Transcript Self-Management Support for Aboriginal people

Self-Management Support for
Aboriginal people
Kate Warren & Fiona Coulthard
Pika Wiya Health Service Inc
Overview
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Background
Self-Management & Self-Management
Support
Principles of Self-Management
Aboriginal Health & Self-Management
LIFE Program
Closing
Background
Part of a National Demonstration Project
Sharing Health Care SA Project 2001 - 2004
Test self-management tools (interventions)
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Flinders Model
Stanford Model
Enhanced Primary Care package (EPC)
Health Promotion & Education
Best practice chronic disease management
3 SA sites: Port Augusta (PWHS), Port Lincoln &
Whyalla
Ongoing data collection to test effectiveness of
interventions during project
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Results
Generally:
 Increased self efficacy, increased quality of life, less
unplanned hospital admissions and casualty visits,
less unplanned GP visits, increased planned GP and
allied health visits
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 Increase self efficacy, better coordination of chronic
care through increased uptake of EPC items eg Aged
Health Assessments & Care Plans
 Other spin offs:
 Community acceptance of & participation in CCSM activities
 Staff empowerment & self-efficacy via training in CCSM
 Increased use of information technology – recognition of
problem areas and development of strategies to improve data
systems
The Centre for Advancement in Health
(1996) proposed the following
definition:
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“Involves [the person with the chronic disease]
engaging in activities that protect and
promote health, monitoring and managing of
symptoms and signs of illness, managing
the impacts of illness on functioning,
emotions and interpersonal relationships
and adhering to treatment regimes.” (p.1)
Kate Lorig (1993) states that selfmanagement is also about enabling:
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“Participants to make informed
choices, to adapt new perspectives
and generic skills that can be
applied to new problems as they
arise, to practice new health
behaviours, and to maintain or
regain emotional stability”.
What is Self-management?
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Self-management is the active participation
by people in their own health care. Selfmanagement incorporates health
promotion and risk reduction, informed
decision making, following care plans,
medication management, and working with
health care providers to attain the best
possible care and to effectively negotiate
the often complex health system.
National Chronic Disease Strategy, 2006
What is Self-Management Support?
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The care and encouragement provided to
people with chronic conditions to help them
understand their central role in managing
their illness, make informed decisions about
care and engage in healthy behaviours
Institute for Healthcare Improvement
Self-Management Support
 Essential elements include:
 Medical, behavioural and socio-economic models of
promoting health
 Ideally can be accessed across all levels:
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 Practice
 Health System
 Community
 Success dependent on:
 Relationships!
Underpins the quality of collaboration, negotiation and client
centredness not just between the client and health care worker
but also between health care workers who must work more as
a team than individual practitioners
 Communication – better electronic data sharing
 Support for health workers to provide self-management
support from all levels of management
 Changes to funding models
 Support systems
Six Principles of Self-Management
1. Know your condition
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2. Have active Involvement in decision making
with the GP or health workers
3. Follow the Care plan that is agreed upon
with the GP and other health professionals
Six Principles of Self-Management
4.
Monitor symptoms associated with the
condition(s) and Respond to manage and
cope with the symptoms.
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5. Manage the physical, emotional and
social Impact of the condition(s) on your
life.
6. Live a healthy Lifestyle
Principles of Self management
 Knowledge
 Involvement
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 Care planning
 Monitor & Respond
 Impact
 Lifestyle
Why are our people dying?
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 Risk factors high
 Healthy lifestyle messages not getting
through
 High rate of chronic disease
 Focus on treatment instead of prevention
 Lack of understanding
 Social determinants of health more of a priority
 Mainstream services inadequate/under accessed
Aboriginal Health Statistics
Difficult to obtain accurate data
ATSI status not recorded
Not asked
Not reported
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Data only obtained from
Hospitalisations
Age at death
Cause of death
Lots of gaps
Not all states & territories collect ATSI specific
information
Moving population
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Pika Wiya Health Service Inc
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L.I.F.E Program
Living Improvements For Everyone
PWHS
health
staff
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L.I.F.E
Course
SHC
Team
HEALTHIER
ABORIGINAL
COMMUNITY
LIVING
LONGER
Health
Promotion
Outside
Providers
Holistic care
coordination
Self-Management
message strong
throughout
L.I.F.E Program
Living Improvements For Everyone
PWHS
health
staff
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L.I.F.E
Course
SHC
Team
HEALTHIER
ABORIGINAL
COMMUNITY
LIVING
LONGER
Health
Promotion
Outside
Providers
Holistic care
coordination
Community
Involvement!
