Good news…. Just one pill I know we are all here to find a better understanding of supporting health in our various fields and that in particular, we want to find answers to the big questions-the overwhelming problems in health related to diabetes, heart disease, depression, arthritis ….the many serious long-term conditions troubling so many of our patients…and us. Well you’ll be happy to know that there is a magic bullet….just one that cures everything for pennies!!!!

Good news…. Yeah RIGHT! Just one pill It would be nice wouldn’t it? However, even if we had that magic pill, I am wondering if any of you here today are absolutely positive that the people with whom you are working would absolutely, without fail, with determination and trust in you and the medication, take that pill??? Yeah RIGHT!

Why doesn’t anybody listen to me??? Actually, many people who work in health find that more often than not, it seems that no one listens. In fact, there are many really good treatments and advice that we have have to offer and we do offer but more often that not we end up feeling like this…..why doesn’t anybody listen to me????? Anyone ever feel like this? Why doesn’t anybody listen to me???

leona@ethc.co.nz health psychology: a bio psycho social approach Psychological Medicine Faculty of Medical and Health Sciences Auckland University health psychology: a bio psycho social approach Well perhaps you need pychologist. Just a little bit more about me-some of you may have noticed that I am from California from my accent. However, I consider myself an honorary kiwi-I came to NZ almost 30 years ago with my late Kiwi husband and my four grown children are all very much kiwi. I studied psychological medicine at the faculty of medical and health sciences at Auckland University and I have been working in primary care in Auckland for several years now. The point of difference for health psychology is that it is not just about the mind—it is based on a whole person approach or the biopsychosocial model. We see mental and physical health on the same spectrum and endeavor to support people broadly….with heart. I have had the opportunity to do some great things within primary care and I’d like to share about that with you today. It is really my story of self-management and would like to speak about self-management in general, how I became interested, what I have been able to do with it and the team that I am currently working with. I am hoping to sprinkle that with some outcomes and excite you to consider what you might do further or differently with self-management support in your settings. leona@ethc.co.nz

Who controls the outcomes? The “Patient” The “Zone of Delusion” Getting back to the “why doesn’t anybody listen to me” frustration. Sometimes we get this feeling when we try to control something that is largely out of our control. So if we look at the health system, what does it control in relation to people’s health?

These tasks include having the confidence to deal with Self-management is defined as the tasks that individuals must undertake to live with one or more chronic conditions. These tasks include having the confidence to deal with the medical management, role management, and emotional management of their conditions. Institute of Medicine 2004

Business definition: “Self-management skills are those abilities that allow an employee to feel more productive when doing their daily routine regardless of the working environment. Well-developed self-management skills will help you efficiently communicate with co-workers, management and customers, make right decisions, plan your working time, and keep your body healthy.” MyManagementguide.com

Health definition: “Self-management skills are those abilities that allow a person with a long term health condition to feel more productive when doing their daily routine regardless of their environment. Well-developed self-management skills will help you efficiently communicate with others, including family and health professionals, make right decisions, plan your working and rest time, and keep your body healthy.” MyManagementguide.com

Set a goal and achieve it Positive + positive thinking Can motivate people-role model Good communicator Confident…self-motivated Proactive, Determined Forward Supportive, well-supported Knows when to ask for help Assertive Hopeful Sense of humour Ability to help others Journey to self-management

Kia Kaha: Manage Better, Feel Stronger AIM: To reduce hospital presentations by 25% in first year Health psychology Stanford Chronic Disease Self-management Programme (CDSMP) Whatever it takes... Kia Kaha: Manage Better, Feel Stronger

Peer Support: part of the intervention Engagement Process

2>unplanned ED admits in 12 months Medical home ETHC Otara locality Patient with 2> LTCs 2>unplanned ED admits in 12 months Medical home ETHC Otara locality Flexible engagement process: Location – clinic, home Peer support worker outreach Comprehensive needs assessment “Patient Voice, Patient Choice” “What matters (most) to you?” Health Psychology intervention Peer support Case coordination Stanford CDSMP

Total presentations per month to Emergency Care for initial 44 patients We started here

Whatever we are doing, we are managing our lives…

How we Manage Makes all the difference to both quality of life and costs

Peer-led self management programmes Generic, Pain, diabetes-Samoan, Tongan, Hindi, Maori, Cook Island specific courses Peer self-management coaching Prof training, supervision Professional/ peer huddles with GP team, with locality networks Peer-professional Careplanning Home SME kits With or without peer phone follow up Referral Pathways between GP, mental health, Kia Kaha, community services Local fitness opportunity Internet and Media Outreach

