Talk about para professionals and guidesSolutions to change and a bridge to services
Worked on interventions for 15 years – same things apply
Always talk in the future tenseVisions ConsultNothing changesBigs figures don’t mean much
Current structures are exclusive – when bottom up is said its not meantShared decision making – some things are a given – see values, methods and practice agreements can be shared.
Achieving behaviour change in health
Achieving Behaviour Change in Health Vicki Fitzgerald Chief Executive Gateway Family Services CIC
A transferrable modelBy designing career pathways for people from localcommunities, using a ‘skills escalator’ model that issupplemented with mentoring and support, we sought to helppeople from disadvantaged communities to work with somevery vulnerable families.We were described as ‘a new kind of health business’(Birmingham and Solihull Social Economy Consortium, 2008)as we sought to address inequalities in health, education andtraining and to deliver health, social and employmentopportunitiesWhy did we do this?......
So many interventions fail Service Redesign Policy Change Re-structure New TargetsNothing changes on the ground
The real pictureWhat services thinkthey are….. ...what the feeling is on the ground
A statistical example• The City’s average smoking rate is 26%• In deprived wards the rate is 40%• In affluent wards the rate is 14%Smoking is the biggest risk in contributing to heartdisease, cancer and respiratory diseaseIf you are a man living in Soho – statistically youwill die 11 years earlier than if you live in Sutton Coldfield
People pursue what they have reason to value• What matters to you might not matter to me• Is privilege acknowledged• Who designs the pathways?• Where does the pathway start?
Small steps to big change• Big change is overwhelming• Support is needed• Understand the force-field• Validation and reinforcement is needed• Visible results are motivators
People are best guided by someone a few steps ahead• The starting point is important• The divide between ideal and reality• Understand the world from differing perspectives• Reachable goals that don’t overwhelm• Common connections
It is time to move to the next level•Structural inclusion in decision making (Bottom up?)•Shared decision making (on an individual level)•Demonstrating equal value (values are usually shared atsome level)•Valuing difference (diversity is a positive thing )Organisations as entities can engage in socialchange (but only if they mean it)
How to achieve a real change• Build up a network of core providers• Listen and learn from them• Maintain regular contact• They are the public health workforce
Case Study 1Lucy and Robert30 year old pregnant woman and partnerHousing issues, smoking, drug misuse, debt anddepressionFather is ex-heroin user is on methadone programmeMother is ex-heroin userDeclined smoking cessation support
What made the difference?Lucy’s father had died a few years earlier and she hadno immediate family for support and fell into a drugfuelled lifestyle as she did not have good role modelsaround for supportLucy received a lot of abuse from family friends abouthaving a baby and wanted to show she could be a goodmotherWhen Lucy gained trust in her POW she began toengage better
Motivators for Change• Fear of losing the baby• Fear of being judged• Constant support from one person over time• Breaking problems down into chunks• Being allowed to get upset and move on• Agreeing to share the change actions
Outcomes• Baby not taken into care• Mom and Dad clean free of drugs• Housing environment improved (heat!)• Breastfed baby• Paying back debt in managed programme• Still smoking some• Still drinking some• Baby is 4 months old
Case Study 2http://www.youtube.com/watch?v=7xrpkY287Do&context=C41f6cd4ADvjVQa1PpcFOqA6W4TJBB4Xek_2tmBCNDyOnwyG6j1Jw
4 Key Considerations for Behaviour Change• Big lifestyle changes happen rarely• Changing behaviour happens in small steps• People will do or be what they have reason to value• The best guide is just a few steps ahead
Services that deliver change are...• Approachable: -Being part of a community, supporting people just like us, who want to be successful. Not a faceless corporate entity, but a friendly face.• Smart: Supporting local people is not frivolous or a luxury, it’s the most intelligent thing we can do to improve our community.• Trustworthy: A credible service that is driven by strong core-values• Connected: Pride in being part of a community• Forward Thinking: Spontaneity and a sense of adventure, not afraid to swim against the tide