1. 1 Delivering the service step by step

2. 2 Step by Step You should have been able to familiarise yourself with the Operational Manual by the time you undertake this session. The manual describes the way that most sessions with clients should be undertaken, the key points to be discussed and tools to use to support the changes they make. If you haven’t already, now is the time to read the manual – cover to cover. The session gives a walk through the manual and working with clients. It provides a suggested approach but flexibility is important in this service so you may need to adapt content/delivery depending on your client.

3. 3 Session1 Setting the scene Session one is an introduction to the service, an opportunity to outline what you can offer (and cannot), set clear working arrangements, explore boundaries and the client’s expectations. This session is mainly around building rapport and finding out a little bit about your client. By the end of this appointment you should have: Explained how the service works, what is offered, what the benefits might be, areas outside of your expertise (for example, clinical issues, medical questions etc) and working arrangements – for example, how often and how you will get in touch.

4. 4 Session1 Setting the scene You should also have had chance to discuss with the client their motivation to make changes and assess their current behaviour. You will have measured them and weighed them and explained why. You may also have had chance to: Discuss goal setting Established behaviours to change Agreed goals or completion of behaviour change diary prior to next meeting

5. 5 Session1 Setting the scene Topics for discussion during this session: Key health messages around eating and activity 5 a day, eat well and 5 x 30 minutes Current behaviours Principles of behaviour change Weight gain and approach the service takes – regular weights to monitor weight gained, focus on eating healthy and being more active, not a diet

6. 6 Session 2 The second session is the starting point for reviewing progress and setting goals. During this session you should Review what the client has done since the last session Check how she is feeling/motivation towards change Discuss successes/difficulties Review goals/s In the early appointments the focus should be on building rapport with the client and learning about them, their motivating factors and any barriers.

7. 7 All sessions in Phase 1 You should continue to discuss health messages and benefits of changes to behaviour – especially if there are barriers. Praise and reward if progress has been good Discuss and review areas for improvement Prepare for difficult situations Offer practical support – for example, explore in more detail barriers - do they have cooking equipment, cooking skills, knowledge of ‘healthy recipes’ – if the answer is no, support them to resolve this. If the answer is yes, what is stopping them putting it all into practice

8. 8 All sessions in Phase 1 Review understanding of health messages, including breastfeeding. Refer to local support service during pregnancy (if available) or consider a joint visit. Encourage client to maintain an open mind Consider referrals to other services such as aquanatal, cook and eat sessions etc – accompanying clients to new settings if necessary Agree next contact and goals set

9. 9 Sessions at the end of Phase 1 At the end of Phase 1 it is important to take a final end of pregnancy weight and to ask client to complete the end of Phase questionnaire. This will enable you to praise and reward them – using the tools to demonstrate how their knowledge and behaviour has changed over the months. Discuss when you will next contact the client, how you will keep in touch and key goals for them to have in the intervening period. Recognise that maintaining progress is likely to be difficult – but plan with client on minimising impact.

10. 10 Phase 2 – After the baby is born Your first appointment after the baby is born is mainly to re- establish contact, see how your client is feeling and make further arrangements for keeping in touch. You will need to leave it with your client to decide how soon after the baby they are happy to see you and when they feel prepared to commence goal setting again. Recognise that maintaining progress is likely to be difficult – but plan with client on minimising impact. For example, if they don’t have time to eat, to plan healthy snacks instead.

11. 11 Phase 2 – Getting back on track At the next appointment, you should review the client’s health behaviour check to establish a new baseline of behaviour and identify with them where they will begin to make changes. Explain that now they have had their baby you will review the principles of eating and activity to promote weight loss (rather than maintaining weight as during pregnancy). You review the boundaries and expectations you agreed at the beginning and outline how the service will work between now and the baby reaching 6 months of age.

12. 12 All sessions in Phase 2 You should continue to discuss health messages and benefits of changes to behaviour – especially if there are barriers. You should focus on eating and activity levels to lose weight and messages around appropriate introduction of solid foods (at around 6 months). You should continue to promote and support breastfeeding where appropriate. During the session: Praise and reward if progress has been good Discuss and review areas for improvement Prepare for difficult situations

13. 13 All sessions in Phase 2 During the session: Offer practical support to barriers– for example, motivation to wean early, family pressures etc Review understanding of health messages. Consider referrals to other services such as aquanatal, cook and eat sessions etc – accompanying clients to new settings if necessary Agree next contact and goals set

14. 14 Phase 3 – Family Phase Phase 3 promotes the benefits of the service to the wider family and includes focus upon the client creating a positive role model for their baby. You should continue to discuss health messages and benefits of changes to behaviour – especially if there are barriers. You should focus on eating and activity levels to lose weight, healthy family meals and behaviours including active play. At the end of this phase you should support the client to plan how they will maintain their new behaviours and to access mainstream services.

15. 15 All sessions in Phase 3 During the session: Offer practical support to barriers– for example, outside influences, fussy eaters, time pressures etc Review understanding of health messages. Consider referrals to other services such as aquanatal, cook and eat sessions etc – accompanying clients to new settings if necessary Agree next contact and goals set Encourage client to take more responsibility for reviewing goals and identifying and overcoming challenges