By the end of the session: You should be able to: • apply Make Every Contact Count within your role • ask people about their lifestyle choices • advise people of facts and tips to help change unhealthy lifestyle behaviours • be confident to deliver Brief Advice (and Brief Interventions) • refer people to appropriate help and support • record your contacts • know where to go for more information Today’s timetable • • • • • • • • • • 10.00 Introduction to Making Every Contact Count 10.15What is MECC 10.45 Group activity and break 11.30 Health information 12.30 What does MECC mean to me? 13.00 Lunch (30 minutes) 13.30 Health Improvements and brief Interventions 14.45 Next steps for cascading training 15.15 Summary, evaluation, questions 15.30 Close Why are we here? • NHS Ambitions / CQUINs • Role of the MECC trainer • Aim of the day – provide input and knowledge on the MECC ambition, and to jointly agree resources and support required to cascade across the Trust Making Every Contact Count Making Every Contact Count focuses on short, one-to-one opportunities with service users to advise and signpost to healthy lifestyle information on: • stopping smoking • drinking alcohol within recommended limits • eating a healthy diet • taking regular physical activity • maintaining a healthy weight • mental health and wellbeing 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. MECC approach MECC is about encouraging people to make healthier choices to achieve positive long-term behaviour change for better health and wellbeing among patients / service users and staff themselves MECC involves: • Systematically promoting the benefits of healthy living across the organisation • Asking an individual about their lifestyle and if they want to make a change • 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 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. Cost basis • Sarah to input local data of alcohol costs . Where are we now? Where do we want to be? • What is the teams/ departments vision about providing health promotion messages? 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 Discussion • What is the profile of our service users? • What are their lifestyle and information needs? • What influences their lifestyle choices? • Does the issue differ for each stage of life? BREAK Smoking FACT: • 30% of the elective surgical population will be smokers • Stopping smoking is the single biggest thing you can do to improve your health. • The systems most commonly affected by smoking are pulmonary function, cardiovascular function, the immune response, and tissue healing. • The most common complication related to smoking is impaired wound and tissue healing and wound infection, and cardiopulmonary complications. TIPS: • You are up to 4 times more likely to quit with the support of NHS Stop Smoking services and medication compared with going it alone. Smoking in pregnancy FACT: • Increased risk of miscarriage and stillbirth • Increased chance of pre-term birth (premature babies) and low-birth weight TIPS: • Even if the pregnant woman / new mother does not smoke, there may be partners or others in the household who smoke? Second-hand smoke can still damage an unborn baby or a new born baby. NHS Stop Smoking services Birmingham Services Call Quit line on- 0800 052 5855 Open; Monday to Friday 9am to 7pm Saturday - 10am to 2pm You can also text ‘Quit’ to 80800. Website: smokefree.nhs.uk What do you think about stopping smoking? Alcohol FACT: • Men should not drink more than 3-4 units per day (1 pint of strong 5% beer or cider). • Women should not drink more than 2-3 units per day (1 standard 175ml 12% glass of wine.) • You should have at least 2 alcohol free days a week. • Avoid consuming any alcohol during pregnancy as rigorous research has not yet determined what safe levels of consumption are in terms of preventing adverse effects to the foetus such as foetal alcohol syndrome. TIPS: • Find out how many units are in your favourite drink. • Have drinks with mixers. Alcohol The Cost • Cost of alcohol misuse in Birmingham is £200 million per year - Alcohol related health disorders & disease - Crime and anti social behaviour - Loss of productivity in the work place - Problems with those who misuse alcohol and their families including domestic violence • - Cost to NHS for alcohol related harm- £54 million Cost of drink driving £10 million Cost of criminal justice system - £37 million Cost of economy of alcohol related absenteeism - £30 million Impacts on health: AUDIT (Babor et al, 1989) Comprises of 10 questions about: • Frequency of alcohol consumption • How drinking affects their life • Signs of dependency • Injuries sustained as a result of drinking • Previous advice to cut down drinking • Alcohol consumption Alcohol units How to calculate units in mls • Multiply the percentage ABV by the volume/amount of drink in millilitres then divide by 1000. • For example with a 13% ABV glass of wine in 175ml glass • 13 (%ABV) X 175 (amount) = 2275 • Divided by 1000 = 2.275 ie 2.3 units Unit Calculation in cl. Multiply % alcohol content By volume in centilitres (cl's) Then divide it all by 100 14% eg 7 5 cl 14 x 75 100 10.5 = Units Royal college of Physicians Guidelines Drinking levels Low risk Male (Units / Week) ≤ 21 Female (Units / Week) ≤ 14 Hazardous 22 -50 15- 35 Harmful > 50 >35 Binge drinking >8 >6 (Regular drinking in one session) Sensible drinking guide suggests 2 drink free days. Alcohol Withdrawal • Some patients are not troubled by alcohol withdrawal • 40% will develop an acute withdrawal syndrome upon stopping or significantly curtailing alcohol intake • The risk of withdrawal is not directly related to intake (DTB 1991, Morgan 1998) • The alcohol withdrawal syndrome may be a continuum from simple tremulousness (the most common symptom) through to seizures and more severely, life threatening delirium tremens (Hall 1997, Rubino 1992, Turner 1989) Symptoms of uncomplicated alcohol withdrawal • Characteristic tremor, starting in the hands but progressing to the head and trunk as the severity worsens • Anxiety, restlessness, irritability, depression, insomnia and tiredness • Anorexia, nausea and weakness • Confusion • Sweating, Tachycardia (100+ b.p.m), Raised BP, Fever (37-38). Preparation for Detox Groups Module 1 Motivation/ Meet your recovery Coach 4 sessions Module 2 Module 3 Preparation for Detoxification 1 session Attendance to Groups internal / External 1 session Module 4 Recovery Capital 1 session AUDIT TOOL RESULTS & CARE PATHWAY Low Risk/ Hazardous Harmful /Complex Dependent requiring detoxification A team 113 Griffins Brook Lane Bournville Birmingham B30 1QN Aquarius 236 Bristol Rd Edgbaston Birmingham B5 7SL Birmingham & Solihull Mental Health Foundation Trust Email: complete form called Birmingham Alcohol Services Referral Form Arch - Addiction Recovery Community Hub Tel. 0121 475 8885 Fax. 0121 475 9018 Tel. 0121 414 0888 Fax. 0121 414 1222 Tel. 0121 3013900 And ask for alcohol practitioner for information and advice. Email address to send referral form to: email@example.com Alcohol Aquarius Tel. 0121 414 0888 NHS Choices www.nhs.uk/livewell/alcohol ww.aquarius.org.uk ARCH (BSMHFT) Alcohol concern Tel. 0121 301 0000 Tel: 0800 917 8282 Can www.bsmhft.nhs.uk/ARCH FAS AWARE UK you Alcoholics Anonymous www.fasaware.co.uk tell Tel. 0845 7697555 Al-Anon Family Groups me www.alcoholics02074030888 about anonymous.org.uk www.al-anonuk.org.uk SMART how Tel. 07966237613 much www.smartrecovery.org.uk alcoh Healthy Eating FACT: • You should aim to eat at least 5 portions of varied fruit and vegetables a day and cut back on sugar, salt and fat. Check the label and swap higher levels for lower ones ‘Swap it don’t Stop it’. TIPS: • Aim for one third of the food you eat to be starchy foods like potatoes, cereal, pasta, rice and bread. Your 5-a-day can include unsweetened fruit juice for one portion, and try adding a handful of fresh, frozen or tinned veg into meals like pasta sauces. Healthy Eating change4life 0300 123 4567 www.nhs.uk/change4life How do you feel about healthy eating and your diet? Weight Loss • The only way to lose weight healthily, and keep it off, is to reduce your calorie intake and increase your physical activity. For more help ask your GP or Practice Nurse. Healthy Eating • Lighten up Tel 0800 5999880 Loose weight and keep it off Speak to you GP for a referral - 12 weeks free. For people with a BMI of over 30 • Loose weight with on line support www.commit2bfit.co.uk- for men www.choose2bslim.co.uk – for women • Children’s Healthy Weight Programmes Tel 0121 4461021 Birmingham Children’s healthy weight programmes – St Patricks Centre for Community Health • A specialist weight management service is available at St Patricks Centre for community Health for people with a BMI over 40 and over. Referral can be made via the patients GP. Physical Activity FACT: • Adults should do at least 30 minutes of moderate physical activity 5 times a week (150 minutes per week). • Children should do 60 minutes of moderate physical activity every day. TIPS: • Moderate activity is where you raise your heart rate, get warm or break a sweat on a warm day • Each 10 minutes counts towards your daily target. Physical Activity • If you have not undertaken recent