MECC Level 2 A Person-centred approach for the integrated care workforce

Welcome to Level 2 Making Every Contact Count (MECC) for Integrated Care

This course supports integrated care working, and looks at conversations about wellbeing in more depth than Level One MECC Welcome to wellbeing.

 It will help to you apply a person centred approach to conversations which support improvements in wellbeing in the people whom you meet through work on a regular basis. It will help you to encourage improvements in lifestyle behaviours and to seek solutions to other key issues which can impact on recovery and independent living.

You will be able to use a simple 3 Question conversation framework to support the person to prioritise issues which are important to wellbeing and encourage them to plan and take their first steps towards their desired personal outcomes for wellbeing

WELLBEING

WELLBEING

WELLBEING and it's importance in integrated care working

Why does wellbeing matter ?

Wellbeing is about feeling good and functioning well - whatever our personal circumstances.

Here are some key things that we know about wellbeing and how it can help people to cope with health conditions:

Supporting people to improve their wellbeing is important for prevention of ill health, recovery from illness and better self care management for people with long term conditions. Some of these people have multimorbidity - they have more than 2 chronic health conditions.

Multimorbidity is becoming more common as people are living longer but not necessarily living with good health.

Multimorbidity is more common in people from less affluent areas. A recent study found that 2/3 of people aged 65 and over had multimorbidity, and 47% had 3 or more conditions

Whereas in older people multimorbidity is largely due to higher rates of physical healthy conditions, in younger people it is more often due to a combination of physical and mental health conditions eg depression

About 10% of people over 65 with multimorbidity also have frailty, rising to between 25-50% of people over 85.

Older people living with frailty are at risk of adverse outcomes to their physical and mental wellbeing after relatively minor events which challenge their body systems eg an infection or new medication

Multimorbidity is associated with

-poorer quality of life

-polypharmacy (use of many medications)

-higher rates of adverse reactions to medications

-higher rates of unplanned and emergency care

HOW CAN WE MAKE A DIFFERENCE?

For individuals to make well-informed decisions about their self-care they must have access to appropriate information and understand the range of options available to them

Person-centred practice engages, supports, encourages and facilitates involvement and helps individuals to make decisions that are right for them.

By having conversations which support enhanced wellbeing we can help people to recover more quickly, adopt good habits of self-care and help them to stay independent for longer. 

 WELLBEING IS ABOUT FEELING GOOD AND FUNCTIONING WELL

It is about flourishing in your life whatever your circumstances. 

  • Wellbeing adds years to life and life to years
  • It aids recovery from illness: poor wellbeing is associated with slower wound healing
  • It is associated with positive outcomes: people with good wellbeing are more likely to have a healthy diet, be physically active and less likely to smoke
  • Young people with high levels of wellbeing are less likely to engage in unhealthy or risk-taking behaviours
  • It is good for the community too - it spreads through social pathways and influences the wellbeing of others close to us
  • It may ultimately reduce the health and social care burden
  • It is associated with broader positive outcomes such as employment, education and relationships



WHAT'S THE PROBLEM?

WHAT'S THE PROBLEM?

Well, the way we live for a start. We are living longer but not necessarily living longer in good health - or with happiness. We are likely to be more isolated as we grow older compared to people living a hundred years ago.

In the last decade alone, physicians and researchers have begun looking deeply into the impact of loneliness and social isolation on health, well being, and mortality, and the data on the subject is overwhelming: a lonely person is significantly more likely to suffer an early death than a non-lonely one.

As we live longer we are more at risk of living with a disability or a long term condition. Sometimes people live with multimorbidities - two or more chronic medical conditions.

Many people with long term conditions feel that life is a bit of a struggle, and their wellbeing may suffer as a result.

Did you know that between 25 and 40 per cent of the population feel disengaged about their own health and wellbeing?  They are more likely to

• feel overwhelmed with the task of managing their health

• have little confidence in their ability to have a positive impact on their health

• misunderstand their role in the care process

• have limited problem-solving skills

• have had substantial experience of failing to manage their health, and have

  become passive in managing their health

• say that they would rather not think about their health.

When people have multimorbidities or care for people with long term conditions, it is important that we enable people to be involved in their own wellbeing. It will help people to stay as independent as possible for longer

People often complain that their care is not joined up - or that they don't feel consulted or listened to.

