By the end of the session:
You should be able to:
• apply Make Every Contact Count within your role
• ask people about their lifestyle choices
• advise people of facts and tips to help change unhealthy
lifestyle behaviours
• be confident to deliver Brief Advice (and Brief Interventions)
• refer people to appropriate help and support
• record your contacts
• know where to go for more information
Making Every Contact Count
Making Every Contact Count focuses on short,
one-to-one opportunities with service users to advise
and signpost to healthy lifestyle information on:
• stopping smoking
• drinking alcohol within recommended limits
• eating a healthy diet
• taking regular physical activity
• maintaining a healthy weight
• mental health and wellbeing
MECC approach
MECC is about encouraging people to make healthier
choices to achieve positive long-term behaviour change for
better health and wellbeing among patients / service users
and staff themselves
MECC involves:
• Systematically promoting the benefits of healthy living
across the organisation
• Asking an individual about their lifestyle and if they
want to make a change
• Responding appropriately to the lifestyle issue/s once
raised
• Taking the appropriate action to either give information,
signpost or refer service users to the support they need
MECC pathway
An example of MECC Impact
In East Midlands
• 288,000 staff
• Millions of patient contacts a year
• If staff MECC with just ten people
• Less than one hour a year for each staff
member
= 2.88 million opportunities to influence
behaviour change.
Cost basis
• There are more than 5,500 alcohol related hospital
admissions and more than 2,000 alcohol related
recorded crimes a year in Bedfordshire. Research
has shown that identifying hazardous drinkers and giving
them brief advice can reduce alcohol consumption on
average by a quarter.
• We want to encourage people to make healthier lifestyle
choices in areas such as smoking, alcohol, diet and physical
activity…Improved health and better health outcomes across
all of these areas gives us an opportunity to make savings up
to £1.9 million over the next four years.
Health profile Bedford
Health profile Luton
Health profile Central Beds
What makes you who you are?
Income
Education
Work
Culture
Religion
Interests and hobbies
Where you live
Community
Family
Place of birth
Transport
Quiz
?
Smoking
FACT:
• Stopping smoking is the single biggest thing you can
do to improve your health.
TIPS:
• You are up to 4 times more likely to quit with the support of
NHS Stop Smoking services and medication compared with
going it alone.
Smoking in pregnancy
FACT:
• Increased risk of miscarriage and stillbirth
• Increased chance of pre-term birth (premature babies)
and low-birth weight
TIPS:
• Even if the pregnant woman / new mother does not smoke,
there may be partners or others in the household who
smoke? Second-hand smoke can still damage an unborn
baby or a new born baby.
NHS Stop Smoking services
Smokefree Bedfordshire
0800 013 0553
www.smokefreebedfordshire.nhs.uk
Smokefree Luton
0800 013 0845
What do you
think about
stopping
smoking?
Alcohol
FACT:
• Men should not drink more than 3-4 units per day
(1 pint of strong 5% beer or cider).
• Women should not drink more than 2-3 units per day
(1 standard 175ml 12% glass of wine.)
• You should have at least 2 alcohol free days a week.
TIPS:
• Find out how many units are in your favourite drink.
• Have drinks with mixers.
Alcohol units
Impacts on health:
Alcohol
CALS (Community Alcohol Liaison Service) - Beds
07729 542381 or 07858 083944
JKP - Luton
01582 723434
Drinkline – national
helpline
0800 917 8282
Can you tell
me about how
much alcohol
you drink each
week?
Healthy Eating
FACT:
• You should aim to eat at least 5 portions of varied fruit
and vegetables a day and cut back on sugar, salt and fat.
Check the label and swap higher levels for lower ones
‘Swap it don’t Stop it’.
TIPS:
• Aim for one third of the food you eat to be starchy foods like
potatoes, cereal, pasta, rice and bread. Your 5-a-day can
include unsweetened fruit juice for one portion, and try
adding a handful of fresh, frozen or tinned veg into meals like
pasta sauces.
Healthy Eating
change4life
0300 123 4567
www.nhs.uk/change4life
How do you
feel about healthy
eating and your
diet?
Weight Loss
• The only way to lose weight healthily, and keep it off, is to
reduce your calorie intake and increase your physical activity.
For more help ask your GP or Practice Nurse.
Physical Activity
FACT:
• Adults should do at least 30 minutes of moderate
physical activity 5 times a week (150 minutes per week).
• Children should do 60 minutes of moderate physical activity
every day.
TIPS:
• Moderate activity is where you raise your heart rate, get
warm or break a sweat on a warm day
• Each 10 minutes counts towards your daily target.
