From Engagement to Commitment: Creating Systems that Work for Consumers

From Engagement to Commitment: Creating Systems that Work for Consumers Learning Community Regional MeetingEngagement Presentation and Group Discussion

Overall Agenda Topics • Part 1: Engagement starts with the workforce • Part 2: Engaging consumers via person centered and relationship building approaches • Designing the initial contact (referral/screening/assessment) to promote enrollment in the PBHCI service • Part 3: From Engagement to Commitment: Effective individual and group programs focused on positive health behaviors • Ongoing engagement that promotes commitment and supports reassessment • Service planning and service delivery that promotes commitment

Part 1: Engaging the workforce • Main point: Engagement of consumers is everyone’s business • Engaging the workforce to understand, value and act in ways that • continually engages consumers • Challenges: • Communicating for buy in (what is the message? Who delivers the message? How do we know if the workforce understands and values the message? What practical actions can the workforce take that promotes engagement of consumers? • How does an organization ensure that the workforce supports the aims of the PBHCI initiative? • How does the organization insure that the primary care partners understand, value and act in ways that are likely to engage consumers.

Engaging the Work Force Some ideas from the organizational change literature

Engaging the Workforce: Critical to Build a Sense of Urgency among the Workforce • Leadership Communication is key: • Communicate to every stakeholder • Organization “owns” the change (Our organization is committed to the aims of the PBHCI initiative) • Content of the message • The change is important • The change is not easy • Everyone is part of making change successful • Pros of success and the cons of failure • Benefit to all stakeholders

Engaging the Workforce: Communicate for Buy In • Emphasize the benefits of adopting an integrated healthcare system • Acknowledge the common reactions of the workforce to change. Staff are often concerned that a significant change will negatively affect…………. • The meaning they derive in their work • Control over their work life • Status in the organization • Involve and engage staff in sharing their ideas about how to successfully involve consumers in the PBHCI initiative • This assists staff to regain control, status and personal meaning in the new direction. • Emphasize the supports, resources and tools available to support the adoption of an integrated system

Group Discussion • What challenges have you encountered with engaging the workforce in promoting the aims of the PBHCI, especially with respect to engaging consumers? • What has been the message to the workforce? Who delivers the message? • How has the PBHCI opportunity been presented? • Just another time limited grant • A way to pay for enhancements to our services • An opportunity to plan for a changing healthcare system and change the way we do business day to day • Does the organization have a way to identify and reinforce staff who are supportive? Identify and address staff who are not supporting the PBHCI aims?

Part 2: Engaging consumers - Why join and follow through with the PBHCI initiative? • Main points: • Engagement is a process of informing and involving a client in making an informed decision and taking action related to health care services that match his/her felt need. • What promotes our own engagement in services? Is it exactly identical to what promotes engagement for people receiving behavioral health services? • You know a person is fully engaged when they make use of available activities and resources and are active participants who take increasing responsibility for their health.

Engaging Consumers to Enroll: Designing a workflow with a customer focus in mind • A customer service perspective is key. Staff placing themselves in the shoes of the client helps to guide the identification of strategies that are likely to be successful at the initial engagement phase. • It also makes clear there are two flows that intersect & must be understood & improved: the customer service-flow & the staff work-flow.

Discussion: Questions to ask ourselves • What do we want as customers of a new service? • What experiences move us towards saying yes and keeps us engaged in the future? • What experiences turn us off now and in the future? • Note: The types of experiences that engage us or turn us off are often based on the key processes (workflow) involved in receiving services.

An organizations workflow influences engagement • Key workflow processes: • Initial referral/screening/assessment • Service Planning • Service Delivery

Initial screening/intake/referral • Who provides the services: where, how and when do I meet them? • Enrolling: • What does it mean to be part of the PBHCI initiative? • What does it mean to join? How do I make a decision to join? Do I have the information to make an informed decision? Who helps me get the information I need? • Service Planning • Service Delivery

The initial screening/intake/referral and invitation to enroll • Ask: What would I like to have happen at my very first contact with a healthcare organization? What information would be helpful in order to make an informed decision? • Think about: How do we initially engage and inform clients? Do we have a way of knowing if the consumer finds the process helpful?

Getting to know the treatment team: • Think about: • How and when do consumers meet the members of their treatment team including the primary care team? • How long before the consumer meets a member of the primary care team? • Who informs the consumers about the members of the treatment team? • Is there a peer on the team? • Who is the main “go to” person for the consumer?

