2. Session Objectives
By the end of this session, you will be able to:
1. Define “Participant Success”
2. Identify two common barriers to participant
success
3. Describe three tools or strategies to improve
participant engagement and outcomes
4. Research supports the following
activities to promote client success
• Counseling delivered by healthcare
professionals
• Brief intervention using the 5As (tobacco)
• Motivational interviewing techniques
• Psychosocial interventions
• Interventions that include woman’s partner
(alcohol)
6. Top Barriers To Participant Success
1. Resistance from participants (63.9%)
2. Limited time to do counseling (43.4%)
~ Based on 2012 First Breath Annual Provider Survey
8. Resistance sounds like…
What kinds of resistant statements do you hear?
• “Doesn’t apply to me.”
• “All my friends do this.”
• “No one understands me.”
• Don’t want to be part of a “program.”
• Guilt/shame
• Tobacco/alcohol cessation is a low priority
9. Preventing Resistance in Clients
1. Set expectations
early
2. Know your client
3. Improve your
program
introduction
4. Provider
Approach
10. Setting Expectations
• What do you expect to happen?
• What does your participant expect to happen?
• Setting an agenda can help
15. Important Points on Introduction
• Voluntary and confidential
• Non-judgmental
• Is NOT a commit-to-quit program
• Designed to help women identify and work
towards goals
• Focus on the process of quitting smoking and
support the participants’ journey
18. Your Approach
• Be aware of your own biases and opinions
– Are you meeting your client where she’s at?
– Reframe negative thoughts
• Be aware of how you react to resistance
• Be aware of your body language
19. Tips from First Breath Providers
• When we have a smoker coming in, we have the incentives
sitting out.
• We offer the program as a way to “quit OR cut back.” The
harm reduction approach can really help.
• We frame First Breath as an “add-on” or extension of the
services already being offered, instead of a new program.
• Let women know that if they’ve recently quit they can still
join!
• I reinforce to patients about the no commit to quit
policy. Even though that is our ultimate goal, that pressure
may scare off potential enrollees.
21. Limited Time For Counseling
How to overcome:
• Figure out program logistics
• Utilize “standardized” provider counseling
tools
• Utilize additional support programs
22. Figuring Out Program Logistics
Things to consider:
• When will you introduce First Breath to your
patients or clients?
• When will the enrollment visit happen?
• When will the prenatal and postpartum visit
happen?
• Where will you store program materials?
• Who will fax or mail completed materials?
28. Important Points
• Ensure that participants receive materials that
fit their needs – depending on social
support, smoking status, goals, and perceived
challenges.
29. Ideas for Saving Time
• Break-up the enrollment visit into two
sessions
• Have participant fill out surveys in advance
and review as part of the counseling session
• Focus counseling on where the woman is at in
her change plan
30. Tips from Current Providers
• Use standard tobacco questions as a lead in to
talking about First Breath.
• We do a combination of office, phone, and home
visits to complete First Breath counseling.
• We have a system set in place so that any woman
who reports a history of recent smoking is flagged.
• We typically bring it up at second or third PNCC
visit, never the first.
• We have tried calling, but found that mixing
appointments (meeting before or after existing
appointments) works really well.
31. Review
• Success is defined in many different ways
• Resistance from clients
1. Set expectations early
2. Know your client
3. Improve your program introduction
4. Presenting the right attitude
• Limited time for counseling
1. Figure out program logistics
2. Utilize “standardized” provider counseling tools
3. Utilize additional support programs
32. Questions?
Chelsea Stover, CHES
Program Coordinator
cstover@wwhf.org
608-251-1675 ext: 118
Carl Oliver, CHES
Program Coordinator
coliver@wwhf.org
608-251-1675 ext: 117
Krissy Alaniz, MPH
Perinatal Health Program Manager
kalaniz@wwhf.org
(414) 902-3192
Editor's Notes
Hello, introduce selves (multiple people presenting)?
(approx. 3-5 minutes?) Open up with questioningattendeees: What does this even mean? When you meet with a woman, what happens in a successful appointment? What does success look like to you? What does success look like to her? Maybe have tear away pads for collecting these ideas and categorizing between provider and client definitions of success. We want more of these things to happen, so we achieve more success.WWHF definitions:Woman enrolls in FB/MBM.Woman completes 3 counseling sessions.Woman quits / cuts back on tobacco / alcohol.Your definitions:Woman actually shows up for appointments.Woman is actively engaged, asks questions and has them answered.Woman makes changes to improve the health of baby.Her definitions:Receives the services she was expectingHas a healthy pregnancy
We hope these are things that you’re already following, as these are the skills and styles of intervention we focus our trainings on.
