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Promoting Behaviour Change – An Introduction

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1 Promoting Behaviour Change – An Introduction
The SCIP Technique Promoting Behaviour Change – An Introduction

2 First Contact Clinical Community Interest Company
Who are we? We are always looking for work that employs our knowledge and skills and helps to improve patient care. We would be happy to talk to you if you about potential projects or consultancy. Find out more at . First Contact Clinical Community Interest Company “Providing solutions to challenge the health related problems found more commonly in disadvantaged areas and communities.” Our values Integrity We mean what we say, and do it. Quality We never compromise on quality. Passion Our beliefs drive our actions. Pioneers We create new and innovative solutions from problems. Together Strong individuals, stronger team. Background Points: Not for profit organisation – clinician lead (GP’s, Counsellor) Skills developed “in clinical settings” ie not a class room Scene Setting: May be useful to get a feel for “who they are”: “ SO THIS IS US....WHAT ABOUT YOU....why are you here?” Key Points: Techniques aimed at “risky drinkers” “people who drink too much but not too too much” Base of Public Health pyramid.....not dependant drinkers.....

3 Aim To explore how motivate those at risk of vascular disease in a time efficient way using a structured behaviour change tool

4 The NHS Health Check Combines screening, communication of risk and lifestyle advice to reduce: the impact of CVD for individuals the time required to care for CVD patients by health professionals the cost associated with CVD in the NHS What is it? NHS Health Check is a national vascular risk assessment and management programme. It began in England in 2009 and will be fully implemented by 2012/13.It used to be called the ‘Vascular Check Programme’ but since April 2009 has been called NHS Health Checks. Most people do not understand the term ‘vascular,’ which refers to heart disease, stroke, diabetes and kidney disease so the term ‘NHS Health Check’ replaced the word vascular. Policy background The National Service Framework for Coronary Heart Disease in 2000 was extremely successful in reducing death from CHD. This suggested that a similar national strategy aimed at preventing CVD, kidney disease and diabetes might be equally successful. That strategy was outlined in the ‘Putting Prevention First’ publication in It argued that a vascular programme would be clinically and cost effective preventing 9,500 strokes a year, 4,000 people from developing diabetes and diagnosing 25,000 with diabetes and kidney disease a year earlier that they would have been diagnosed. Local policy NHS South of Tyne and Wear introduced the concept of primary prevention of vascular disease in advance of the National Program. The “Closing the Gap” program included two Local Enhanced Services aimed at GPs as well as a number of innovative community based projects. These have had mixed success particularly in reaching the target group of unworried unwell. NHS Health Checks replaces these previous programmes and is supplemented by other local iniatives aimed at improving CV health SOTW. Who is eligible for a Health Check? Who to risk assess and when to intervene The Health Check programme recommends that everyone aged without pre-existing CVD should be offered an assessment of their CV risk. This is based on information about their medical history and circumstances, together with BMI, lipid and blood sugar measurements. The risk score where treatment is warranted is 20% or over. At this point lifestyle and drug treatment should be offered. People under 40 are considered to be at low risk of CVD. People over the age of 74 are automatically considered to be at high risk of CVD over the following 10 years. This is a generalisation – some younger patients will be at increased risk of CVD and will benefit from lifestyle and drug interventions. These include; South Asians (people from India, Pakistan, Bangladesh) People with familial hypercholesterolaemia (FH) People with diabetes mellitus People with metabolic syndrome People whose risk is lower than 20% will still benefit from lifestyle advice and interventions for specific risk factors such as raised blood pressure. People known to have hypertension are eligible to have a Health Check. If they are having treatment to control their blood pressure or lipids practitioners will need to use pre-treatment readings to calculate their CV risk. Access to Health Checks Health Checks are available from GP surgeries, health centres, walk in centres and pharmacies. The aim is to make it easy for people to access a check and to attend for follow up advice and support. Who can do the Health Check? Any competent trained professional can do a check. This is likely to be a nurse, pharmacist, pharmacy assistant or doctor.

5 Which requires….. Maximum uptake of screening in the target group
Accurate communication of CVD risk and lifestyle advice Some people to make difficult lifestyle changes

6 ….and possibly a ‘new conversation’

7 Today’s Training Three Minute Motivation The New Conversation
Behaviour Change ABC The SCIP Technique Skills Rehearsal Sweet and Sour Takeaway

8 Exercise One - Part 1 Using the worksheet provided come up with as many reasons to achieve the actions highlighted in each of the boxes.

9 Exercise One - Part 2 Following the instructions on your worksheet now complete the second part of exercise one!

10 Three Minute Motivation
Motivational Interviewing is an evidence based intervention. It is a useful tool that has never been needed more. We are faced with a growing health crisis. Changing unhealthy lifestyles is an essential part of reducing health inequalities and closing the life expectancy gap. However Motivational Interviewing takes time: to learn and deliver. We don’t always have the time and resources available. We need to be able to have effective conversations about change that are easy and quick to deliver. We need to make the skills and techniques of motivational interviewing as accessible to as many people as possible. We need a “new” conversation!