Health Promotion
Empower people through
 Prevention & early intervention: Adult Health Checks, Child Health
Checks (EPC), Immunisations, Ante-natal & baby care etc
 Building Self Efficacy – self confidence, self reliance
 Knowledge:
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 Services available and what’s works best at what time
 Healthy lifestyle choices – education to link lifestyle risk factors with
disease
 Disease Specific Information
 Art For Heart/Kidney Foundation/Cancer Council etc
 Chronic Disease/Diabetes Camps
 Community Activities:





Crocfest
Health Expos
Community Days
Media – Umeewarra Radio, Transcontinental
Fundraising & Awareness Raising Activities
All these activities involved, empowered and educated the
community
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“If you don’t have
diabetes now, then
eat proper food so
you don’t get it.”
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L.I.F.E Program
Living Improvements For Everyone
L.I.F.E
Course
PWHS
health
staff
Health
Promotion
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HEALTHIER
ABORIGINAL
COMMUNITY
LIVING
LONGER
SHC
Outside
Team
providers
Holistic care
coordination
Focus on
TEAMWORK
Holistic Care Coordination
 Chronic disease Triage
 All clients screened at presentation
 Thorough assessment of health needs including EPC items,
immunisations, blood & other tests
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 Flinders Model of Chronic Condition Selfmanagement
 Enhanced Primary Care (EPC) items
 Care planning (GP & Health worker, TCA)
 Aged Health Assessments
 Diabetes Cycle of Care
 Asthma plans etc
 Best practice chronic disease care plan templates
 Supportive IT system (Medical Director, CME, etc)
 Internal and external referral system
 Automated recall and review system
Flinders Model of Chronic Condition
Self-Management
Flinders Human Behaviour & Health Research Unit
(FHBHRU)
 Generic set of tools:
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 Partners in Health (self assessment)
 Cue & Response (interview by HCP)
 Problems & Goals
 Self-management Plan
This process assesses the clients self-management
skills and behaviours and ensures that social &
emotional aspects of the clients life are identified
and included in the medical management plan
EPC care plan and team care arrangement
Impact of Flinders Tools
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 Traditional assessment methods focus on medical
and physical
 Structured approach builds rapport and mutual trust
and respect
 Identifies the social, economic, spiritual, emotional
and cultural issues which may be barriers to selfmanagement
 Client agrees what is to be addressed, when and
how. Their priorities are important!
 Not all things can be tackled at once!
 Health workers need to look after themselves as
well! They are role models!
Training involves
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2 day workshop
Flinders Resource Manual
Open mind and willingness to participate
Volunteers on 2nd day
Certificate of competence issued when 3
completed plans evaluated by trainer within 3
months of completion of training
Tertiary qualification also available via
Flinders online course
Enhanced Primary Care (EPC)
 Care planning
 Health worker involvement as advocate imperative!
 GP Management Plan – anyone who has a chronic condition
 Team Care Arrangement – multidisciplinary needs
 Access to Private allied health services
 Via care planning process
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 Aged Health Assessment
 Over 55 if ATSI
 Home Medicines Review
 Anyone with multiple medications – initiated by GP but anyone can
refer or recommend
 Case Conferencing
 Used in conjunction with care planning for multidisciplinary meetings
to plan or review care.

Adult Health Check for ATSI – 2 yrly
 Any person of ATSI 15 – 54 years of age
 Child Health Checks
 Maternal & infant Checks
Care Plan Case Study
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Ms A, 55 year old lady with multiple chronic
conditions, obese, hypertension, high cholesterol
Care plan completed:
Multiple medications…
BSL 18.3 (random) – recurrent thrush & bleeding
gums
Attended most sessions and 2 camps. Formed
friendship with other ladies in the group. Tried ten
pin bowling for the first time in her life
Outcomes:
Medication review
Blood tests & screening
Referrals & appointments
Follow up
Care Plan Review…
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Care plan review - all clinical
measures improved:
BP↓,
weight↓,
cholesterol↓,
HbA1c↓ (from 8 to 6.5)
She is also more confident in dealing
with day to day problems.