As workers we also can use this as an opportunity to find out more about each other too- so we understand a little more about each others' roles and we can communicate better to each other about how to best meet people's expressed needs



ENABLING ENGAGEMENT IN WELLBEING

SO HOW CAN WE MAKE EVERY CONTACT COUNT FOR WELLBEING?

We know that wellbeing matters. People say they have good wellbeing when they 

  • feel that they can cope with whatever life throws at them
  • feel they have supportive friends and good relationships with health and social care staff
  • feel they are listened to and supported to make any changes that are meaningful for them
  • feel that they can still participate and have meaning in their lives - through having a good social life, through what they can give back to others, through joining in with activities that are important to them or whatever

We can all do a bit more to help people

  • identify what's really important to them about health and wellbeing and what  actions could they take to achieve their own welllbeing goals - these  goals are called their Personal Outcomes
  • be more in control of their health and wellbeing - by having up to date information about how lifestyle behaviours can affect their medical conditions -and how to change them; 
  • feel they are real partners with us in improving their health and wellbeing - by being able to ask questions of their health and social care workers about the plans in place to help them recover or cope better with their conditions; by having the confidence to challenge health and care workers, and to plan the support that they need with them
  • access local groups and services so they can have more fun and meaning in their lives


As part of the integrated care workforce we can 

  • listen, understand and communicate better with other health and social care workers about how best to meet people's wellbeing needs



BUILDING THE HOUSE OF CARE

MAKE EVERY CONTACT COUNT WITHIN INTEGRATED CARE

Partnerships start with good conversation skills and a willingness to see the person as the expert in their own lives

5 KEY THEMES THAT ARE IMPORTANT FOR WELLBEING

5 KEY THEMES

WELLBEING IS NOT JUST ABOUT HEALTH

Here are 5 key themes that people have identified as being important for their wellbeing.

Do you recognise any of these issues as being pertinent for the people with whom you work?

HERE ARE SOME OF THE THINGS THAT PEOPLE HAVE SAID ARE IMPORTANT TO THEIR WELLBEING

HEALTH

I feel I am coping well with my condition at the moment

I am attending all the health checks that I have been invited to

I have access to food and drinks so I don't go hungry or thirsty

I attend a medications review on a regular basis so I don't suffer from side effects of my medicines

I feel relaxed and I sleep well at night

I keep active as much as I can

I don't smoke or drink too much alcohol

RELATIONSHIPS

I have regular contact with other people

I can skype my family when I don't get to see them for any reason

I have some friends whom I trust and on whom I can rely

I get on well with my carers

PARTICIPATION

I have joined a local wildlife group and we do activities together that benefit our local community

I am a volunteer at our local charity shop

I help out at the hospital on a regular basis, chatting to patients and directing visitors

I have become a member of our local church choir

I go to my Mosque on a regular basis

I get out and about and have fun!

HERE ARE SOME OF THE THINGS THAT PEOPLE HAVE SAID ARE IMPORTANT TO THEIR WELLBEING

SECURITY

I have had a home safety check by our local Fire Service

I have a working smoke alarm

I have chain locks on my doors so I control who enters my house

I used to gamble a lot but I sought help - now I feel much more financially secure

I'm very careful to have safe sex as I feel this is really important

INDEPENDENCE

I can get out and about now I have a motorised wheelchair

I try to keep as active as possible so i can get out of the house and stay independent

I keep my brain active by playing chess every day and I've even compiled some crosswords for our local community magazine!

I sat down with a list of questions in front of my GP and was able to have a proper discussion about my care plan with him

If I feel there needs to be more support for me, I am able to bring up this topic with my care co-ordinator and have a good chat with her


WHAT ARE THE 5 KEY THEMES?

  • HEALTH, SAFETY, SPIRITUALITY, RELATIONSHIPS AND EDUCATION
  • HEALTH, RELATIONSHIPS, PARTICIPATION, SECURITY AND INDEPENDENCE
  • HEALTH, SEXUALITY, SPIRITUALITY, INDEPENDENCE AND SAFETY

A PERSON-CENTRED APPROACH TO PERSONAL OUTCOMES

WHAT DO WE MEAN BY A PERSON-CENTRED APPROACH TO OUR CONVERSATIONS?

A PERSON-CENTRED APPROACH to integrated care working

A person-centred approach to care is a way of thinking and doing things that sees the people using health and social services as equal partners in care to make sure it meets their needs.

