The document describes the development and implementation of a Making Every Contact Count (MECC) training programme for third sector organizations in East Sussex, England. It discusses: 1) How three flexible training packages were created (generic, older people-focused, and wellbeing-focused) based on feedback to improve relevance. 2) Key aspects of the training included behavior change techniques, health quizzes, and role plays to teach brief intervention skills. 3) Over 22 training courses were held between 2012-2014, training 267 staff and volunteers from 8 organizations on opportunistic healthy lifestyle advice. 4) The training programme was successful in meeting its aims and received positive participant feedback, leading to expanded future

1. EAST SUSSEX
MAKING EVERY
CONTACT
COUNT
TRAINING
PROGRAMME
Jazka Atterbury
Behaviour Change Trainer
WWW.ACTION-FOR-CHANGE.ORG
Action for Change has been using Behaviour
Change techniques to provide alcohol
identification and Brief Advice since 1993. We
have a reputation for quality, innovation and
goal orientated recovery and a consistently
high success rate in helping people address and
change unhealthy behaviours for the long term.
The Making Every Contact Count (MECC)
training programme was the first ‘end-to-end’
Behaviour Change training programme based
on the Prevention and Lifestyle Behaviour
Change Competencies designed for the Third
Sector in East Sussex. The training programme
was commissioned by the East Sussex Public
Health team and aimed to teach staff and
volunteers the skills and knowledge needed to
provide opportunistic Brief Advice in healthy
eating, physical activity, smoking and alcohol.
Behaviour Change has now become part of the
fabric of support provision in East Sussex and
MECC training has been added to the
Homeworks Floating Support contract as an
essential criteria.
ThisEvaluationReportprovideskeylearningpoints
raisedinthe developmentandimplementationof
the MECC trainingprogramme designedforand
deliveredtothe ThirdSectorinEast Sussex.

2. 1 | P a g e
About us
Action for Change is an innovative, forward looking charity whose mission is to enable
people of all ages to take positive action so that they can lead meaningful and healthy lives.
The particular focus of our work is in providing advice, information and support around the
impact of alcohol, drugs, smoking and other similar health and social issues can have on an
individual or a family.
Our vision is that people should be more responsible for their own behaviour and the
impact that their behaviour has on others and society in general. Society will be healthier,
more cohesive, and more able to realise the hopes of individuals within it.
We are based in Eastbourne and run training, support, recovery and community
engagement services across East Sussex and Hertfordshire. We also design and deliver
training interventions and provide alcohol and behaviour change advice and consultation
nationally.
TABLE OF CONTENTS
Summary/Training Programme Aims and Objectives 2
Development of MECC Training Programme 3 - 6
Flexible Training Packages that Improve with Learning 6 - 9
Engaging with Participating Organisations at all levels 9 - 11
Social Capital and Capacity Building 11 -
Evidencing MECC in the Workplace
Secondary Gain
Marketing Strategy
Organisations Trained
Beneficiary Satisfaction
Training Participants Demographics
Appendices

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Summary
The MECC Training Programme ran from October 2011 to September 2014. The first draft of
the MECC training package was developed in June 2012, with a pilot training session held for
Action for Change alcohol support staff and volunteers in June 2012.
Throughout the duration of the training programme 22 1-day MECC training courses were
held with a total of 267 frontline staff and volunteers across 8 organisations working in East
Sussex trained in MECC between June 2012 and September 2014.The training programme
met all service agreement aims and objectives with participating organisations trained and
participant numbers and satisfaction levels exceeding targets set out by Action for Change.
The success of this training programme led to Action for Change being awarded a new 3
year contract by East Sussex Commissioning Grants Prospectus to design and deliver
Behaviour Change for Health training for support providers in East Sussex including the
Third Sector, Public Sector and Peer-led community groups. The new training programme
builds on the current MECC training incorporating both learning and development achieved
and successful Behaviour Change health interventions that have been carried out elsewhere
across the UK. Action for Change have also been awarded East Sussex Commissioning Grants
Prospectus training contracts in Alcohol Identification and Brief Advice and Physical Activity
Brief Advice. This is largely due to our reputation as experts in Behaviour Change training
and the application of this skill to the Brief Advice carried out by our alcohol support staff.
