Task Seven: Working with your complex needs client

In this task you need to work with a client who has complex needs.

A complex needs client might be one who is:

1. Pregnant

1. Diabetic

1. Being treated for smoking related illness (e.g. lung disease, heart or blood vessel disease, cancer)

1. Diagnosed with mental health illness (e.g. depression, schizophrenia)

1. Suffering drug, alcohol, or gambling addiction

Check with nts@inspiring.org.nz if you are having trouble identifying a complex needs client.

You need to submit, along with this completed Assessment Task, a Portfolio of Evidence for your Complex Needs client.

In the client’s Portfolio of Evidence, you will provide evidence of the work you have done with your client to support them in their stop smoking attempt.

This is broken in to three parts:

· PRE QUIT – Building a good relationship and setting them up for their quit day.

· QUIT DAY – Helping your client make a strong start in their quit attempt.

· AFTER QUIT DAY – Supporting your client to remain smokefree.

Verification and client feedback

1. You need to get a verification / observation form completed by your supervisor or manager as you work with your Complex Needs client in a stop smoking support session.

The verification form is on page 14 below.

2. You will need to ask your Complex Needs client to provide feedback on how you have worked with him or her on their quit journey.

The Client Feedback form is on page 17.

Note: If it is not possible for you to be observed during a stop smoking session with your client by your manager or supervisor, you can, with your client’s permission, record a voice file of your session with your client and submit an MP3 file to NTS who will act as your verifier

Contact nts@inspiring.org.nz if you have questions about the verification process.

Before You Begin:

Read through what you need to submit to NTS in your Portfolio of Evidence for your Complex Needs client before you get started.

Instructions are included at the end of this Assessment Task about how to submit them.

Important: In order to comply with the Code of Rights and to keep things private and confidential, black out the name, address, phone numbers, NHI number and any other identifiable personal information about your clients on ALL documents you submit.

Call the client – CLIENT CX

STOP SMOKING PRACTITIONER PROGRAMME

(New Zealand Certificate in Health and Wellbeing (Level 3) Support Work, 70 Credits)

Your Portfolio of Evidence for your Complex Needs Client.

(Note: You MUST provide all the information that is requested)

1. Referral documentation: A copy of the referral documents for your clients that shows all these steps:

· Who made the referral – Medical Clinic, Midwife, self-referral etc.

· How the referral was accepted.

· How the referral was processed and recorded in accordance with your organisation's policies and procedures.

· If there was no formal referral for your client, i.e. self-referral, you can explain this in a section of the assessment task document below.

Clearly label the referral document/s: Task Seven: Referral - CLIENT CX

2. Your client’s Assessment Forms and Case notes: A copy of your Client Assessment forms that you normally use in your role to record your client’s history, personal details, quit plan and the support you provided and other information about the client.

You will need to submit:

· First meeting session Client Assessment form

· At least 4 (four) weeks of your client’s case notes following the first assessment that includes at least one post quit date session case notes.

The submitted forms need to include all of the following:

· The individual characteristics of the client – age, culture, gender, etc.

· The client’s goals.

· The client’s needs.

· The client’s strengths and issues.

· The client’s resources.

· The client’s level of tobacco dependence.

Also include client background factors, which include three of the following:

· Cultural implications.

· History of the client.

· Social factors.

· Economic factors.

· Risk and resiliency factors.

The forms submitted need to show the assessment processes are matched to the characteristics of the client in accordance with your organisation's policies and procedures.

Quit Day – Complex Needs Client

3. Client’s Stop Smoking Plan: The Stop Smoking Plan you developed in partnership with your client, which includes the following information:

· Age.

· Culture.

· Gender.

· Nature of the client’s complex need.

· A quit date.

· Coping strategies.

· Stop smoking medicines.

· Identification by the client of the personal relapse risk factors.

· Strategies to reduce relapse risk.

· Referral to a medical practitioner for prescription medications (if needed).

· Referral to other interventions and services if needed at this point.

After Quit Day – Client CX

4. Progress Notes: You need to provide evidence that you have documented and reported changes with your client and the client’s progress over a period of time in accordance with your organisation’s processes.

Submitted progress note need to show:

· The changes and progress you observed the client make as a response to your care and your programme.

· How your ongoing support assisted the person to monitor their progress and adjust his/her stop-smoking strategies in accordance with their stop-smoking plan.