IT STARTS WITH YOUR MINDSET

  • See the Person not the Patient
  • See people as Experts on their own lives
  • Understand that people are more resourceful than you think


Person-centred care is not just about giving people whatever they want or providing information. It is about seeing the person as an individual, and working together to develop appropriate solutions

  • taking into account people’s preferences and expressed needs
  • working together to make sure there is good communication
  • making sure people are physically comfortable and safe
  • offering practical and emotional support
  • involving family and friends
  • making sure people have access to appropriate care when they need it


We may have outcomes to meet in our roles, of course, but we need also to attend to the personal outcomes for the people we are working to support - these are the outcomes that really matter to the person. They are the personal outcomes that matter to their wellbeing


SO HOW DO WE FIND OUT WHAT PERSONAL OUTCOMES ARE IMPORTANT TO OUR CLIENTS?

Personal outcomes are the most important health, wellbeing and life goals an individual aspires to at a given time and in given circumstances. These may or may not be documented as part of a support plan. In any event they should be the focal point of any conversation between a person and their service delivery professionals. Personal Outcomes should always be defined by the person

We can only assess what outcomes are important for the person by ENGAGING them in a conversation about welllbeing and ASKING them what issues they feel are important for their wellbeing

We can also do a formal Personal Outcomes Assessment if this would help. There is a Personal Outcomes Assessment Tool in the MECC PLUS for INTEGRATED CARE TOOLKIT


WHAT DO WE MEAN BY PERSONAL OUTCOMES?

  • THE ISSUES THAT WE THINK ARE MOST IMPORTANT FOR THE PERSON
  • THE DESIRED OUTCOMES THAT THE PERSON HAS IDENTIFIED WILL IMPROVE THEIR WELLBEING
  • THE ISSUES THAT ARE IN THEIR CARE PLAN
  • THE ISSUES THAT ARE LINKED TO THE REASONS THAT WE ARE SUPPORTING THEM OR TREATING THEM

PERSONAL OUTCOMES ASSESSMENT TOOL

Help people to identify their personal outcomes

Help people to identify the changes they would like to see

A 3 QUESTION FRAMEWORK

A 3 QUESTION FRAMEWORK TO HELP YOU ENGAGE PEOPLE ABOUT WELLBEING

HERE IS A 3 QUESTION FRAMEWORK WHICH YOU MAY FIND USEFUL IN ENGAGING PEOPLE IN WELLBEING

Q1. "What really matters to you?"  We have discovered how the 5 key themes for wellbeing are important for people's health, recovery and independence. 

Our role as a worker, however, may focus on very specific issues and not take into account all of the 5 key themes. We need to make sure that we don't become "blinkered" and forget to think about all of those themes when we have conversations with our clients

So, after you have finished your specific tasks with the person, why not take the opportunity to enquire

"Is there anything else that is important to you right now?"

This is what is called an OPEN DISCOVERY QUESTION. 

It gives permission to the other person to tell us about THEIR views and THEIR needs. 

You can of course use the Personal Outcomes Tool to help this conversation, by showing the person a graphic of the 5 key themes and inviting them to think about each in turn.

"What really matters to you in terms of your health right now?"

"What really matters to you in terms of your relationships right now?"

"What really matters to you when thinking about how much you feel you participate in life at the moment - what might add some extra meaning to your life right now?"

What really matters to your security right now?

What really matters to you in terms of becoming more independent?


QUESTION 1

"WHAT REALLY MATTERS TO YOU?"

Ask gently and sensitively a question which will elicit the issues that the person feels impacts on their wellbeing right now

QUESTION 2: "WHAT WOULD "DOING GREAT" LOOK LIKE IN THIS AREA ?

Once the person has identified any particular areas of concern in those 5 key themes, you can begin to explore together what might be the desired Personal Outcome for them

" In this area of concern for you, if things were at their best, what  would "doing great" look like for you?"


For a person concerned about feeling safe at home their ideal personal outcome may be to have all the keys to their own front door in their possession, or to be able to say No to people who come around to their home expecting things from them; it may be about having strong locks on their windows and doors; it may be having a plan in place to pay off  debts, or being able to put aside savings every week to pay for bills and maybe have a holiday in the future.

For a person concerned about their health it might be having a warm home this winter, reducing the side effects from their medications, having a thorough health check, becoming more active and less sedentary, having enough food and drink available to them, quitting smoking or whatever.