Our training packages are popular and successful because they are always at least 70%
practice based and teach participants the skills needed to deliver Brief Advice and affect real
Behaviour Change, rather than simply teach participants an understanding of Behaviour
Change work. As soon as participants complete our half-day or 1-day training courses they
carry with them the skills and competencies needed to encourage and facilitate Behaviour
Change with clients, in the community and often for themselves.
Training Programme Aims and Objectives (2011)
The project aim is to deliver the ‘Prevention and Lifestyle Behaviour Change’ competence
framework known as ‘Making every Contact Count’ (MECC). This will be done by identifying
Third Sector Organisations providing health improvement and preventative services through
the East Sussex Commissioning Prospectus, to undertake brief interventions to support
people to lead healthier lifestyles. The project will research service provision and referral
processes in East Sussex and adapt core material from the national MECC framework to
provide a comprehensive training and support programme for Third Sector Organisations.
This will enable organisations taking part in the MECC training programme to give healthy
lifestyle advice to their clients in smoking, alcohol reduction and healthy eating [physical
activity was not included in the original project proposal] and refer clients on to more
specialist services. The project will evaluate the outcomes associated with increasing
knowledge and skills of those involved in providing low level preventative services to groups
facing the highest health inequalities. The project will also identify gaps in referral processes
and barriers to implementation and potential for scaling up brief intervention through this
route.

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Development of MECC Training Programme
An Evaluation and Performance Management tool was produced to set out an initial plan for
the development of the training programme as a whole. This tool included guidance in pre-
engagement with and organisational analyses of participating organisations, training plans
and evaluation structures, organisational impact and client group outcomes, innovation and
best practice, sustainability and impact analyses.
(See Evaluation and Performance Management Appendix 1)
The MECC training package was created using a standard training intervention framework:-
1. Research
2. Develop
3. Pilot
4. Review and Adapt
5. Roll Out
6. Review and Adapt
1. Research
The Trainer researched national MECC training programmes and the ‘Prevention and
Lifestyle Behaviour Change’ Competence Framework, National Institute for Care and Clinical
Excellence Behaviour Change Guidance (2007, 2014) the Action for Change Identification
and Brief Advice (IBA) training programme and the original Action for Change MECC training
programme which had been rolled out to Castle Hill Hospital Acute teams in Hull. The
Trainer took part in training events including Royal Society for Public Health Introduction to
MECC, East Sussex County Council Healthy Foundations Segmentation Tool Workshop and
alcohol awareness training at Action for Change.
The Trainer met with East Sussex Hospitals NHS Trust healthy living teams including Smoking
Cessation, Alcohol intervention, Health Trainers, Healthy Eating, Healthy Weights and the
East Sussex Health Training team and contributed to a review of national MECC support
tools. Throughout the duration of the project the Trainer kept up-to-date with research
reports including ‘Clustering of unhealthy behaviours over time’ and other reports and
research blogs published by the Kings Fund and the Behaviour and Health Research Unit.
The Trainer also kept abreast of statistical analysis published by the Office of National
Statistics and National Observatory and Population Health Profiles in East Sussex and East
Sussex Joint Strategic Needs Assessment for comparative analysis. NHS Choices were used
to provide Information Standard approved data on healthy eating and physical activity,
smoking and alcohol. Other reputable sources were researched and cited within the training
including the British Heart Foundation National Centre, Diabetes UK, 4Children, Mind and
other research bodies working in the community. This approach ensured that the
information provided in the training came from a broad spectrum of sources including
research institutions and support service providers.