Physical Activity
• If you have not undertaken recent physical activity, it is
best to start gradually. If in doubt, check with your GP.
• Children: community is support available through your
child’s school and your local council community physical
activity department.
• Adults: Activity for health 12 week activity referral
programme. Ask your GP or Practice Nurse.
change4life
What physical
0300 123 4567
activities do you do
www.nhs.uk/change4life
each day that raise
your heart rate?
Mental Health
FACT:
• 1 in 4 people experience emotional, psychological or
mental wellbeing issues at some point in their lives and
1 in 6 adults experience such problems at any one time
which can include stress, anxiety, panic attacks and depression.
TIPS:
• Talking to others, being active, helping others / volunteering,
learning something new and appreciating the things around
you can lead to better mental wellbeing.
If you are worried that someone is a danger to themselves or
at risk then follow safeguarding procedures.
Mental Health
• Speak to your GP to discuss any issues, who can
recommend appropriate help and support.
Mind the national mental health charity, can provide
practical advice and links to local services
0300 123 3393
www.mind.org.uk
How do you
feel about your
mood day
to day?
Free NHS Health Checks
If any service users are aged between
40-74 years old they may be eligible for
a free NHS Health check to screen
for heart disease, stroke, diabetes
or kidney disease risk, if they do not
already have a diagnosis.
Please ask them to request one from their GP.
Activity in pairs –
What does MECC mean to me?
• What does Making Every Contact Count mean to
you in your role or at home?
• How can you use it in your everyday contacts?
• Do you think you already include MECC in your
everyday work or home life, what do you cover?
• Is there anyone or anywhere else you think you could
use it with?
• What issues particularly affect your user group / family?
• What might motivate them to make a change?
• Do you have any concerns?
Health improvement
• Behavioural Change
• Educational Approach
• Social Change
©
The Behavioural Change approach
Aim: to help individuals adopt healthy behaviours
Methods used in this approach are targeted at the
individual
• One-to-One
e.g. goal setting / action plans
• Education
©
Brief Advice – Level 1
BRIEF ADVICE is pro-actively raising awareness of, and
assessing a person’s willingness to engage in further
discussion about, healthy lifestyle issues. It is usually given
opportunistically.
It normally takes between 30 seconds to 3 minutes
©
©
What to do?
Remember:
• Ask open questions.
• Advise on how to make changes, ask service user to
suggest how they might make changes.
• Act – help the service user to set their own goals or access
further help (signpost).
Remember to think about the environment – privacy, comfort
Considerations
• Time - it might only take 30 seconds to ask a question.
• You need to start from where the service user is,
not where you think they are or where they should be.
• You need to be open minded not critical or judgemental.
• Brief advice is working with the individual on their health
goals. You are not lecturing them or telling them what to do.
• You are providing simple, clear advice and signposting.
• You can’t always tell what is going on from outward
appearances. You are not expected to be a counsellor.
Activity
• Where do you live?
• Do you have children?
• What is your job?
•
•
•
•
•
•
Can you tell me about…
What do you think about…
How do you feel about…
What happened next …
Why do you think that…
So what you’re saying is…
Where to start
• Ask – use open questions
• “How do you feel about your health and wellbeing today?”
• “What could you change to make your lifestyle healthier?”
• “On a scale of 1-10 how important is it for you to make
your lifestyle healthier?” (1 being not important at all and
10 being very important)
• Listen to what the client tells you
• Reflect back “So what you’re saying is…”, “Can I just check…”
• Advise – give a fact, tip and know where to signpost to. If they
are not interested don’t force the issue – leave the door open.
Spiral of Change
termination
maintenance
action
Progression of
change
decision
contemplation
maintenance
action
lapse/
relaps
e
decision
contemplation
pre-contemplation
Scaling
How do you feel about your health and wellbeing?
1
2
3
4
5
6
7
8
Not good
9
10
Very good
How important is it for you to make a change?
1
2
3
4
5
6
7
Not important
8
9
10
Very important
How confident do you feel to make a change?
1
2
3
Not confident
4
5
6
7
8
9
10
Very confident
Challenges....
If the service user is:
• Not interested – leave the door open
• Aggressive or confrontational
• Under the influence of drink or drugs
• Too emotional
• Too ill or injured
Consider privacy – if the client is in a busy waiting room they
may be unwilling to engage. So think about when and where you
raise the issue.
Dealing with resistance
What if the person
• doesn’t want to talk?
• is defensive?
• is not fluent in English?
• is tearful?
• is in a hurry?
• is not telling you the truth?
