from engagement to commitment: creating systems that work for consumers learning community regional...
TRANSCRIPT
From Engagement to Commitment: Creating Systems that Work for Consumers
Learning Community Regional MeetingEngagement Presentation and Group Discussion
Overall Agenda TopicsPart 1: Engagement starts with the workforce
Part 2: Engaging consumers via person centered and relationship building approacheso 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 behaviorso Ongoing engagement that promotes commitment and supports
reassessmento 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 WorkforceLeadership 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 mindA 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)
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 engaging wellness and healthcare services
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 discussionConsumers 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 groupsMain Points: PBHCI grantees conduct numerous wellness and health promoting groupsGroups 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 owning them.
• 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 groupsThe 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 weekSTEP 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 topicSTEP 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)