The MECC training package was adapted as and when new research on healthy communities
and behaviour change was published; the training package was kept up-to-date with annual
data reviews. For example, weight bearing activities and resistance training were added to
the training package when these became recommended by the UK Government as part of

5. 4 | P a g e
the minimum physical activity needed to be stay fit. Health Profiles were also changed to
reflect current population health changes. In the 2011 East Sussex Joint Strategic Needs
Assessment Obesity amongst 10-11 year olds was higher than the England average.
However, in the 2014 Joint Strategic Needs Assessment these figures had changed and
Obesity in 10-11 year olds was no longer higher than the England average in East Sussex.
This data was subsequently updated in the MECC training programme and furthermore the
Trainer explored what interventions had taken place to support these figures in an effort to
learn more about successful Behaviour Change work being carried out locally.
2. Develop
The MECC training package was developed through researching tried and tested methods
used in training and Behaviour Change. Service Managers at Action for Change were
interviewed to discuss Behaviour Change tools used by Alcohol Key Workers and
international Behaviour Change Interventions were explored and researched for usability
and application. The Trainer also drew on her own knowledge and experience of developing
training packages that were person centred, practice based and aimed at changing the way
staff and volunteers provide support. Scenario based role play with participants playing a
keyworker, client and observer were included as a tried and tested training exercise, as
were health quizzes, goal setting, motivation and practical group and pair exercises.
Learning styles were taken into account, as were any learning needs participants might have
including Dyslexia with the background colour of slides changed to make words easier to
read and standardised font and size used for accessibility of information being shared.
Participants needed a basic understanding of English and be able to read, but all exercises
were concise and explained clearly by the Trainer. Creative tools were also used with
training toys available for use and innovative training methods including Forum Theatre
introduced to the training.
The MECC Training programme was based on the Prevention and Lifestyle Behaviour
Change: A Competence Framework:
Generic Competences: Level 1
1.1: Ensure individuals are able to make informed choices to manage their self care needs
1.2: Support and enable individuals to access appropriate information to manage their self
care needs
1.3: Communicate with individuals about promoting their health and wellbeing
1.4: Provide opportunistic brief advice
Generic Competences: Level 2
2.1: Ensure your own actions support the care, protection and well-being of individuals
2.2: Select and implement appropriate brief lifestyle behaviour change techniques with
individuals
2.3: Enable individuals to change their behaviour to improve their own health and wellbeing
2.4: Undertake brief interventions
Participants were taught the skills and knowledge to give opportunistic Brief Advice on
healthy living related to smoking, alcohol, healthy eating and physical activity. Participants

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were trained in how to deliver Brief Advice through the introduction of tried and tested
techniques used successfully within Behaviour Change work. These techniques included;
1. Test your knowledge Health Quiz
2. Goal Setting Exercise
3. Support Assets Exercise
4. SMART Objectives
5. Motivational Interviewing Exercise
6. Client, Practitioner and Observer Role Play Exercise
7. Making a Plan for Change Exercise
8. Delegate Workbook
9. Top Tips Factsheets
10. Local and national healthy living resources information
Exercises were supported with presentation slides on health issues and benefits related to
smoking, alcohol, physical activity and healthy eating, population health of communities in
East Sussex and the background to Behaviour Change and how to motivate people.
Participants were also given Delegate Packs that included healthy living and Behaviour
Change factsheets, Behaviour Change toolkits and workbooks to record and evaluate Health
Chats and individual learning and development.
3. Pilot
The original MECC training resources and exercises being used in Hull were reviewed in full,
with a 3 hour MECC pilot training session rolled out to Action for Change staff. This training
included a practice based Health Chat exercise which gave participants the opportunity to
practice giving Health Chats with the knowledge and skills they already had and learn new
support and motivation skills from their peers.
4. Review and Adapt
Feedback and evaluation of the training was taken into account and included a second stage
of development, i.e. more practise based exercises, more service specific scenarios etc.
