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‘Changing risky behaviours in families, • by helping them run out of ways of doing it wrong’ • June 2014 Early Help Conference-‘Lifestyles and Risky Behaviours’ • Dr. Alan Curley, PhD
Outcomes i was asked to deliver in the Workshop • 1=Brief history of what i do & what i think works well at helping complex clients change behaviours. • 2=To inspire & motivate the delegates that it will be ‘worth it’ to keep working with complex clients. • 3=Provide a couple of quick, easy strategies to help delegates working with complex families. • 4=To help delegates develop new innovative ideas/approaches in their work with complex families.
About You • 1=What do you do, what team do you work in ? • 2=What type of Clients do you work with ? • 3=How frequent or long do you work with them ? • 4=What is the ’aim’ of the work you do with them ? • 5= What do you hope to get from todays workshop ?
Outcomes i was asked to deliver in the Workshop • 1=Brief history of what i do & what i think works well at helping complex clients change behaviours.
Risky behaviours-What do they all have in common? • 1=Smoking • 2=Alcohol • 3=Drugs • 4=Gambling • 5=Eating • 6=Sex • They are all ways of socially bonding & interacting • and to help us feel better in the present?
Potential future benefits • Present Functional tasks • Pleasure/enjoyment • Question: What types of things can we spend our daily time & energy on? • Work • paid • hobby • TV • Sleep • Socialising • Computer • House • Studying • children • Family • Travel • Gym • Bills • Sport • Moisturising • We need the support, skills and insights in order to get the balance correct?
Outcomes i was asked to deliver in the Workshop • 2=To inspire & motivate the delegates that it will be ‘worth it’ to keep working with complex clients.
Helping complex clients with health & social inequalities is like eating a trifle • The deeper the level of inequalities, the bigger the spoon you need to reach them. • Every Mary that you support to change against the odds, Will make you feel • happier & more proud than a 1000 Allistair’s and she will be your career highlight.
ALLISTAIR • MARY • Exercise Question: • What has Allistair got more of which makes him most likely to make successful changes in Life? • -Expectation levels • -Self-Motivation levels • -Self-Confidence/Belief • -Experiences of self-success • -Awareness of what helps • -Planning & Preparation • -Ability to absorb & retain • information (education) • -Learning rates • -Goal-Setting • -Commitment/will-power • -Good Role models/Examples • -No. Coping strategies/self-efficacy • -Attending/requiring support • -Adhering to Medication • -Self-encouragement • -Keeping positive Focus • -Results/benefits obtained • -View of relapse/prevention • -No. and frequency of attempts needed • People either Generate these by themselves INTERNALLY (Allistair)or they have to get them nurtured EXTERNALLY (Mary) by us or others
Not taking your medication properly • for the proper length of time • Going out every break/lunch-time with smokers • who offer you cigarettes • Going out drinking alcohol with people who • offer you cigarettes whilst you are drinking • 12 weeks support and medication • Letting people smoke in your house • Not having a plan for when you get a craving • Not attending your support sessions • Why does Mary need to boomerang so many times before she can make a change? • Not telling people that you are trying to quit • Keeping cigarettes in the house • Difficulty level • Mary needs to boomerang many times, to physically learn what makes it easier and what helps her to cope better? • 10/16/13
Question: 4 young female smokers who took part in different quit programs. • -Which program gave the NHS the worst outcome • Emma- • Started to smoke at 14 • Began to quit at 16 • Needed 9 attempts • Quit at age 25 • Gerri- • Started to smoke at 15 • Began to quit at 18 • Needed 6 attempts • Quit at age 28 • Victoria- • Started to smoke at 16 • Began to quit at age 18 • Needed 2 attempts • Quit at age 46 • Mel B- • Started to smoke age 12 • Began to quit at age 13 • Needed 12 attempts • Quit at age 29 • 10/16/13
Question: How do I keep motivated working with Mary when she has been boomeranging without success for a couple of years? • Answer: Think of Mary as the Chinese bamboo Tree • Mark Twain said: • ‘The best way to motivate someone is to be motivated yourself’
Outcomes i was asked to deliver in the Workshop • 3=Provide a couple of quick, easy strategies to help delegates working with complex families.
Relapse rates with Patients is linked to lobster-syndrome. • Question: • Why Can Fisherman leave Lobsters in a bucket & they don’t manage to escape? • The biggest Influence on the relapse rates in any addiction is the amount of other addicts that are still in their social networks.
‘We need to start Writing a lot more Social Prescriptions.’ • (Worklessness is the biggest public health problem in the UK) • Always try and put Mary into a Group: • -Either physically, • -Theoretically • -In cyber-space • Because: • -People are influenced by other people more than anything else ( facts, data etc..) • -Groups help build connectedness & resilience & sometimes competitiveness • -Groups increase level & frequency of support that mary can get. • -You get multiple boomerang experiences at same time.
You are ~9 times more likely to change if successful in week 1 Predictors for future success • In a large European trial with > 3,500 patients it was found that: • First week success (1,698) = 25.1 % still quit 1-year • First week smokers (1,877)= 2.7 % quit at 1-year • We need quick results, so should we do more sessions in change week • Tønnesen P, et al. Eur Resp J 1999; 13:238-246.
Possible withdrawal symptoms for Nicotine Question:What things will people feel when they stop-smoking? • BLOODY BRILLIANT • We need to keep thinking positive, • to keep them focused on staying positive. • West, R (1999) Tobacco Withdrawal Symptoms extract from Manchester Stop Smoking Training Manual 2007 edition page 24
Mood scores over time from the day of change. • Tønnesen P, et al. Eur Resp J 1999; 13:238-246. • We need to make first week of changing as easy as possible and be aware that • it will be 8 weeks before it begins to naturally get easier and take less effort. • This is why pointing out compliments, results, benefits and keeping them • focused on the positives is so important for the first week and up to 8 weeks at least.
Efficiency of different support & medications on 4 week quit rates1 • People are more successful at making changes, when they are part of a group. • A guide to smoking cessation in Scotland 2010. Planning and providing specialist smoking cessation services. NHS Health Scotland 2010 pg 27.
Outcomes i was asked to deliver in the Workshop • 4=To help delegates develop new innovative ideas/approaches in their work with complex families.
Use What motivates complex clients? • Nelson Mandela and the ANC members & Robben Island • -MONEY • -FAMILY • -SOCIAL • -HEALTH • People make changes for Life-improvement not health-improvement.
People only change for the 3 E’s in Life • ENJOYABLE • EASIER • EFFECTIVE • Get quick results or benefits • Less effort and • Less time required • Less pain or • discomfort
The goal “People are generally better persuaded by the reasons which they themselves think they discovered, rather than by those which have come from the minds of others.” –because some people need to feel in control of the decisions they make. Blaise Pascal (17th C French Mathematician/ Philosopher) • Don't tell them to do anything just use stories about other people like them who have said they have got the 3E’s. ’