For some people it may be about having more friends or seeing existing friends more often so they don't feel so isolated or lonely

For some people it may be about having more meaning in their lives - being able to visit their church, gurdwara or mosque; becoming more involved in local charities, or maybe even getting back into some employment

For some people it may be having a more active say in their Care Plan - feeling that they are being consulted and listened to by health and social care staff.

Only when you BOTH have a clear idea of what the ideal outcome would look like can you support the person to take some first steps towards achieving that outcome.


QUESTION 2

"What does "doing great" look like in this issue for you?"

This is the "miracle question". If a miracle happened and everything was fine in the area that concerns you most, what would this new landscape look like?

"What would have to have happened to make a real difference to your wellbeing?"

"What's the  difference that makes the difference?"

QUESTION 3

"What will be your first steps towards achieving your personal outcome, and what support will you need?

"Now you have a clear image in your mind about what your desired personal outcome is, it may be helpful to think about what you need to make this image a reality"

"What will your first steps be towards achieving your personal outcome?"

"What support do you need to make this happen?"

QUESTION 3

"What will be your first steps towards achieving your personal outcomes, and what support will you need?"

WHY IS CHANGE DIFFICULT SOMETIMES?

People sometimes think that motivation is enough for change to happen. Not so!

Humans are complex beings, and supporting people to change can be a challenge sometimes.

It helps if we think about the key ingredients that seem to be necessary for people to successfully make lasting changes

It may surprise you to know that 

Motivation on it's own is not enough and it's NOT all about willpower

In fact, often people are already very motivated to change, but they are just not sure HOW TO change. Think about trying to eat a healthier diet if you do not understand how to real food labels,or do not know what a healthy diet is supposed to look like.

Sometimes people's experience of change is that it just doesn't work for them. They may have tried change -to quit smoking, to make friends with others, to feel happier, to sleep better, to lose weight or whatever - on many occasions and just not succeeded yet.

For older people and people living with long-term conditions, it is important to encourage greater engagement in their own care. They may feel that improvement is difficult or even impossible, they may not be aware of the benefits that improved wellbeing and healthier lifestyles can have on their recovery and future health risks. They may have lost heart and feel that they are a hopeless case.


So if we help people to 

-believe that they can succeed

-know how to make changes

-have support, encouragement and the right opportunity to change

we can make a real difference.

We have found a good framework to use when we want to help people to change:

We know that there are 3 key ingredients necessary when ANYONE wishes to change. These are  CAPABILITY MOTIVATION and OPPORTUNITY. 



CAPABILITY, MOTIVATION AND OPPORTUNITY ARE 3 KEY INGREDIENTS NECESSARY FOR CHANGE

People will be much more likely to succeed at changing their behaviours if they feel

-capable: do they need more information to make a decision about how to change? do they need to learn any skills? do they need practical support to change? would learning to go online or to use Skype help?

-motivated: does the person really want to change? have they imagined all the benefits if they do change? Can they make good plans to change and make a new habit of doing things differently?

-have the opportunity to change: does the person have people around them supporting them to change? would  they like a buddy to support them or to join a group? do they need support to access services to help them?




WHAT CAN WE DO TO ENHANCE CAPABILITY, MOTIVATION AND OPPORTUNITY?

CAPABILITY

Check the person has the INFORMATION that they need eg Do they need information about how to have a balanced diet?

Do they know what the recommendations for being active are?

Do they know where to access further support?

Do they need to learn a new skill such as cookery?

MOTIVATION

Be encouraging and supportive of the person making changes

Encourage them to make a SMART goal

Encourage them to make a proper plan to change

OPPORTUNITY

Ask them if having a change buddy or if joining a group would help

Ask them if they have people who will encourage and support them

Arrange for help with transport if needed

HOW CAN WE ENHANCE CAPABILITY, MOTIVATION AND OPPORTUNITY TO CHANGE?

  • Support the person to identify any skills or information about how to do things that they need to build capability to change
  • Organize everything on their behalf as you know what people need to change
  • Invite the person to imagine how good they will feel when they have made the change, in order to increase their motivation
  • Invite the person to consider whether they need to access practical support and advocacy
  • Just focus on motivation as nothing else really matters
  • Just give them a leaflet as if they are not keen to change then there's nothing anyone can do that will make a difference
  • Ask the person to consider the support and information they feel they need to take the next step

WHAT ARE THE 3 KEY INGREDIENTS NECESSARY FOR CHANGE?