Following this a 1-day training package was developed and rolled out to the first 2
participating organisations engaged with – Age UK East Sussex and Sussex Deaf Association.
Training evaluation and participation feedback was assessed and the MECC training
programme was developed to further include 3 MECC training packages;
1. Generic
2. Older People
3. Wellbeing
Key learning is explored below in ‘flexible training packages that improve with learning’.
5. Roll out
Participating organisations agreed to provide training venues (including tables and chairs
and a projector and screen) and refreshments for their staff. The MECC Trainer provided
their own lunch and travel expenses and all the materials needed to run the training,

7. 6 | P a g e
including laptop, hand-outs, training toys and exercises. The MECC Lead was contacted by
the MECC Trainer and e-mailed pre-course training materials, training resources required
and a database requesting any support requirements participants might have. MECC Leads
were asked to provide a delegate list and any training support needs to the MECC Trainer a
minimum of 2 weeks before the MECC training was due to run. This ensured that the MECC
trainer could arrange any support needed for participants and also have the right number of
training materials ready to run the training session.
6. Review and Adapt
See ‘flexible trainingpackagesthatimprove withlearning’section below.
5 Key Learning Points
1. Flexible Training Packages that Improvewith Learning
During the early stages of the development of the MECC training programme a generic
training package was developed. This was piloted over the first few training sessions and
feedback was gathered from participants in relation to content, relevance and the practical
application of skills being taught. We used the first few training sessions to gather written
and verbal feedback from participants to gain a deeper understanding of the varying aspects
of support being offered to clients and how Brief Advice could fit in with organisational
systems already in place. We knew a one-size-fits-all approach to training would not work
due to the diverse nature of organisations being trained but did not have the capacity to
write a bespoke training package for each participating organisation. Therefore, our training
tools and exercises needed to have common themes found in support provision and Brief
Advice, but also have some service reflection so that participants would recognise aspects of
their own work which would help them engage with the new work practice being taught. In
other words, for the MECC Competencies to be accepted and taken on board the training
had to mean something to participants. We will discuss engaging the ‘hearts and minds’ of
organisations and training participants in the Secondary Gain section of this report.
From the feedback gathered it became apparent that participants working for Age UK East
Sussex had very specific skills and knowledge and were working exclusively all aspects of
health and support related to old age. This highlighted that old age needed to be central to
the training we provided for this organisation. As we had a Service Plan objective to engage
with and train some organisations who largely work with older people due to the population
demography in East Sussex we agreed it would be of value to create an older people specific
MECC training package. This training package included scenarios based on older people and
roles carried out by training participants including foot care and community club staff. The
training package also included examples of the Health Profiles of older people in East Sussex
and how lifestyle choices in relation to alcohol, smoking, healthy eating and physical activity
affect older people differently from working age populations. The training aimed to educate
participants in research on binge drinking amongst older people, obesity in older women
the sharp increase in Type 2 Diabetes and why it’s vital for older people to stay physically
active. The Age UK East Sussex Director of Operations relayed that the older people’s MECC
training “...looks wonderful and is incredibly relevant.” Through consultation with Age UK

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East Sussex we also produced a Goal Setting memory card as a supplement to the full
version taught in the training. The memory card was aimed at older people and those with
Dementia as it was relayed to us by Age UK East Sussex that a high proportion of their
clients would forget goals set and a short memory card would be a useful tool to add.
(See Goal Setting Memory Card Appendix 2)
Two further training packages were developed for use alongside the older people’s MECC
training package. The first being a generic MECC training package which included a selection
of general scenarios and regional and national population health statistics and evidence of
working age individuals (the training programme was aimed at organisations providing
support for working age adults and older people, not children and young people). The
second training package developed was a wellbeing specific training package which included
wellbeing specific scenarios with health statistics and evidence highlighting the benefits of
healthy eating and the impact of alcohol on mental health, for example. The wellbeing
training package was developed in response to the numbers of wellbeing provider
organisations awarded Prospectus Funding in East Sussex in 2012 and thus the likelihood 2
or more of these organisations being trained in MECC. Participating organisations were
assessed during the first contact meeting and the appropriate training package was rolled
out. It is worth mentioning that the only difference between the training packages were
some of the scenarios used in the Health Chat exercise and some of the population health
evidence and lifestyle related illnesses. All training exercises, behaviour change tools and
skills taught were the same across all 3 training packages.