· Ongoing support assisted the person to monitor their progress and adjust his/her medication levels as the person's pattern of smoking changed.

· Any collaboration with other professionals and services to support your client to stop smoking that is in accordance with the person's stop-smoking plan.

5. Medicines given: Provide the following information:

A copy of evidence of the medicines this client was given.

(This might be a copy of the record book in which you record the medicines, or it might be your client notes to say you gave the medicines to the client, or it might be in your database of medicines used.)

Clearly label the document/s: YOUR FIRST AND LAST NAME Task Seven: Stop Smoking Plan and Medicine Given – Client CX. (27505 2.6)

PRE-QUIT - Building a good relationship with your complex needs client

In addition to the documents above, you must answer all of the following questions related to each stage of the work you do with your complex needs client. The boxes will expand as you type.

Your first and last name:

Your email address:

The date you did this assessment:

What ethnicity is your complex needs client? Pacific Island, Maori, European, Indian etc.

What is the nature of your client’s complex need?

You need to provide information related to your client regarding each of the items listed below.

Complete the chart below with the answers requested. Your answers must be done in accordance with all related Smoking Cessation Guidelines. (27504 2.1, 2.3, 2.4, 2.5)

Read each of the things or items in the left hand column below. Then, in the right hand column, write bullet points or brief sentences to describe how this thing or item affects your client.

1. Referral

If the client did not come to you from a referral – explain how they knew to see you:

Item/issue/effect

How does this affect your client?

Cues that trigger smoking for this client.

Pretend example:

e.g. When she hears a baby crying she gets afraid of being a mum and instantly wants a smoke.

2. Cues that trigger smoking for this client.

3. Causes of past relapse/s for this client -

If your client has tried to quit in the past then they have relapsed. (If no relapse for your client write: “No relapses”)

4. Which withdrawal symptoms for this client come from nicotine withdrawal?

TIP – make sure you have checked this as MANY people include things that are not linked to nicotine.

5. Things the client does to make excuses for smoking.

6. Current impact on this client’s budget.

7. Current impact on this client’s health.

8. Current impact on this client’s social life or circle.

9. Benefits of quitting on this client’s budget.

10. Benefits of quitting on this client’s health.

11. Benefits of quitting on this client’s social life or circle.

12. People in the client’s life affected by them smoking.

13. What are the risks to any client’s lungs if they continue to smoke?

14. What are the risks to any client’s cardio-vascular system if they continue to smoke?

15. Write a few sentences to describe how you prepared your assessment process to suit the complex needs client’s age, culture and condition. You also need to make sure you follow your workplace policies and procedures for this. (27505 1.3)

16. Think about the barriers your client had or clients in general may have that prevent effective communication. (28857 1.1)

Choose two barriers and describe how they prevent effective communication.

Barriers might include:

· lack of health literacy

· use of jargon

· cultural practices

· language

another barrier you identify yourself (28557 1.1)

Barrier one

How does this

barrier prevent

effective

communication?

Barrier two

How does this barrier

prevent

effective

communication?

17. What communication supports are available in your workplace to help if a client has communication barriers? (28857 2.1)

18. What is the procedure in your organisation for accessing these supports? (28857 2.1)

19. Complete the table below with the details of one of the discussions you had to support their wellness. (28857 3.1)

Communication could include:

· introducing self

· addressing a person by preferred name in a respectful manner

· selecting an environment conducive to effective communication

· use of respectful body language and positioning

· supportive use of questioning

· responding to a person’s questions

· use of plain language

· use of non-verbal responses

· providing and/or recording oral and written information

· or any other communication that you have identified

A. Describe the situation.

B. What were the person’s communication preferences?

C. Describe any barriers to effective communication.

(28857 3.2)

D. What did you do to address these within the boundaries of your role as a support worker?

E. Describe two communication techniques you used.

Quit Time: Working with your Complex Needs client

After meeting your complex needs client the first time and building rapport you now have to provide information to show how you worked with your complex needs client to help his or her to quit!

Go through each of the questions and provide the answers or the information as requested.

20. Consider the smoking cessation information and advice that would best help this client and complete the table below. There should be at least three sets of info you discussed.

You are welcome to add more. (27505 2.1 27506 1.1, 1.2)

LIST THE INFO AND ADVICE you gave below.

How does this info’ and advice match his or her goals and needs?

How does this info’ and advice match his or her strengths?

How does this info’ and advice match his or her available resources?