Deciding to enroll in the PBHCI initiative: Think about: • How do clients make a decision to enroll? What information is provided? • What information would you want in order to make an informed decision? • Are clients provided any written information that they can share with others if they so choose? • Are peers involved in supporting the client to make an informed decision?

Part 3: From Initial Engagement to Commitment: Service Planning and Service Delivery Think about… • What would make a person stick with the PBHCI initiative? • What are the benefits? • What services and relationships keep people engaged?

Commitment to services involves…. • Service Planning that makes sense to the consumer, reflects preferences and felt need, non-pressured and builds on and reinforces strengths • Service Delivery that is easily accessible, involving, fun, non-pressured, non-judgmental, not embarrassing and builds confidence and social support

Successful engagement: Consumer commitment to the aims of the PBHCI opportunity • Engagement is an ongoing process that gets strengthened or weakened day by day • Reassessment or healthcare follow up of health status is part of quality healthcare • Reassessment may be approached as part of good healthcare: monitoring progress and checking on health status from time to time

Discussion: Questions about Service Planning • How does the organization provide information about all the services available to the client? • Who works with the client to make informed decisions about which services are needed and most importantly, wanted? • In what way does the client participate in the identification of needs and services? • What contribution does the client make directly to the documentation of the service plan? • How is information communicated (e.g., just verbally or with written information?)

Service Delivery: Those services focused on improving health behaviors and overall wellness including prevention Main Point: The goal of wellness and health promoting services is to assist individuals to apply the information learned and the strategies developed in his/her day to day lifestyle. Think about? • Do we take into account a person’s readiness to change health behaviors? • Do our services offer opportunities to ACQUIRE and APPLY knowledge in the context of the consumer’s day to day experience? • How are the menu of services determined? • Is there a system in place for consumers to identify and shape the service menu? • How do consumers access services? • Is there a systematic way to determine consumers response to services and make changes accordingly?

Matching engagement strategies with readiness Source: Adapted from DiClemente and Prochaska, 1998

Characteristics of engaging wellness and healthcare services • Positive focus of the services (goals to achieve rather than the problem to solve) • Create opportunities for consumers to identify and share strengths throughout all encounters (what’s strong vs. what’s wrong) • Integrate wellness and health promoting behavior as part of the routine discussions across all services and encounters

Characteristics of engaging wellness and healthcare services • Health limitations, weaknesses, unhealthy behaviors, deficits are framed as opportunities for improvement that the consumer may decide to address. • Non-prescriptive approach doesn’t use scare tactics and avoids lecturing • Wellness topics include information that is clearly and simply presented and honestly engages consumers to consider the pros and cons of current health related behavior • In group settings, the size of the group enables opportunities to personalize the information (Optimally group size is 10 or less)

Characteristics of engaging wellness and healthcare services Label and focus the work on the positive gains associated with the program rather than the negative losses For example: Alternatives to labeling a health related theme centered group such as a smoking cessation group • Building stamina • Breathing easy • Looking smart and feeling good • Saving money-saving health

Characteristics of engaging wellness and healthcare services • Assists consumers to systematically personalize the information in a way that recognizes strengths as well as areas that the consumer may wish to improve • Assists consumers to make a specific plan and take action to make progress towards personally meaningful health goals • Assist consumers to monitor progress and identify barriers. (Nothing is more reinforcing than success, even small gains make a difference)

Characteristics of engaging wellness and healthcare services • Action steps need to be practical in light of the consumers financial resources, age, gender, cultural values and overall health • Building in social supports may be very helpful (e.g., engage family/friends, peer buddy system) that aligns with consumer preferences • Health promoting activities that are fun, intrinsically rewarding, non-pressured (may be helpful to avoid the common tendency to present information in the form of a lecture full of “should’s” “must’s” and “ought to’s.”

Characteristics of engaging wellness and healthcare services • Utilize the power of peer led and supported health promoting services and activities • Involve participants in the development of wellness activities and programs • Peer support, self-help, peer led and peer co-led activities and programs offer unique opportunities to inspire and engage consumers. • In what way has your program involved peers as an integral part of the PBHCI service?