Six months into rolling out the training sessions the MECC Trainer assessed scores for
training Objective 4 which was ‘...to develop the skills and confidence to initiate a Health
Chat’. These scores were generally lower than scores in other training objectives, even
though participants practiced Health Chats 3 times within each training session and also
made a Plan for Change for clients within the training. The trainer also noted a small
number of participants had asked to have more training in active listening and knowing
when to talk about lifestyle and how to motivate clients in general. Participants relayed that
they didn’t always feel confident initiating discussions with clients around weight, smoking
and alcohol as these were often deeply personal issues. Some participants did not have the
training or experience to open up discussions around lifestyle and health as they assumed
that they would come across as being judgemental and not supportive. Furthermore, some
participants questioned why they were expected to give advice around healthy living when
they themselves were obese or smoked. We will explore participants recognising their own
unhealthy habits and behaviour and subsequently addressing these in the Secondary Gain
section of this report. Participants were supported to explore person centred approaches to
providing Brief Advice during the training sessions, including couching conversations around
health in terms of healthy living and the impact weight, smoking, inactivity and excessive
use of alcohol can have on health and longevity. Participants were reminded to always start
Health Chats from a point of care which would lead helping clients receive the right
information or support, rather than feeling judged based on their appearance or behaviour.
Participants were taught to recognise verbal and non-verbal clues which could lead them
into a conversation about a client’s health. For example, a client being out of breath or
mentioning they had a bad night’s sleep are examples of opportunities to open up a Health
Chat.

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During early training sessions it was observed that there was some difficulty for less
experienced support staff in knowing how to ‘ask the right questions’ and open up
conversations that kept clients in the driving seat and not put participants at risk of losing
their client’s trust. Therefore, the MECC Trainer developed a 30 minute exercise in
Motivational Interviewing, which gave participants another opportunity to practice Health
Chats and also provide a taster session in language styles and techniques used in this type of
questioning. Once the exercise was introduced scores for training Objective 4 immediately
went up to the same level other training objectives were being met; user satisfaction of
‘well and very well’ being the majority scores. Furthermore, the Motivational Interviewing
exercise regularly came up as one of the most useful aspects of the training during training
evaluation feedback. We also found that participants who had already trained in
Motivational Interviewing elsewhere relayed that the exercise was a useful refresher of the
skills they had learnt in the past and reminded them how useful Motivational Interviewing
could be in delivering Brief Advice to clients. This came as no surprise to Action for Change
who have been successfully using Motivational Interviewing in alcohol recovery since 1993.
(See Motivational Interviewing Exercise Appendix 3)
In year 2 of the MECC training programme the Lead Commissioner for the project requested
that the MECC training package be altered to include learning around Behaviour Change and
Physical Activity. This was in response to wider initiatives by Public Health England to focus
on Active Travel and Functional Fitness in the community. As the MECC training was
teaching participants how to provide opportunistic Brief Advice around lifestyle related
behaviours it was logical to include a section on Physical Activity. The training package was
adapted to include a presentation on the impact of inactivity on health and the benefits of
physical activity on longevity and health. The Health quiz was also changed to include a
section on Physical Activity and the Top Tips Factsheets were altered to include Physical
Activity. We have now been awarded a new East Sussex Public Health contract to design and
deliver training in Physical Activity Brief Advice and will develop this training out of the some
of the initial work carried out within the MECC training.