physical activity, it is best to start gradually. If in doubt, check with your GP. • Children: community support is available through your child’s school and your local council community physical activity department. • Adults: Activity for health 12 week activity referral programme. Ask your GP or Practice Nurse. change4life What physical 0300 123 4567 activities do you do www.nhs.uk/change4life each day that raise your heart rate? Mental Health FACT: • 1 in 4 people experience emotional, psychological or mental wellbeing issues at some point in their lives and 1 in 6 adults experience such problems at any one time which can include stress, anxiety, panic attacks and depression. TIPS: • Talking to others, being active, helping others / volunteering, learning something new and appreciating the things around you can lead to better mental wellbeing. If you are worried that someone is a danger to themselves or at risk then follow safeguarding procedures. Mental Health How do you feel about your mood day to day? • Speak to your GP to discuss any issues, who can recommend appropriate help and support. • Birmingham & Solihull Mental Health Foundation Trust There website has a wealth of information on local services and a website will an array of useful leaflets • http://www.bsmhft.nhs.uk/health-andwellbeing/copyof-self-help-booklets/ Mental Health • Samaritans Tel. 0845 790 9090 www.samaritans.org Confidential support for anyone in a crisis • Rethink Tel. 0300 500 0927/02078403188 www.rethink.org Provides info and a helpline for anyone affected by mental health problems. Monday -Friday 10-1pm. • No panic Tel. 08001388889 www.nopanic.org.uk • Relate Tel. 0121 643 1638 www.relate.org.uk Help with marital or relationship problems • National Debt Line Tel. 0808 808 4000 www.nationaldebtline.co.uk Help for anyone in debt or concerned that may fall into debt • Triumph over Phobia Tel. 08456009601 www.topuk.org Provides national network of self help groups for people with phobias or OCD. • Mind Tel. 0300 123 3393 www.mind.org.uk The national mental health charity, can provide practical advice and links to local services Mental Health • Anxiety care • www.anxietycare.org.uk • Email: firstname.lastname@example.org rg.uk • Anxiety UK Tel: 08444 775774 www.anxietyuk.org.uk The two services above provide information and support to those suffering from anxiety disorders. • British Association for Counselling and Psychotherpay Tel. 01455 883316 www.bacp.co.uk Offers an information service providing contacts for counselling in England and Wales • CRUSE Bereavement Care Tel. 0121 687 8010 www.crusebereavementcare.org. uk Offers advice and support for those affected by bereavement. Free NHS Health Checks If any service users are aged between 40-74 years old they may be eligible for a free NHS Health check to screen for heart disease, stroke, diabetes or kidney disease risk, if they do not already have a diagnosis. Please ask them to request one from their GP. Activity in pairs – What does MECC mean to me? • What does Making Every Contact Count mean to you in your role or at home? • How can you use it in your everyday contacts? • Do you think you already include MECC in your everyday work or home life, what do you cover? • Is there anyone or anywhere else you think you could use it with? • What issues particularly affect your user group / family? • What might motivate them to make a change? • Do you have any concerns? LUNCH Health improvement • Behavioural Change • Educational Approach • Social Change © The Behavioural Change approach Aim: to help individuals adopt healthy behaviours Methods used in this approach are targeted at the individual • One-to-One e.g. goal setting / action plans • Education © Brief Advice – Level 1 BRIEF ADVICE is pro-actively raising awareness of, and assessing a person’s willingness to engage in further discussion about, healthy lifestyle issues. It is usually given opportunistically. It normally takes between 30 seconds to 3 minutes © What to do? Remember: • Ask open questions. • Advise on how to make changes, ask service user to suggest how they might make changes. • Act – help the service user to set their own goals or access further help (signpost). Remember to think about the environment – privacy, comfort Considerations • Time - it might only take 30 seconds to ask a question. • You need to start from where the service user is, not where you think they are or where they should be. • You need to be open minded not critical or judgemental. • Brief advice is working with the individual on their health goals. You are not lecturing them or telling them what to do. • You are