An Introduction to Lifestyle Management- working with the person not the condition

1. An Introduction to Lifestyle Management-working with the person not the condition Ross Grieve Lifestyle Management Service Thistle Foundation, Edinburgh rgrieve@thistle.org.uk

2. Self Management as a �Process� Transformative Regaining Purpose A process of moving towards acceptance of their current health condition Moving on in life in new and rewarding ways despite limitations Greater control, coping and confidence

3. What people want � Medical needs Knowledge of condition Support in managing medical aspects of the long term condition Rehabilitation � long term review/ ongoing contact

4. What people want -Non medical needs Psychological support Assistance with coping with change/ emotional impact Lifestyle management - moving on with life Support to make health behaviour changes Advocacy Peer support -group based/ individuals/ volunteers Support groups Exercise classes Relaxation classes Walking Weight management Smoking Support for carers

5. 

6. Questions What could a LTC management facility look like ? What would the service designed specifically around the person rather than the condition look like ? Can this service really fit all ? Can the service be adapted to become disease specific eg cardiac/ pulmonary rehab ? What are the core competencies required of workers to deliver this service ?

7. Questions Can non-health professionals deliver these programmes ? Which approaches can be most easily taught to non-health professionals such that the �spirit� of the approach ( collaborative, non expert ) is ensured From multi to inter disciplinary teams containing both health and non health professionals ?

8. Thistle Foundation Long Term Conditions Management Facility Facility Gym Pool Caf� Yoga rooms Relaxation rooms Seminar rooms Therapy rooms Physiotherapy Lifestyle management service Non medical needs Individual, group services Support for maintenance groups Peers support training Carers

20. Lifestyle Management in Practice

21. Lifestyle Management Courses 10 weekly, 3 hour sessions Review, change based discussion Exercise Relaxation Discussion topics - Lifestyle management philosophy, sleep, stress, energy management, relaxation, getting active/ goal setting, time management/ planning, communication skills, mind body connection, preventing, minimising, recovering from relapse, review and forward planning

22. Biopsychosocial Model of Illness It is not just the extent of physical impairment� but cognitive, behavioural and other psychosocial factors � which most closely correlate with poor prognosis, long term disability and quality of life:

23. Spiralling to Disability

24. Disability spirals

25. Who can benefit from our service? People who: Are struggling to come to terms with diagnosis Are struggling with the physical, mental and emotional effects of living with a LTC Are at risk of increasing disability due more to psychosocial factors rather than physical/biomedical factors Are trying to cope with health issues and extreme life situations Have mild to moderate mental health problems � perhaps who are on a long waiting list for psychological services Are hoping to cope better, gain more control and build confidence to move on in life in more effective ways Have not responded well to other treatment options orientated toward that of learning more about illness, compliance with medications, and behaviour changes

26. Outcomes 75% completion rate Independent review 2007 Self- efficacy questionnaires Research and evaluation a priority for 2008/9

27. Our Team Salaried - includes individuals with backgrounds in physiotherapy, occupational therapy, mental health, fitness management and Magic!! Volunteer Peer Facilitators

28. General Competencies �  the non expert stance We don�t: Assume an expert/ authoritative role leaving the participants in a passive role Lecture, teach - do most of the talking, or function as a unidirectional information delivery system Offer direct advice or prescribe solutions to the problem without the person�s permission or without actively encouraging the person to make his/her own choices Argue that the participants have problems which should be fixed by the facilitator�s/ manual�s ideas Impose diagnostic labels, including labelling of personality traits Behave in a punitive or coercive manner

29. General Competencies We do: Offer participants an experience of empathy, respect and genuineness Work with participants� hopes for the course, their stage of coming to terms with illness and their readiness to change aspects of their lives

30. Principles of Lifestyle Management � Recovery and the Solution Focused Approach Adopting a non expert stance, workers focus on: what the client wants evidence of resource, coping, control, confidence signs of strength, achievement Competency, qualities that might help descriptions of client�s preferred outcomes change

31. Group Facilitation Basic communication/ counselling skills Engagement Solution Focused Approach Principles of adult education and group facilitation Relaxation training and mindfulness practice Principles of exercise prescription

32. Specific Competencies in Individual meetings Engage successfully with clients Manage psychological distress/ anxiety if present Negotiate client�s goals, hopes, motivation Create a future orientation/ expectant attitude Highlight and amplify Psychosocial predictors of recovery emphasising�. Health beliefs and adaptive coping behaviour Internal, external resources (including) Client�s existing knowledge Engage clients in change based conversations Related to client�s goals Related to (worker�s defined/ negotiated?) health behaviours Review progress, manage relapse