The MECC Trainer regularly kept up-to-date with reports on population health and other
areas of research throughout the duration of the programme which was a vital part of
providing up-to-date evidence and research to participants. The MECC trainer also kept
abreast of alternative MECC training packages being delivered throughout England. Whilst
assessing other training programmes it was noted that the utilisation of Support Assets had
not been explored in any of the MECC training packages being rolled out across England. In
response to this a Support Assets exercise was developed for the MECC training in East
Sussex. This exercise would work alongside the Goal Setting exercise participants were
asked to carry out and was initially included in the MECC Review Seminar. However, after
review it was recognised that the Support Assets exercise would work even more effectively
if it was carried out immediately after participants had completed the Goal Setting exercise
– participants could apply their personal Goal to the exercise to identify their own Support
Assets (or support networks) which would make both exercises more impactful and of real
value to participants. This meant that participants would leave the training with their own
personal plan for behaviour change in the form of a Goal and alongside this a personal plan
in how to access Support Assets to fulfil this Goal. These tools engaged participants on a

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deeper level by providing personal gain from the training. Moreover these exercises gave
participants the skills and confidence needed to facilitate the use of these Behaviour Change
tools with their own clients – participants were better able to ‘sell’ Goal Setting to clients if
they had actually worked through setting a Goal for themselves.
(See Support Assets Exercise Appendix 4)
The key learning realised from introducing the Support Assets exercise and moving it into
the main part of the MECC training so it worked immediately alongside the Goal Setting
exercise was the first stage of the development of the 5 Steps to Success MECC Toolkit. This
toolkit included exercises in how to initiate a Health Chat, Goal Setting, Support Assets,
SMART Objectives and Maintaining Change. The aim of the Toolkit was to provide a formula
which could be picked up and used by anyone providing Brief Advice to support clients to
change behaviours. The Toolkit was not specific to health but rather focused on practical
elements needed to be considered when working through Behaviour Change including the
mechanics of Goal Setting and Motivation. The idea for the MECC Toolkit came out of all the
tools that had been developed for the training being pulled together in a linear format and
easy to use booklet. This booklet was designed and printed in Year 2 of the MECC training
programme and is now a stand-alone Behaviour Change product that can be used by anyone
regardless of whether they have taken part in the MECC training or not.
(See 5 Steps to Success MECC Toolkit Appendix 5)
2. Engaging with Participating Organisations at all levels
A crucial aspect of the MECC Training Programme was the need to provide continual and
ongoing support to organisations to take part in the training. In the past organisations and
staff have proved to be reluctant to go on ‘just another day’s training’ or ‘shut down client
services for the day to take part in free training’. Service providers needed support to build
the training and work practice changes into organisational and managerial structures and
monitoring support. The MECC training programme was unique in that participating
organisations were given an ‘end to end’ service that supported the implementation of the
MECC training at all levels of an organisation. For example, management level MECC leads
were identified within each organisation and were responsible for working with the MECC
Trainer to ‘install’ the MECC training programme into organisations by adding the MECC
training programme to team meetings and supervisions, case reviews, support planning and
support monitoring. This meant that the MECC training programme became part of support
staff work practice and reflection at the start of take up, rather than down the line when
staff were asked to evaluate the impact the training had on their work practice. This
resulted in fewer gaps between participants taking part in the MECC training and their
organisations embedding new work practices into organisational structures of record and
evaluation, review and reflection. Furthermore, this holistic approach ensured that there
was sufficient buy-in from participating organisations which created an environment where
organisations and their training participants felt fully supported to take on a new way of
working and moreover had the tools to build MECC and its evaluation into organisational
structures already in place. To keep us on the right track we developed a Training
Intervention Strategy to action the different stages of engagement and used this as a guide
to inform our work with participating organisations.

