on Pain and
Other Symptoms
Attend Services
and
Appointments
Manage Pain
Triggers and Risk
Factors
Manage Healthy
Lifestyle Factors
(see lifestyle
menus)
Know and
understand your
medications
Know and
understand about
pain
Monitor and
manage pain
Have pathology
and other tests as
required
Identify and
manage flare-up
triggers
Manage nutrition
and eating
Understand
different types of
pain medication
Do specific
rehabilitation
activities
Attend a pain
management
clinic
Visit General
Practitioner
Plan and pace
activities
Manage physical
activity
Use accurate dose
and timing
Do strength,
flexibility and
balance exercises
Recognise and act
on signs of
deterioration
Visit other health
or medical
specialist/s
Protect joints or
body from stress
and pain
Manage stress
and mood
effectively
Recognise and act
on side effects
Use body and
posture
awareness
Use nonmedication
strategies
Attend education
or assistance
program/s
Manage and
prevent
inflammation
Manage fatigue
and energy
Seek a
medications
review
Do relaxation
exercises
See a professional
for assistance
Arrange transport
and other access
to services
Manage weight
(*see separate
menu)
Engage social
support
Other...
Use bracing,
supports and aids
effectively
Other...
Other...
Other...
Other...
©2016 HealthChange Australia
www.healthchange.com
HealthChange®
Prevent Falls
Menu of Options
Manage
Medications
Effectively
Prevent Falls
Engage in
Specific Falls
Prevention
Activities
Monitor and Act
on Falls and
Symptoms
Attend Services
and
Appointments
Manage Falls
Triggers and Risk
Factors
Manage Healthy
Lifestyle Factors
Know and
understand own
medications
Do balance and
strength exercises
Know and use
emergency action
plan/s
Have pathology
and other tests as
required
Identify falls
triggers and risk
factors
Manage nutrition
and eating to
maintain strength
Use accurate dose
and timing
Avoid infections
and illnesses
Recognise and act
on signs of
improvement
Visit your General
Practitioner
Manage alcohol
consumption
Manage physical
activity
Recognise and act
on side effects
Manage wounds
and dressings
effectively
Recognise and act
on signs of
deterioration
Visit medical and
other health
specialist/s
Minimise trip
hazards (incl. pet
strategies)
Manage stress
and mood
effectively
Take care of
devices and
equipment
Use bracing,
supports and aids
effectively
Monitor and act
on near misses
Attend a falls
prevention
program
Use continence
aids to avoid
rushing
Manage fatigue
and energy
Seek a
medications
review
Adjust physical
environment to
minimise risk
Monitor and
manage illness
symptoms
Arrange transport
and other access
to services
Use aids, alarms
and equipment
effectively
Engage social
support
Other...
Other...
Other...
Other...
Arrange a home
assessment
Other...
©2016 HealthChange Australia
www.healthchange.com
HealthChange®
Manage Osteoarthritis
Menu of Options
Manage
Medications
Effectively
Engage in
Arthritis
Treatment
Activities
Manage
Osteoarthritis
Monitor and Act
on Pain and
Other Symptoms
Attend Services
and
Appointments
Manage
Symptom
Triggers and Risk
Factors
Manage Healthy
Lifestyle Factors
Know and
understand your
medications
Know and
understand about
osteoarthritis
Monitor and
manage pain
Have pathology
and other tests as
required
Identify and
manage flare-up
triggers
Manage nutrition
and eating
Understand
different types of
pain medication
Do specific
rehabilitation
activities
Attend a pain
management clinic
Visit your General
Practitioner
Plan and pace
activities
Manage physical
activity
Use accurate dose
and timing
Do strength and
balance exercises
Recognise and act
on signs of
deterioration
Visit other health
or medical
specialist/s
Protect joints from
stress and pain
Manage stress and
mood effectively
Recognise and act
on side effects
Manage joint
mobility
Use nonmedication
strategies
Attend an arthritis
self-management
program
Manage and
prevent
inflammation
Manage fatigue
and energy
Seek a medications
review
Do stretching
exercises
See a professional
for assistance
Compile and
maintain personal
medical records
Manage weight and
waist
circumference
Engage social
support
Other...
Use bracing,
supports and aids
effectively
Other...
Other...
Other...
Other...
©2016 HealthChange Australia
www.healthchange.com
HealthChange®
Menu of Options
Manage
Medications
Effectively
Manage Oral
Health
Engage in Specific
Treatment
Activities
Monitor and Act
on Symptoms
Attend Services
and
Appointments
Manage Triggers
and Risk Factors
Manage Healthy
Lifestyle Factors
Know and
understand own
oral medications
Brush, floss, rinse
Know and use
emergency action
plan/s
Have pathology
and other tests as
required
Identify and
manage triggers
Manage nutrition
and eating
Use accurate dose
and timing
Apply topical
treatments
Recognize and act
on signs of
improvement
Visit Doctor
Manage alcohol
consumption
Manage physical
activity
Recognize and act
on side effects
Manage wounds
and infections
Recognize and act
on signs of
deterioration
Visit medical
specialist/s
Address
recreational drug
use
Manage stress and
mood effectively
Take care of
equipment
Use appliances
effectively
Monitor and
manage pain
Attend education
or assistance
program/s
Reduce or quit
smoking
Manage fatigue and
energy
Seek a medications
review
Avoid or manage
infections and
illnesses
Monitor and
manage other
symptoms
Arrange transport
and other access to
services
Manage weight and
waist circumference
Engage social
support
Effectively manage
comorbidity
medications
Other...
Other...
Other...
Other...
Other...
©2016 HealthChange® Associates
www.healthchange.com
HealthChange® healthy lifestyle self-management
menu of options
Manage Healthy
Lifestyle Factors
Manage
Nutrition and
Eating
Manage
Physical
Activity
Manage
Stress and
Mood
Manage
Fatigue and
Energy
Healthy Lifestyle
Targets
Manage
Triggers and
Risk Factors
Group tasks into overarching behavioural categories
(health self-management objectives) in order to create a
person-centred health self-management plan
© 2016 HealthChange Australia
Engage Social
Support
© 2016 HealthChange Australia
Person-centred Care
shared decision making, health
care team approach, behaviour
change support, consideration of
patient beliefs, cognitions, social
and cultural contexts *
Intuition is not enough – we need a systematic approach
* Bauman et al. 2003
© 2016 HealthChange Australia
© 2016 HealthChange Australia
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Booklet contents Day
Front cover page
Title page
Permission page
Contents page
Glossary
Alignment with health service imperatives doc (1 page)
Copies of slides with Ask RICk exercise embedded
2-page summary of behaviour change literature from Gale
& Skouteris, 2013
Goal hierarchies description document (1 page)
Clinical condition goal hierarchy (grey scale)
Lifestyle factors goal hierarchy (grey scale)
Typical client profile (2 pages)
PPET skills audit tool (2 pages)
Lined pages
Back cover page
© 2016 HealthChange Australia
1
Slide 121
Handouts - Day 1 workshop
1) Day 1 Booklet
2) HealthChange® Mini Guide
3) Double-sided hierarchies/menu of options white card
4) Workshop Evaluation Form
All handouts (except the eval form) are to be
brought back by participants to the Day 2
workshop
© 2016 HealthChange Australia
Slide 122
© 2016 HealthChange Australia
Slide 123