Time to have a go
Activity - Elephants in the room
What issues might prevent your trainees from delivering
brief advice consider:
• Being a smoker
• Having a weight issue
• Drinking above the recommended limits
• Being physically unfit
• Experiencing mental health issues
• How would you address it?
Brief Interventions – Level 2
BRIEF INTERVENTIONS occur when a person responds
positively to proactive brief advice or specifically asks
for help with a health-related issue.
Typically between 10 minutes and 30 minutes and includes:
• Giving simple opportunistic advice to change
• Assessing a person’s commitment to change
• Supplying self-help materials or resources
• Signpost to specialist support
• Offering a follow-up appointment if appropriate
• Recording the outcome of discussion
Motivational Interviewing
Motivational interviewing is described as a process of
exploring a person’s motivation to change through
interview in order to assist them towards a state of action.
The techniques used are adaptations of counselling skills and
particular attention is paid to the listening skills of the
interviewer. Motivational interviewing can be understood
as an approach which can be adopted for delivering
a brief intervention.
Pros and Cons
Identifying success behaviour:
• Can you think of a time in the past where you set a
goal and achieved it? (it doesn’t have to be health related)
• What made you successful – what skills and techniques did
you use? How can you use these to achieve this new goal?
Pros and Cons
• What are some benefits of changing? Personal, financial…
• What are some drawbacks of staying the same?
• What are the benefits of staying the same?
• What are the drawbacks of changing?
SMART Goals
If the client wants to work on goal setting, it can be
anything from making a phone call for a self-referral
to losing weight. You can help them set goals in a structured
way to improve their chances of success.
• Specific
• Measurable
• Achievable
• Relevant
• Timely
What if things go wrong?
Time to have a go
• Think of something you want to change
• Think of a previous time you achieved a goal, what
steps did you take, why was it a success?
• What are the pros and cons of making a change vs. staying
the same?
• Write down your three main reasons for making a change?
• Is now a good time to start?
• Make yourself a SMART goal related to starting to change.
Repeat quiz!
• To see what you’ve learned
Summary
Brief advice is short, simple and factual. You are raising
awareness and motivating people to think about making
a change.
• Ask and Advise – provide facts, tips and where to go for
more help. If someone isn’t interested – leave the door open.
Brief interventions build on brief advice to help equip service
users to take action.
• Act – Eliciting service user to identify areas for change, their
readiness to change, and facilitating them to set their own
goals and a means to achieve them. This may include: scaling,
SMART goal setting and signposting to further support.
We are all different…
The 5 groups:
•
•
•
•
•
Health Conscious Realists
Balanced Compensators
Live for Today's
Hedonistic Immortals
Unconfident Fatalists
Health Conscious Realists
• Feel in control of their loves and their health
• Tend not to take risks and take a longer term view of life
• The least fatalistic about their health
Balanced Compensators
• Like to look and feel good about themselves
• A healthy lifestyle is generally easy and enjoyable
• If they take health risks they will use compensatory
mechanisms to make up for this
Live for Todays
• Short term view of life
• Believe in fate
• Leading a healthy lifestyle doesn't sound like
much fun, and think it would be difficult
Hedonistic Immortals
•
•
•
•
Want to get the most from life
Don't feel they will get ill anytime soon
Intend to live healthily
Anything that is enjoyable cant be all bad
Unconfident Fatalists
• Fairly negative about things, and don't feel good
about themselves.
• A healthy lifestyle is not easy nor are they in control
• They know there health is bad and that they should
do something about it but are demotivated.
Segmentation- Cluster Map
Fighting
High Motivation
Health Conscious
Realists
(21%)
+ ve Environment
Balanced
Compensators
(17%)
- ve Environment
Thriving
Hedonistic
Immortals
(19%)
Live for Today
(25%)
Unconfident Fatalists
(18%)
Surviving
Disengaged
Low Motivation
Healthy Foundations
Healthy Foundations
55
55
East of England
Activity
• Make your own presentation from
slides based on your trainee group
Recording contacts
• Tell us who you’ve trained
• Submit a monthly form
Using MECC could…
• Result in someone being grateful you took the
time to take an interest
• Help someone to make links between their lifestyle and
realising other life ambitions
• Make someone feel able to take control of their health
• Mean that someone could live a longer and healthier life as a
result of what you did
Questions?
?
We can’t do it without you
Start Making Every Contact Count today.
Further training: There are options to take the training
further such as Alcohol IBA training, Smoking Brief Advice and
stop smoking service level 2 training.
On-going support: If you have any questions that arise following
today’s training or want to feedback thoughts or experiences
please contact me by calling 01234 276875 or emailing
Sarah.Banfield@bedfordshire.nhs.uk