About Taking Control

1. About Taking Control

2. Introducing Taking Control • A self management care plan which aims to support individuals with elevated CV risk to develop self-management skills (ie; build health literacy and to achieve behaviour change) in order to improve their heart health • Designed to be worked through in a structured way with a healthcare provider • Developed using co-creating design principles

3. Thinking behind Taking Control • No quick fix or magic cure for elevated CV risk • CV risk management outcomes are mediated by individual’s own behaviour/lifestyle • Essentially, for CV risk management as with other long term conditions individuals have to take control and do it for themselves - they need to become effective self-managers • Health professionals’ role is to support individuals to become effective self-managers

4. What makes a good self-manager? Evidence suggests that self-management is contingent upon four key things happening for individuals and families: Achieving self confidence Getting good information Altering behaviour Having technical skills

5. Strategies to support self-management British Health Foundation 2011: Helping people help themselves

6. Which techniques and strategies work?For individuals and families: Evidence unequivocal: • Not a ‘one size fits all’ • Different people need different things and need to be able to build their own package • Needs will change over time and as disease progresses or situations change But some strategies are proven to be more effective than others for the majority of people.

7. Which techniques and strategies work?For health professionals: • Need to be practical and sustainable • Move from rhetoric to ‘how to’ and address known issues relating to self-management programmes – time, complexity • Model has to align with ‘business as usual’ (30 mins)

8. Self-Management Strategies used in Taking Control:Effective and Practical Focus on building self-efficacy Risk communication Telephone coaching Care planning Goal setting and action planning Focus on providing good information Focus on supporting behaviour change Accessible written information Self-monitoring Focus on developing technical skills Health Literacy

9. Model of care Developed to be delivered in a structured way Face to face risk communication and ‘plan for change’ Face to face review and ‘plan for change’ Telephone follow up Telephone follow up 30 mins 5 -10 mins 5 -10 mins 15-20 mins

10. Taking control overview Divided into three steps: • Understand risk - risk communication / risk factors • Plan for change - goal /target-setting/support/problem solving/ self-monitoring • Information, tools and support

11. Usability testing / co-creating Taking Control

12. Usability testing with three practices • Provided team training at each practice • Practice delivered programme using structured model of care • Group feedback on all components of programme from health professionals, individuals and families

13. Individual and family feedback Risk communication • “It was a wake up call.” • “Hearing that you have a high risk gives you a kick up the britches.” Goal setting • “It gave you permission to focus on one thing.” • “It encourages you to (gradually) extend your tent pegs - to make your tent bigger and be in a better position to do more.”

14. Individual and family feedback Supportfrom health professional and family/friends • “Having my wife as ‘coach’ has really helped.” • “My nurse contributed 100% to our experience.” Information(framed positively and practical ‘how to’) • “It’s very positive - the way its presented - not you can’t do it, but you can do it.”

15. Health professional feedback Appreciated structure and process • “Provided a script to follow.” Risk communication • “You could see the light going on.” Goal setting • “It didn’t make it overwhelming.” BUT TOOK TIME “..so much information to give.”

16. Key messages for practice development • Information! Navigate don’t teach! • Health professionals shift from educator to facilitator/coach • Flow of information in booklet provides a structure to follow • Linking with community resources • Practice systems and workflow

17. The last word Patients “the programme is life changing” “I had a wake up call” “it gives you a pattern – something to work towards” “it’s there for you to take” Health Professionals “you could see the light going on” “it didn’t make it overwhelming” “helped keep it simple” “just focussing on one thing – giving permission to be very specific”

18. Taking Control in actionCourse 5, eModule 3

19. Group Activity: Taking Control - Making it Happen To consider how you can support the use of Taking Control within your practice teams • Identify implementation challenges and enablers for supporting use of Taking Control model of care within your practices • Consider how you might overcome challenges • What other support/resources would be helpful to you?

20. Presenting Promotional/Teaching Materials • A Guide to working with a client using Taking Control • Power point presentation • eLearning programme which can be accessed at http://learnonline.health.nz • Patients’ workbook; Taking Control • Supplementary resources • Materials available online repository • Moderated forum planned for 2013

21. Review of expectations and feedback