How does this info’ and advice match his or her level of tobacco dependence and previous experience with stopping smoking?

Pretend example:

We discussed how she was going to do xxxx and yyyyy this week.

She needs to make sure she achieves her goal of vvvvv so it is important she just focus on these two things.

When she wants to she can be really strong and committed so these two tasks should be something she can achieve.

No other resources are needed for this so she should be fine.

While she has been a heavy smoker with a high level of dependency this will allow her to do aaaa and bbbb and this will give her the best result.

You need to provide some details to explain what you did as you developed the quit plan for the client. Jot down some brief notes in each box provided to answer the questions on the left. (27505 2.2, 2.3, 2.4, 2.5, , 27506 1.1, 1.2)

21. Past quit attempts:

A. Approximately how many past quit attempts has this client had?

B. What happened in these past quit attempts?

C. Describe what you understand from the client about these attempts to quit?

22. Treatment programme:

What type of programme is supporting this client?

23. Tobacco dependence and withdrawal:

A. How did you measure your client’s tobacco dependence?

24. Stop smoking medicines

A. Which stop smoking medicine did this client use?

B. Describe why this medicine was used for this client.

C. How does the client get access to this medicine?

D. Describe what you said to the client about how to use the medicine.

E. Describe the follow-up monitoring process you use for this medicine and how frequently you do this.

25. Social Support: (Quit Buddy, Whanau supporter/s, supportive friend, etc)

A. Describe what you did to put the social support in place for your client.

B. What sort of social support is identified with this client?

26. Quit date:

A. Describe what you said to the client about the importance of a quit date.

B. What date did the client choose?

C. Why did they choose that date?

27. Not a Single Puff: (Or whatever you call the concept of committing to NO cigarettes)

A. What did you do to secure a commitment from your client to quit and follow the “not a single puff” rule? (27505 2.3)

28. Now consider when people come to your service. They may have been referred to you or they may have just walked in or called directly. Thinking about the three-step ABC approach, describe which person or which service did each of those three steps. Fill in the chart below. Refer to NZ Smoking Cessation Guidelines to complete this question. The A and B might have been done by one group and the C by your group. (27504 3.1)

STEP

Who or which service did each step?

What did they do in each step?

A

B

C

29. Provide a few sentences to describe how the smoking cessation strategy for your client will improve his or her health. (27507 1.6)

30. What protocols or special processes did you have to be mindful of to respect the client’s culture and build a rapport?

When this is complete you then need to provide information about how you worked with the clients after quit day.

AFTER QUIT DAY: Supporting Your Complex needs Client

You need to observe the changes to your complex needs client’s condition since commencing the smoking cessation programme. You need to document the changes in your file notes and complete all of the components below.

31. Provide information about how you collaborated or worked with other professionals and services to support this client to quit according to their stop smoking plan. These might include the GP, Maori or Pacific people’s services, mental health services, Community Corrections, problem gambling services, alcohol and drug services. Note – it may be that there are no others you need to collaborate with for this client – it will depend on the initial quit plan you developed with your client. (27505 2.5, 27506 2.2,)

32. Think about the medication your client used and how you supported and advised his or her to use it correctly. Complete the chart below with the information as requested. (27506 2.3)

A. How did you support the client to use the medicines correctly and record and report what was used?

B. Describe any side effects the client had from the medicine.

33. Overall – how well do you feel you were able to assist this client? What were the highs and the lows of the journey for you with this client?

Getting Verification from Others

You have worked with your complex needs client and you need to get the following people to each complete the following forms:

· One verification form from your supervisor or manager to verify the work you did with your complex needs client.

· Your Complex Needs client to provide feedback on how you have worked with him or her on their quit journey.

Verification from Your Supervisor or Manager

This form is to be completed in pen by your supervisor or manager to provide information about the process you used with your complex needs client. Once completed please scan the document and include it in your portfolio with the title:

YOUR NAME - Task Seven - Manager Verification.

NOTE: If it is not possible for you to be observed during a stop smoking session with your client by your manager or supervisor, you can, with your client’s permission, record a voice file of your session with your client and submit an MP3 file to NTS who will act as your verifier

Verification from Your Supervisor or Manager

First and last name of Stop Smoking Practitioner:

First and Last Name of Verifier:

Verifier’s role:

Employer:

Date:

Verifier – please note. Your employee is completing the NZQA qualification as a smoking cessation practitioner. Your employee has worked with a complex needs client. You must provide verification of the work the employee has done and confirm it accurately reflects the support your employee has offered the complex needs client and that the support given aligns with all company policies and procedures and legislative requirements.