Unfortunately, sometimes following evidence based best practice isn’t enough. In spite of what research supports, sometimes things still get in the way of participants succeeding. Based on the First Breath provider survey that many of you participated in last month, we found that the two most common barriers impeding participant success were…(read from slide)We’re going to look at each of these a little more in depth.
For those of you with some experience with First Breath, what are some of the things your clients say when they’re resistant? What does resistance look like? What does it sound like?
A few things you can do to help overcome resistance…(read off list). We’ll be looking into each of these a little more in depth.
Expectations are an important piece that sometimes is overlooked. It’s easy for a person to become resistant if something happens that they don’t expect. In the context of your work, if a woman isn’t aware that you are planning to talk about certain topics, she might be caught off guard and become resistant. You also want to know what your client is expecting to happen during this meeting. Is she expecting to walk away from the appointment with something? Is she expecting you to fix a problem? Setting these expectations early on will help reduce resistance, as well as increase the chances that you and your participant walk away from the appointment feeling like it was successful.
One of the tools you can utilize, which you will find in your packet and may have seen elsewhere, is the Agenda setting tool. This is a very simple tool, in that it’s just a series of circles. What this does is allow you to identify a few of the key topics you want to discuss, as well as letting your client identify topics they want to discuss. It can be helpful to utilize a tool like this instead of a list, in that there is no inherent order, so your client’s priorities and expectations are on the same level as yours.
Review the chart. Know where your client is coming from and where she wants to go. Respect what she wants for herself and help her achieve her own goals. What you talk about with a person who has already quit will be different than what you talk about with a person who only wants to cut down.
Again, know your client. If she is a “light drinker” – don’t approach with an aggressive plan.Note: NIAAA = National Institute on Alcohol Abuse and Alcoholism
Pair off, we’re going to do another quick exercise. It’s going to involve a little role playing. One of your pair is going to be a provider, the other is going to be a woman who qualifies for First Breath. I want you to practice how you introduce First Breath. Do you have a “go to message?” What language do you use? how do you “sell” the program? Test a couple different ways to bring up the program, and then trade roles. Explain what FB is. Debrief: Who feels like their partner had a great way to present the program?As the client: what were your concerns? Did you want to enroll?
Standardized “Tools” can be used to jump start or focus the counseling session! If quitting smoking or alcohol use is rated highly on importance or confidence, this can be another smooth way to bring up First Breath or My Baby & Me. These questions can also provide another way to gather more information about where your client’s motivations and feelings are regarding a specific behavior. These can give you an opportunity to ask follow up questions as well. “Confidence is at a 4, what would have to happen to move you to a “5”?
Decisional balance can also bean intital way to start the conversation. Used for women who are ambivalent about quitting smoking or just to get them talking. it’s a GOOD thing to acknowledge the things she likes about smoking, because it helps her verbally explore her ambivalence. She will feel like both sides of how she feels are being heard!
Before you go into your appointments, be aware of where your head is at as well. We all have biases and opinions, and we want to keep these from negatively impacting our client’s engagement. Sometimes it can be frustrating, when you really want a woman to make a change and you feel like it’s so obvious what she needs to do that you just want to spell it out for her. Remember, to meet your client where they are at. If you do find yourself having any negative thoughts, and they happen (She keeps saying she wants to quit, but she doesn’t do anything.) (She missed her last four appointments, but NOW she has time to meet with me). Reframe those thoughts so they are a little more positive.Also be aware of how you react when resistance comes up. Resistance requires two people. When resistance comes up, do you fight back or do you roll with it?And I almost took this point out, because I know people in your line of work develop the poker face pretty early on, but just be aware of your body language as well. You might not have a shocked face when she says something surprising, but what do you do with your body when she’s acting resistant?
These are a few tips that have come up from our visits with sites in the past year, some tips for how to handle resistance.
We recommend that new First Breath sites schedule a separate meeting (apart from initial training) to determine how the program will be implemented as part of the services they’re offering. It is important to ensure all staff are on the same page about how the program will work at your agency.
In addition to some of the other tools mentioned earlier (assessment ruler, decisional balance) - - Another tool to really streamline counseling sessions to the bare minimum is the quit smoking action plan. It’s a way to get things on paper, come up w a simple step by step plan and identify major challenges.
If you are short on time, many providers also “assign homework” i.e. ask women to reflect outside of the visit. The workbooks are an excellent tool for this purpose.
You can also refer women to support programs (texting and online support group). Relieves some of burden off of provider knowing that she is getting support elsewhere. Also refer to QuitLine.
Show how to sign women up for texting program and FB group.
Short on time – another support system. You can refer women to this website for an individualized curriculum.
Materials and support programs use when appropriate!! Probably goes without saying – but just a reminder…if a woman has low literacy – workbook might not be best option. No computer?? Don’t refer her to the online support group!