11 Exercise One - Inner Conflict
Reasons not to change Reasons to change Reasons to stay the same Reasons not to stay the same Exercise One: Understanding Ambivalence This exercise is to highlight the two sides of the inner conflict. Think of something that you could change. This can be anything! Complete Box 1 (below). Once you have completed the box – are you more or less likely to change? Or are you still Ambivalent?

12 A: Ambivalence “To want to and not want to at the same time…”
No Change Change Ambivalence What’s bad about now What’s good about now What’s good about change What’s bad about change The Inner Conflict: most people are aware that some changes are good for them – they know good reasons to change. Most people are also comfortable with their usual routines and change requires some effort and sometimes discomfort (exercising for the first time in a while, nicotine withdrawal, losing a social life centred around an unhealthy behaviour) – they know good reasons to stay the same (not change). The default position is status quo – inertia – stay the same. The usual pattern is: think about the reasons to change, then counter that with a reason not to change and ultimately: do nothing. They become stuck in AMBIVALENCE. There is an inner conflict: Reasons Not To Change Reasons To Change Reasons To Stay the Same v Reasons Not To Stay the Same There are things that can happen that move the person in one direction or the other: making change more or less likely. When we are motivating a behaviour change we are trying to guide people towards the “change side” and as a result make change more likely. We need to be aware that there are things that we do that move them in the opposite direction – so despite our best efforts making change less likely. “To want to and not want to at the same time…”

13 B: Beware the Righting Reflex
No Change Change Ambivalence When we are talking to people about change we are doing so because we see what good the change will do. We understand why stopping smoking or doing more exercise would be good. We are trying to “help” them. For some of us that’s our job! We explain carefully why change is good, why staying the same is bad and offer helpful suggestions of how they might do it. We do a good job!

14 C: Change Conversations
Think about how we might do things differently? Ask rather than advise Listen more and talk less We understand the inner conflict of ambivalence and how our natural desire to help and make it “right” can actually frustrate us. So how do we move people on – away from status quo and towards change? We need to have change conversations! The “righting reflex” can frustrate us because the wrong person is talking about change. We need to swap roles and have a change conversation. A change conversation is a way of getting the right person talking about change. The difference between the righting reflex and a change conversation is subtle but important and it is down to what you do: You ask rather than advise You listen more and talk less

15 Behaviour Change ABC A: Ambivalence B: Beware the “Righting Reflex”
C: Change Conversations Adapted from “Motivational Interviewing in Health Care” by Rollnick, Miller and Butler

16 One Problem! How do we have an effective “change conversation”, that moves the person out of ambivalence and towards change in a busy setting without using the righting reflex to manage the time? We have spent time look at the ABCDE of Behaviour Change. We understand the basic principles. The next step is to put it into practice. Problem: How do we have an effective “change conversation”, discover what will fuel the change, empower the patient and move them towards commitment in a busy setting without using the righting reflex to manage the time? Answer A: You won’t always Answer B: You do more training and skills practice in Motivational Interviewing Answer C: You use the SCIP technique

17 The SCIP Technique SHARE the risks COMPARE to the benefits discuss IDEAS make a PLAN No Change Change Ambivalence I could…. I should…… I might… I WILL The SCIP technique is a simple four step process: SHARE the risks, COMPARE to the benefits, discuss IDEAS, and make a PLAN. It uses bespoke “SCIP Charts” designed to generate effective Change Conversations. The technique guides the changer from ambivalence through intention to commitment. It is designed to be time efficient and with a small amount of practice can deliver results in three minutes.

18 SCIP Charts SCIP Charts:
The SCIP charts are created for a specific behaviour change. They give examples of the risks of the current behaviour (the reasons not to stay the same), benefits of the new behaviour (the reasons to change) and ideas that other people have “found useful” when considering this change. The content is age, sex and behaviour specific. The examples are offered to stimulate the changer and generate change talk. What stimulates change talk in a teenage boy will be different from what stimulates change talk in a middle aged woman. So the examples offered to each group are different! By asking specific open questions and using the charts as prompts we can generate change talk quickly and efficiently.

19 SCIP: Skills Rehearsal
SCIP: Demonstration Dave is a 43 year old with a CVD risk factor of 27% during his Health Check he disclosed he drank 8-10 units of alcohol 3 to 4 times a week. SCIP: Skills Rehearsal

20 Exercise Two Using the SCIP training template have a different conversation aimed at raising motivation to commit to reducing alcohol consumption.

21 Useful Tips If you are doing all the speaking you are “directing”. Resist the righting reflex – ask an open question (what....? How.....? Where.....? Tell me about......?) and listen to the answer. Don’t PUSH the changer to the next stage before they are ready but don’t help them to get stuck – beware “chronic contemplators”. Ask what would have to happen to help them move on....? Remember the patients ideas, thoughts and feelings are more important than yours – get them to share whilst you try not to. If you get stuck: stop – directing and pushing just creates further resistance

22 Sweet and Sour Takeaway
What have you enjoyed? What have you not liked? What will you take away?

23 This session is supported by
Three Minute Motivation Increasing Physical Activity Smoking Cessation SCIP Healthy Eating Drug & Alcohol SCIP

24 The SCIP Technique Questions and Answers

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