Your signature on this form means you stand behind what you are verifying and you will be happy to provide supplemental comments to an assessor should he or she call you.

Indicate whether the employee did each of the following by ticking “Yes” or “No”

1. If this client was referred to the stop smoking service was the referral handled correctly (used guideline MOH Smoking Cessation Tier one service specification):

Appropriate response time to client

Was the response back to the referrer conducted in a timely manner?

YES NO

2. Did the stop smoking practitioner display rapport building skills during the session with the client?

YES NO

3. Did the practitioner initiate and maintain communication following the preferences of the person being supported.

· communicate in a way that considers and addresses any barriers to effective communication, within the boundaries of their role.

· communicate information about the client they support to others following privacy, confidentiality and reporting requirements at all times.

· check information communicated by others for comprehension, interpretation and clarity of intent.

consistently communicate effectively in the workplace.

YES NO

YES NO

YES NO

YES NO

YES NO

4. Did the stop smoking practitioner communicate well with the client so there were no barriers?

YES NO

5. The paper or online form to assess the client was filled out accurately and reviewed by the stop smoking practitioner.

YES NO

6. The treatment programme was explained to the client giving clear expectations – how many sessions, support and medicines, etc.

YES NO

7. Was tobacco dependence discussed in this session?

YES NO

8. Were withdrawal symptoms discussed in this session?

YES NO

9. The client’s plans were appropriate for the client.

YES NO

10. Was the rationale of Not a Single Puff discussed with the client?

YES NO

11. Was the quit date discussed with the client?

YES NO

12. The cultural needs of the complex needs client were addressed during this session’s interactions and advocacy/self advocacy shared with the client aligned with empowerment, was respectful and met the policies and procedures your organisation has.

YES NO

13. Medications were recommended correctly and then their use monitored and recorded appropriately for the client.

YES NO

14. The participant ensured the client understood and monitored that medication must be kept in storage, especially clear of children, and remaining medication would be returned to storage.

YES NO

15. The participant ensured medication used and any errors were reported and recorded correctly.

YES NO

16. The participant clearly supported clients to use their medications correctly and in a manner aligned with their plans.

YES NO

17. The client file notes and progress notes were completed correctly and met your organisation’s requirements.

Documented change notes are accurate and effective.

YES NO

18. Referrals made for the client were handled correctly and the appropriate follow-ups were conducted.

YES NO

19. The Code of Rights was adhered to with the client as well as all other legislation and Acts that apply in your workplace, and ethical and professional behaviour was displayed.

YES NO

20. Write a few sentences to describe how well the employee worked with the complex needs client and how you know this.

21. Describe any other services the client was referred to. (27505 2.5)

Signature - Supervisor or Manager:

Date:

Feedback from your Client

This form is to be completed by your client in pen – remember this person is called CLIENT A. Once completed please scan the document and include it in your portfolio with the title YOUR NAME Task Six Client Verification.

First and last name of Stop Smoking Practitioner:

Verification from:

CLIENT A

Date:

Please note. The Stop Smoking Practitioner is completing the NZQA qualification as a smoking cessation practitioner. The Stop Smoking Practitioner has worked with you and we would like to get some feedback about what they did.

Indicate whether the candidate did each of the following by ticking “Yes” or “No”

1. Your Quit Smoking plan was right for you – it was what you needed (27505 ER 2, 27506 ER1)

YES NO

2. You had meetings and follow-ups as planned. (27506 ER 1, 2)

The meetings were handled well and the forms were right.

YES NO

3. Your rights and cultural needs were met and the practitioner was professional and ethical. (25987 1.5 or 28542 4.1 4.1)

YES NO

4. You understood the information about your medicines.

You knew how much to take and when to take them.

You knew where to keep them and who to call if there was problem

(20827 ER3)

YES NO

5. Tell us what you think your Stop Smoking Coach did well to help you quit smoking.

27505/6 overall)

You have now answered questions and compiled evidence to show how you supported your real client.

Summary

Please scan and save all the documents using the following:

FIRST NAME LAST NAME FP Task Seven (and the name of the document e.g. Client Assessment Forms)

Then email your portfolio attachments and these questions to: nts@inspiring.org.nz