providing simple, clear advice and signposting. • You can’t always tell what is going on from outward appearances. You are not expected to be a counsellor. Activity • Where do you live? • Do you have children? • What is your job? • • • • • • Can you tell me about… What do you think about… How do you feel about… What happened next … Why do you think that… So what you’re saying is… Where to start • Ask – use open questions • “How do you feel about your health and wellbeing today?” • “What could you change to make your lifestyle healthier?” • “On a scale of 1-10 how important is it for you to make your lifestyle healthier?” (1 being not important at all and 10 being very important) • Listen to what the client tells you • Reflect back “So what you’re saying is…”, “Can I just check…” • Advise – give a fact, tip and know where to signpost to. If they are not interested don’t force the issue – leave the door open. Scaling How do you feel about your health and wellbeing? 1 2 3 4 5 6 7 8 Not good 9 10 Very good How important is it for you to make a change? 1 2 3 4 5 6 7 Not important 8 9 10 Very important How confident do you feel to make a change? 1 2 3 Not confident 4 5 6 7 8 9 10 Very confident Spiral of Change termination maintenance action Progression of change decision contemplation maintenance action lapse/ relaps e decision contemplation pre-contemplation Challenges to MECC If the service user is: • Not interested – leave the door open • Aggressive or confrontational • Under the influence of drink or drugs • Too emotional • Too ill or injured Consider privacy – if the client is in a busy waiting room they may be unwilling to engage. So think about when and where you raise the issue. Dealing with resistance What if the person • doesn’t want to talk? • is defensive? • is not fluent in English? • is tearful? • is in a hurry? • is not telling you the truth? Elephants in the room What issues might prevent your trainees from delivering brief advice consider: • Being a smoker • Having a weight issue • Drinking above the recommended limits • Being physically unfit • Experiencing mental health issues • How would you address it? Pros and Cons Identifying success behaviour: • Can you think of a time in the past where you set a goal and achieved it? (it doesn’t have to be health related) • What made you successful – what skills and techniques did you use? How can you use these to achieve this new goal? Pros and Cons • What are some benefits of changing? Personal, financial… • What are some drawbacks of staying the same? • What are the benefits of staying the same? • What are the drawbacks of changing? Time to Practice Time to have a go • Think of something you want to change • Think of a previous time you achieved a goal, what steps did you take, why was it a success? • What are the pros and cons of making a change vs. staying the same? • Write down your three main reasons for making a change? • Is now a good time to start? • Make yourself a SMART goal related to starting to change. Summary Brief advice is short, simple and factual. You are raising awareness and motivating people to think about making a change. • Ask and Advise – provide facts, tips and where to go for more help. If someone isn’t interested – leave the door open. Brief interventions build on brief advice to help equip service users to take action. • Act – Eliciting service user to identify areas for change, their readiness to change, and facilitating them to set their own goals and a means to achieve them. This may include: scaling, SMART goal setting and signposting to further support. Next steps for training • In small groups discuss: • How best to deliver this session to your department / ward? • What training resources would you need? • What sections from today include / remove? • What additional support is needed? Using MECC could… • Result in someone being grateful you took the time to take an interest • Help someone to make links between their lifestyle and realising other life ambitions • Make someone feel able to take control of their health • Mean that someone could live a longer and healthier life as a result of what you did Questions? ? We can’t do it without you Start Making Every Contact Count today. Further training: E-learning modules: Making Every Contact Count: Level 1 - Brief Opportunistic Advice Level 2 – Brief Interventions Online tool kit of resources: http://nhs.lc/makingeverycontactcount On-going support: If you have any questions that arise following today’s training or want to feedback thoughts or experiences please contact: Sarah Needham, Matron, and David Richardson, Head of Learning and OD.