Wheel of Support provided by a clinician/peer/volunteer teamlet* Careplan Groups Professional led group appointments Manage Better Courses Peer led self-management training Health Coaching Peer health coaching "Be-friending" Peer support Manage Better Supporting Groups Support groups Options to self-tailor care Phone support Manage Better Facebook & Twitter Online support Here now Wheel of Support provided by a clinician/peer/volunteer teamlet* * http://www.cepc.ucsf.edu http://www.chcf.org/publications/2006/12/building-peer-support-programs-to-manage-chronic-disease-seven-models-for- success

Wheel of Support provided by a clinician/peer/volunteer teamlet* Careplan Groups Professional led group appointments Manage Better Courses Peer led self-management training Health Coaching Peer health coaching "Be-friending" Peer support Manage Better Supporting Groups Support groups Options to self-tailor care Phone support Manage Better Facebook & Twitter Online support Here now Wheel of Support provided by a clinician/peer/volunteer teamlet* * http://www.cepc.ucsf.edu http://www.chcf.org/publications/2006/12/building-peer-support-programs-to-manage-chronic-disease-seven-models-for- success

“Helpful to share with someone else… “Helpful to share with someone else….to see through someone else’s eyes”

“I put things in my own words…. Yes! I can do this!”

Wheel of Support provided by a clinician/peer/volunteer teamlet* Careplan Groups Professional led group appointments Manage Better Courses Peer led self-management training Health Coaching Peer health coaching "Be-friending" Peer support Manage Better Supporting Groups Support groups Options to self-tailor care Phone support Manage Better Facebook & Twitter Online support Here now Wheel of Support provided by a clinician/peer/volunteer teamlet* * http://www.cepc.ucsf.edu http://www.chcf.org/publications/2006/12/building-peer-support-programs-to-manage-chronic-disease-seven-models-for- success

Language specific self-management communities

Culture specific courses

Manage Better Leaders: Clinician-Peers-Volunteers

Age Range and Diagnoses of Participants, n=344 Common diagnoses Depression (all types) Diabetes Gout Hypertension Arthritis COPD Asthma Chronic Renal Failure Age of participants Average Age= 54 78 were over 65 <30 were 18

What has the Manage Better Course done for you? Conceptual themes derived from participant feedback Support Person Self-Management Skills Information Problem Reappraisal Practical Skills ‘Not Alone’ Understanding Illness Perceptions Social Anxiety What has the Manage Better Course done for you? Social Aspect Awareness Group Setting Self Improvement Acceptance Participants were asked at the end what the course has done for them. Responses were analysed and grouped into 4 themes: practical skills, self-improvement, social support, and illness perceptions. Hope Confidence Change Positivity Motivation

Wheel of Support provided by a clinician/peer/volunteer teamlet* Careplan Groups Professional led group appointments Manage Better Courses Peer led self-management training Health Coaching Peer health coaching "Be-friending" Peer support Manage Better Supporting Groups Support groups Options to self-tailor care Phone support Manage Better Facebook & Twitter Online support Here now Wheel of Support provided by a clinician/peer/volunteer teamlet* * http://www.cepc.ucsf.edu http://www.chcf.org/publications/2006/12/building-peer-support-programs-to-manage-chronic-disease-seven-models-for- success

Wheel of Support provided by a clinician/peer/volunteer teamlet* Careplan Groups Professional led group appointments Manage Better Courses Peer led self-management training Health Coaching Peer health coaching "Be-friending" Peer support Manage Better Supporting Groups Support groups Options to self-tailor care Phone support Manage Better Facebook & Twitter Online support Here now Wheel of Support provided by a clinician/peer/volunteer teamlet* * http://www.cepc.ucsf.edu http://www.chcf.org/publications/2006/12/building-peer-support-programs-to-manage-chronic-disease-seven-models-for- success

“Kia Kaha helped us to learn about pain management and make a strategic plan as a family. My wife is no longer worried about me dying, my whanau is re-connected and we have a tool box.” Diva

“I can now control my anxiety by using all of the techniques that were taught…my goal is to get better and stay healthy”

““I guess the reason I refer my patients to the Manage Better Courses is that I see clinical and psychosocial evidence that it works. .. patient’s HbA1c are generally better, they seem happier and proud of their achievements; also there is the companionship and sharing with other similar individuals.  There is ongoing support and development.   For some patients I was seeing all the time, visiting frequency seems to have reduced.” Dr Walter Muller, GP Otara locality

Wheel of Support provided by a clinician/peer/volunteer teamlet* Careplan Groups Professional led group appointments Manage Better Courses Peer led self-management training Health Coaching Peer health coaching "Be-friending" Peer support Manage Better Supporting Groups Support groups Options to self-tailor care Phone support Manage Better Facebook & Twitter Online support Here now Wheel of Support provided by a clinician/peer/volunteer teamlet* * http://www.cepc.ucsf.edu http://www.chcf.org/publications/2006/12/building-peer-support-programs-to-manage-chronic-disease-seven-models-for- success

Manage Better, Together