  • MOTIVATION, MOTIVATION AND MORE MOTIVATION
  • CAPABILITY, MOTIVATION AND OPPORTUNITY
  • MOTIVATION, MONEY AND PAST EXPERIENCE OF SUCCESS

COMMUNICATION

BODY LANGUAGE

Communication starts with the signals that you give out through your body language

Are you sending out signals that are welcoming? 

 - have a relaxed, open posture.

- stand or sit at the same level

- smile and use their name

-have a gentle tone of voice

-speak clearly- 

OPEN QUESTIONS

Open Questions are very useful because they help us to be Person-Centred. They put the control over where the conversation is going back in the person’s hands. They also help the person to consider the things that they want to change, and how to do so.

Open questions start with words like

Who?  What?  Why?  How?  When? Where?

“What are you interested in changing?”

“How will you know when you have reached your outcome?”

“Why is it so important for you to make this change right now?”

“Who can help you to make this change?”

“When can you take your first step towards your goal?”

“Where can you go to for more support?”


WHICH OF THE FOLLOWING ARE OPEN QUESTIONS?

  • "How are you feeling today?"
  • "Have you thought about quitting smoking?"
  • "Would you like to make improvements to your wellbeing?"
  • "What do you feel would make a real impact on your wellbeing?"
  • "What support do you think you may need to make this change?"
  • "What benefits can you think of if you made some changes here?"
  • "Do you think your first step is seeing your GP?"
  • "Would you like this information about wellbeing?"
there are 4 correct answers

SUPPORTING CHANGE

MAKING A PERSONAL OUTCOME A REALITY

SET A SMART GOAL

If the personal outcome is vague, such as "I think I need to get a bit more exercise to improve my wellbeing" then it may be harder to achieve. 

So help the person to think about their first steps- and to set a SMART goal

S = SPECIFIC             "What sort of exercise would you like to do each day?

M - MEASURABLE   "How much brisk walking will you do- ten minutes a day? twenty?"

                                         "Can you keep a diary to make sure that you do this as you planned?"

A = ACHIEVABLE      "Is this something that you feel you can achieve?"

                                         "Will you need to check with your GP first?"

R = RELEVANT          "Tell me about why you feel going for a brisk walk will improve your wellbeing."

                                         "Is  making this change going to help you to achieve an improvement in your wellbeing?"

T = TIMELY                  "How long will you do this for? "

MOST CHANGES NEED TO BE KEPT UP FOR ABOUT 3 MONTHS BEFORE THEY BECOME A HABIT

IF-THEN PLANS

PLANNING WORKS!

Sometimes all is going well - and then we get de-railed!

"We were planning to go for a jog after work every day - but then winter set in and it's too cold!"

Planning makes a real difference

In one study, participants were asked to plan where and when they would exercise each week 

(e.g., “If it is Monday, Wednesday, or Friday, then I will hit the gym for an hour before work.”) 

The results were dramatic: months later, 91% of if-then planners were still exercising regularly, compared to only 39% of non-planners! 

An "IF-THEN" plan also helps a person to plan contingencies for when things go awry

"If it is raining and it's too wet and cold to go jogging, then I will go swimming instead"


WHAT DOES SMART STAND FOR?

  • Sensible, Measurable, Achievable, Realistic and Timely
  • Specific, Meaningful, Achievable, Realistic and Truthful
  • Specific, Measurable, Achievable, Relevant and Timely

MORE TOP TIPS

START WITH SMALL STEPS

Nobody ever climbed Everest on their first attempt to walk!

Encourage small but meaningful steps towards the personal outcomes of choice

Think CAPABILITY

Think MOTIVATION

Think OPPORTUNITY

Help the person to identify their first steps which will improve their capability, motivation and opportunity to change

MAKE A COMMITMENT

Encourage the person to tell other people of their decision to change

or write down on a piece of paper their personal commitment to change

REWARD SUCCESS

Change takes effort, so it is good to have a reward if you are on the right track

Encourage the person to build in small rewards along each of their steps towards their personal outcomes

THANK YOU

THANK YOU FOR USING A PERSON-CENTRED APPROACH TO MAKING EVERY CONTACT COUNT