L.I.F.E Program
Living Improvements For Everyone
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Pika Wiya Health Service Inc
L.I.F.E
Course
PWHS
health
workers
Health
Promotion
HEALTHIER
ABORIGINAL
COMMUNITY
LIVING
LONGER
Outside
SHC
providers
Team
Holistic care
coordination
Focus on
Peer
Education
Stanford Model of
Chronic Disease Self Management
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 Follows the principles of self management
 Meet once per week for 6 weeks - 2 ½
hours
 Focus on group interaction & dynamics
 People with different chronic health
problems attend together
 Course is led by 2 trained leaders, at least
one should be peer educator
 Skills learnt and practiced every week are
goal setting (action planning) and problem
solving
Other topics include:
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 Techniques to deal with difficult emotions
such as anger, fear & frustration
 Appropriate exercise to improve and
maintain strength, flexibility and endurance
 Safe use of medicines
 Communicating effectively with family,
friends and health professionals
 Nutrition
 Cognitive symptom management
Training involves
4 day intensive
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Experience the course as a participant
Practise teaching sessions (assessed)
Bring a volunteer (1:1 ratio encouraged)
Leave your HP hat at home!
PROCESS VS CONTENT
Ideally split over 2 weeks (2 days per week)
Text book “Living a Health Life with Chronic
Conditions”
Leaders manual
Stanford & Aboriginal Health
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Presented course (in original format) to a
group of Aboriginal community members who
all have chronic conditions
Participants were invited to give feedback at
every session
Through our observations, evaluation activities
and a focus group after the course, we found
that changes were needed
Adaptation Process
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Course re-presented with a few minor changes…
Findings:
 Difficulties with language predominant
 Some activities needed to presented in different
order
 Examples to reinforce concepts were made ‘real’
 Grief & Loss recognised as having a major impact
on Aboriginal people’s health – new activity designed
using the same process!
 Less emphasis on people attending only one 6 week
course
Outline of ‘Understanding Grief & Loss’
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 Placed immediately after ‘Dealing with Difficult
Emotions’
 After a brief definition of ‘Grief’ we brainstorm “What
are some of the feelings that people go through
when they are grieving?”
 Stages of Grief & explanation
 Brainstorm “What are some of the reasons for
people to feel grief?”
 Discussion around Coping with Grief
 Brainstorm “What are some ways for people to cope
with grief?”
 Further discussion leading to possible ways to get
help
How did it go?
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Previous sessions on grief and loss difficult –
some people loathe to discuss - “taboo
subject”
This session, based on the process
designed by Stanford, was a gentler way to
get people to open up and no one objected
The process allowed people to talk generally
without feeling like they were in the spotlight
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Cover for the LIFE Course Manual reflecting the
overall theme of the course people looking after
themselves and each other
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Session 1: reflecting the Keeping Active theme
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Session 2: reflecting the themes of relaxation,
spirituality, grief and positive thinking
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Session 3: reflecting the themes of healthy eating
and bush tucker including goanna’s, witchetty
grubs, honey ants, quandongs, wild figs, bush
tomatoes, bush bananas and bush berries
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Session 4: Reflecting the themes of
communication, communities and relationships
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Session 5: Reflecting the themes of bush
medicine, western medicine, doctors, health care
workers, people and patients
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Session 6: Reflecting the themes of family,
families, camps, shelter, water and being bored
Master Training Implications
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Leaders manual needed to be more user
friendly
Aboriginal Leaders trained in the future need
to be confident enough to lead courses in
their own communities
Training competent and confident Leaders is
an integral part of adapting the Leaders
Manual
LIFE Leaders Training
An extra day
Rationale for change
New manual
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Paintings
Different order of activities
Language
New activity modelled
More practice teaching (assessed)
Trainees encouraged to draw on local
knowledge and adapt further as needed
Organisational Change Management
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Health care worker culture change
Teamwork crucial
Communication – meaningful and timely!!
Commitment from key health care workers
Staff acceptance
Information systems
Staff training & Education (ongoing)
Marketing & promoting to staff & community
Management commitment and support
Administrative support
Meetings and more meetings…
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Self
management
is an
essential
element
across the
care
continuum:
Something to think about…
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“Mum, is it true that I am going
to die 20 years before my friend
Sarah?”
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The L.I.F.E Program has the
potential to turn that statistic
around.
Our Contact Details
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Kate Warren
Research Associate/Regional Chronic Condition Self
Management Training Coordinator
Spencer Gulf Rural Health School/University of SA
Phone: (08) 86476001
Mobile: 0419 849 199
Email: [email protected]
Fiona Coulthard
Community Development Officer
Australian Red Cross
(08) 86412495