Characteristics of wellness and healthcare services that work: Peer involvement and discussion Peer and staff counseling that emphasizes…… • Strengths and felt need for change, • Inspiring testimonials- before and after presentations by peers to build confidence and address self-perceived barriers and • Offer opportunities to join non-pressured and easily accessible and directly observable health promoting activities • (walking groups, gardening, exercise room, cooking groups, community visits)

Characteristics of wellness and healthcare services that work: Peer involvement and discussion • Activities are designed to be highly interactive, non- pressured, systematic and focused on self- management skills. • Individual and/or group programs employing established self-management curriculum based programs that are focused, structured and designed to promote application of health related behaviors • Whole Health Peer Led Program • Wellness Self Management • Illness Management and Recovery • Solutions for Wellness

Characteristics of wellness and healthcare services that work: Peer involvement and discussion • Consumers informed that set backs are common for all people working on changing health related behaviors. • Not to get discouraged when setbacks occur. Anticipate it and have strategies when feeling discouraged or defeated • Social supports often plays an important role in sustaining improvements. • buddy systems • peer led healthy lifestyle activities outside of the treatment setting • involvement of members of the consumers support network (e.g., family, friends) in accordance with the consumers preferences for who and what kind of support is desired.

Engaging framework for facilitating a health related topic group

Characteristics of highly engaging health promoting theme centered groups • Main Points: • PBHCI grantees conduct numerous wellness and health promoting groups • Groups have many advantages • Universality (you’re not alone) • Social/emotional support from people you trust • Safe way to try out new behaviors • Social-observational learning • Builds hope and confidence • Corrective experiences (opportunities for people to receive feedback on their thinking/beliefs/behaviors • Power of peers to influence behavior

Groups also have many challenges • Groups present “emotionally high risk” situations (safety and trust is critical) • Wide diversity of experiences, background, knowledge, skills, needs, expectations and readiness among members • How to personalize the experience for each person • How to insure that each member has the opportunity to apply learning in the context of his/her circumstances • Challenges associated with closed vs open group • How to ensure the group is interesting and meaningful to participants

So, how can we address these many challenges? • Having clear and easily visible ground rules that have been generated and agreed upon by members can go a long way • Structure, focus and engaging material also goes a long way • Having a clear, transparent and easy to follow group learning format is a real plus!

Ground Rules • Ground rules promote safety, and help people to stay on task. (for example)] • One person talks at a time • Treat each other with respect (no put downs) • What is said here stays here • Stay on topic • Avoid separate conversations • Ground rules are established very early on in the process, typically during the first group meeting. • It is essential to engage group participants in establishing their ground rules – this will result in members owningthem. • Posting ground rules also helps

Ground rules are not enough! • It’s helpful to have an organizing framework that: • Promotes safety and trust • Personalizes the experience for each participant • Transparent and clear to all (makes sense) • Keeps people on track and on topic but also flexible • Focus on issues that empower people • Emphasizes shared decision making and choice • Helps participants to remember and revisit the main ideas of the group • Gives participants an opportunity to continue and/or apply their learning • Gives group leaders a common sense and easy to apply group format

The R.O.P.E.S. Framework: One effective approach to facilitating groups • The ROPES framework is based on the principles of adult education and the work of Bill Anthony and associates at the Center for Psychiatric Rehabilitation at Boston University • The group is simply formatted into a beginning, middle and end phase. The ROPES acronym stands for…. • R = Review • O = Overview • P = Presentation • E = Exercise • S = Summary

Beginning the group: Review and Overview STEP 1: Review of important points from previous lesson STEP 2: Review of previous action step during the past week STEP 3: Review of participants’ current knowledge of and experience with the current topic (elicits strengths) STEP 4: Review of participants’ understanding of the importance of the current topic STEP 5: Overview of the current group agenda

Middle of the Group: Presentation and Exercise Presentation part of the R.O.P.E.S format begins a focus on the current health topic. The presentation includes: • Important Information • Introduces the topic: What it is? Why it’s important? • Personalized Worksheet or activity • Opportunity for participants to connect to the materials in their own personalized manner • Helps to identify strengths and areas to consider improving • Discussion points

Middle of the Group: Exercise • What is it? An invitation to participants to: • continue their learning • apply their learning between meetings • A twist on homework assignments- the action step • Not required • Not given by the “teacher” • The person chooses to give him/herself a homework assignment • High value placed on identifying areas of interest and using it to set the agenda in individual meetings

Ending the group: Summary • Ask participants to share the main take away message and key information about the topic • Feedback on the upside and downside of the group meeting • Suggestions for improvements • Group leader and participants share positive aspects of the group (reinforce individual and collective strengths)

From Engagement to Commitment: Creating Systems that Work for Consumers