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The idea for an ‘end to end’ training programme came from knowledge and experienced
gathered from running single training sessions. In the past, as was standard, participants
were given pre-course materials and simply asked to turn up to a training session at an
allotted time. Training research has shown that to fully engage participants and embed new
work practices in organisational structures participants and organisations needed to be
engaged at a number of different levels and over a period of time. This involves working in
partnership with participating organisations before, during and after training sessions had
been rolled out. The following section details the 5 stages needed for successful end to end
training interventions with the Third Sector.
Stage 1
Identify potential participating organisations working in partnership with Commissioning
teams, utilise partner organisations and contacts and refer East Sussex Commissioning
Prospectus. Also refer to Joint Strategic Needs Assessments to identify clusters of
communities who face the highest health inequalities and target service providers working
in these areas. Also identify any other behaviour change training providers in the region and
assess work so as not to duplicate training provision. Identify the appropriate person to
contact i.e. service director, training manager or service manager to pitch the training to. E-
mail training publicity, wait 2 weeks and then and call to arrange the first contact meeting.
Key Learning
Although the targets were met both in numbers of participants trained and number of
courses run in year 2 and year 3 of the training programme, lower numbers of staff and
volunteers were available to attend the MECC training than was originally anticipated by the
MECC Trainer. The mismatch in expected numbers of staff and volunteers and actual
numbers trained was largely due to organisations working with reduced staff teams and
relying more on peer support and volunteers. Volunteers did not always have the right level
of client support knowledge and experience to take part in the 1 day MECC training course
as they were new to support and the MECC training programme required a working
knowledge of support provision. Some participating organisations appeared to have larger
staff teams ‘on paper’ yet did not have as many staff or support work trained volunteers as
the MECC Trainer expected. This learning highlights wider economic issues faced by the
Third Sector where once thriving service providers now struggle to run services with
reduced workforce and financial instability in the form of short term contracts and
competitive tendering processes.
In response to this we have developed a half day Healthy Communities training package
aimed at volunteers working in the community providing peer support and healthy living
groups. The training will form part of the Behaviour Change for Health Training Programme
and teach participants basic skills in support provision including active listening, motivation
and person centred support as well as an understanding of health issues related to lifestyle
choices. This training package will be available as an Introduction to the 1-day Behaviour
Change for Health training or as a stand-alone training course, depending on participants
training needs and organisational capacity.

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Stage 2
Hold first contact meeting with participating organisations to provide information about the
training programme and gather feedback on services to identify those appropriate to put
forward for MECC training. Go through the MECC Memorandum of Agreement and identify
a MECC lead from each participating organisation whose role it will be to drive the
implementation of the MECC programme within their organisation. It was important that
each MECC Lead was the main contact for the Trainer and have the capacity to change staff
supervision templates and have a say in client record keeping in accordance with the MECC
Memorandum of Agreement. Mangers were therefore usually identified as MECC Leads
within each participating organisation. It was also important to create an Organisational
Profile of participating organisations to detail services provided, geographical and support
areas worked in, numbers of staff and volunteers and a training needs analysis of staff and
volunteers taking part in MECC training. The Trainer also had to agree training venues and
refreshments to be provided by participating organisations and arrange a MECC Lead
Induction to be scheduled, preferably before training sessions were rolled out.
(See Memorandum of Agreement Appendix 6)
Stage 3
Hold MECC Lead induction – include action plan, Memorandum of Agreement, pre-course
training preparation for participants, evidence of training materials used and MECC
Delegate Workbook and Delegate Pack. The Trainer had to agree methods for embedding
MECC into organisational work practice including adding Health Chats to staff supervision
and team meetings and adding Health Chats to client record systems to measure impact.
Agree how to put staff and volunteers forward for the training i.e. put managers through
training first so they can sell it to staff and volunteers or ask managers to take part in
training sessions with their staff? Also consider if staff teams should be mixed and any other
issues or concerns the MECC Lead may have with regards to staff engagement with the
training and subsequent new work practice.
