Developed by Tony Connell Learning and Development Consultant and the East Midlands Health Trainer Hub,

hosted by NHS Derbyshire County

Making Every Contact CountSkills Workshop Session

Shaleen Meelu28th February 2013

Pre Session SurveyI feel knowledgeable about

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

• Refer people to appropriate help and support

• Consider how you might record your contacts

• Know where to go for more information

Today’s Timetable

• 10.00 Introduction to MECC, the health profile of MK, and a look at lifestyle issues

• 11.15 Break

• 11.30 Activity in pairs- What does MECC mean to you, raising the issue, the behavioural change approach, and monitoring the impact of MECC

• 13.00 Lunch (45 minutes)

• 13.45 local MK services

• 14.45 Summary, questions, evaluation

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

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

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

•I t is not about you telling somebody what to do and how to love their life

• It is about you helping other people to know how they can improve their own health and wellbeing

MECC means making the best of every appropriate opportunity to raise the issue of healthy lifestyle•Systematically promoting the benefits of healthy living across the organisation•Asking individuals about their lifestyle and changes they may wish to make•Responding appropriately to the lifestyle issue/s once raised•Taking the appropriate action to either give information, signpost or refer service users to the support they need.

What is MECC?

MECC pathway

Health profile Milton Keynes

• Milton Keynes has higher than average smoking and obesity rates.

• Residents have poorer diets, exercise less and consume more

• Higher harmful levels of alcohol than the rest of the England

Lifestyle risk issueMilton Keynes (%) England (%)

Adults smoking22.9 20.7

Increasing and higher risk drinking 19.9 22.3

Adults not meeting healthy eating standards73.5 71.3

Adults not meeting recommended physical activity levels90.2 88.8

Obese adults 25.3 24.2

What makes you who you are?

Education

Culture

Where you live

Place of birth

Community

Family

Religion

Income

Interests and hobbies

Work

Transport

Physical ActivityWhy is it important?

Regular physical activity can reduce the risk of:- Coronary heart disease - Strokes- Type 2 diabetes - Musculoskeletal disorders- Mental illness - Some cancers

How much activity should we be doing?

• Adults should aim to achieve 150 minutes moderate intensity activity over the week• 30 minutes X 5• Reduce time spent sedentary (sitting)• Moderate intensity will cause increased temperature, breathing and heart rate, but should still be able to carry on a conversation• Example exercises; brisk walking, cycling, gardening, sport

Healthy Eating & Weight ManagementWhy is it important?

• Being overweight and not eating a healthy diet can cause many illnesses

• In Milton Keynes 25.3% of the adult population are obese and 73.5% of adults do not eat 5 a day of fruit and veg

What should we be aiming for?

• BMI between 18.5 – 25

• Achieving 150 minutes moderate intensity physical activity over the week

• Base your meals on starchy foods, eat lots of fruit and veg (5 a day), eat more fish, choose lean cuts of meat, cut down on saturated fat and sugar, and drink plenty of water

Smoking• Smoking is the main avoidable cause of

premature death in England• In Milton Keynes 22.9% of the adult

population smoke• Giving up smoking can have many benefits

and the effects can been seen almost immediately

For advice and information about smoking, quit tools, and stories of real life quitters support is available at www.smokefree.nhs.uk or by calling 0800 022 4 332

AlcoholWhy is it important?

Drinking to much alcohol increases the risk of developing:• Serious liver disease• Stomach and pancreas disorders• Anxiety and depression• Accidents• Cancers (mouth, liver, colon and breast)• Muscle and heart disease

What should we be aiming for?• Women should not regularly drink more than 2-3 units a day• Men should not drink more than 3 – 4 units a day• Pregnant women, or women trying to become pregnant, should be advised to avoid alcohol altogether• Try to have 2 alcohol free days a week

Mental wellbeing

Why is it important?

Mental health problems can cause:

• Panic attacks• Loss of interest in social activities• Feelings of sadness or loneliness• Low self esteem or persistent guilt• Heavy or frequent alcohol consumption• Smoking excessively to relieve stress• Difficulty in sleeping

Mental Wellbeing

Suggestions you could make:

• Keep active (ideally 30 minutes exercise a day)

• Eat healthily do not smoke and only drink alcohol in moderation

• Enjoy nature (try gardening or have a pet)

• Keep in touch with friends

• Accept the person you are and avoid harmful emotions

• Do something creative and learn new skills

• Talk about your feelings.

Health Checks

The NHS Health Checks programme aims to prevent heart disease, stroke, diabetes and kidney disease

Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions, will be invited (once every five years) to have a check to assess their risk of developing these illnesses and will be given support and advice to help them reduce or manage that risk

Using a comprehensive approach;

• Inform and support people to make healthier and more responsible choices

• Creating an environment in which the healthier and more responsible choice is the easier choice

• Identifying, advising and treating those at risk

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?

When can you raise an issue?

• During any day to day contact with the client

• When you hear them mention a lifestyle problem

• When you can see that support with a lifestyle issue may be of help

• As part of existing information gathering arrangements

• Consider making a list of when you have contact with clients – face to face, phone, forms etc.

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

1 2 3 4 5 6 7 8 9 10

How do you feel about your health and wellbeing?

Not good Very good

1 2 3 4 5 6 7 8 9 10

How important is it for you to make a change?

Not important Very important

1 2 3 4 5 6 7 8 9 10

How confident do you feel to make a change?

Not confident Very confident

Responding to a lifestyle issue

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.

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?

Making Effective Contacts

Look interested

Involve yourself by responding

Stay focussed on information giving

Test your understanding

Evaluate what is not being said

Neutralise your feelings.

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

Spiral of Change

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decision

decision

actionmaintenance

terminationPr

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ch

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contemplation

actionmaintenance

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The elephant in the roomWe might find it difficult to raise a lifestyle issue with a client if we…

• smoke

• drink too much

• eat an unhealthy diet

• don’t exercise enough

• have sexual health issues

• have emotional health problems …ourselves!

The elephant in the room

• We have a responsibility to convey healthy lifestyle messages to our clients

• Providing information provides choice

• Proving information and support about unhealthy behaviours may lead to us considering lifestyle changes ourselves.

Time to have a go

Monitoring the impact of MECCHow do you know you have had an impact?

How do you monitor?

Discuss how you can monitor your contacts and the impact MECC may have had

Monitoring needs to be tailored according to the needs and structure of your team/organisation

Any questions?

Post session surveysI feel knowledgeable about

How confident do you feel about raising a lifestyle issue with a colleague?

1 = not confident at all 2 = a little confident

3 = fairly confident 4 = very confident

Contact:

Jennifer Howells

Jennifer.howells@milton-keynes.gov.uk

01908 254267

Sarah Worbey

Sarah.worbey@milton-keynes.gov.uk

01908 254205