Stage 4
Roll out training; ensure the MECC Lead takes part in the training. Send Training Evaluation
feedback and CPD certificates to the MECC Lead and feedback any training issues or themes
that evolved from the training. Remind the MECC Lead the MECC Workbook is a tool for
measuring Health Chats given and revisit the MECC Lead Action plan to assess any
outstanding actions agreed.
Stage 5
6-12 months after participating organisations have taken part in the training hold a number
of impact interventions including focus groups held at the end of staff meetings, MECC
participant Questionnaires and MECC Lead Interviews to gather feedback on MECC in the
workplace. Also request copies of MECC Workbooks for record and evaluation of Health
Chats in the workplace and copies of supervision templates evidencing Health Chats being
discussed and any client records where MECC or Health Chats are being carried out within
each participating organisation.

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3. Social Capital and Capacity Building
At the start of the MECC Training Programme organisations supporting individuals and
communities with the highest health inequalities were targeted including older people,
carers, people with wellbeing issues and those in recovery. We were unable to engage with
BME specific provider organisations due to contractual restrictions around only making the
training accessible to organisations in receipt of Commissioning Grants Prospectus Funding
– there were no were no suitable BME specific organisations we could approach within this
boundary. Therefore, we targeted organisations like Southdown Housing, Sussex Oakleaf
and Together who provided general needs and wellbeing floating support to a range of
individuals with multiple needs and from different cultural and religious backgrounds.
All organisations we approached to participate in the MECC training engaged with the
training except Care for the Carers who were keen to take up the training but were unable
due to an organisational restructure. Wave Leisure, providing part of the Otago Exercise
Programme were also keen to take up the MECC training but were unable to facilitate staff
time off to attend before the contract end.
Access to healthy living services
British Sign Language (BSL) Interpreters were needed for some participants to take part in
the MECC training. The cost of this was not factored into the original budget as there was an
explicit Equalities Offer within the Commissioning Prospectus. This offer was not been met
by East Sussex County Council and there was some misunderstanding as to who was
responsible for meeting the cost of BSL Interpreters and other special requirements. East
Sussex Public Health Commissioning team met the cost of Interpreters for the duration of
the MECC Training Programme and advised that future training programmes have
interpreting costs built into project proposals. We have now built in Interpreting costs into
all our training and community programmes at Action for Change. Gaps in referral processes
were also highlighted including Health Walks and other healthy living services not
advertising BSL Interpreting. This highlights the need for healthy living service providers to
advertise their services proactively to clients with specific needs or requirements. For
example, Health Walks could add a sentence to their flyers such as ‘BSL and BME
Interpreters provided, booking required in advance’, which would make their service more
inclusive and help to capture more people with disabilities or English as a second language.
Volunteers
Participating organisations were encouraged to identify and support volunteers to take part
in the MECC training. The training programme was aimed at professionals with a working
knowledge of support provision and therefore only 6% of people who took part in the MECC
training were volunteers. The main reasons for this were;
1. Some participating organisations felt that many of their volunteers were still very
new to support provision and did not have the basic support skills and knowledge
needed to take up the MECC training.
2. Some participating organisations ran their services on reduced work teams with high
numbers of part-time staff and expressed that they had to prioritise the MECC
training to paid staff and those who were available to take part in the training on a

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normal work day, rather than be expected to take part in the training on a non-work
day, of which they would not be paid as they were volunteers.
Key Learning
In response to the low engagement of volunteers with the MECC training programme we
are developing a half day Healthy Communities training package aimed at Community
Interest Companies, community volunteers with limited support experience and peer-led
community groups. This training package will form part of the new Behaviour Change for
Health training programme being delivered in East Sussex between October 2014 and
September 2017 and will give participants an introduction to basic 1-1 and group support
skills in relation to motivation, active listening and healthy communities.
Working in Partnership
We developed strong partnerships with organisations participating in the MECC training by
engaging with organisations at a number of different levels to ensure the MECC training had
a chance of survival and the skills and competencies taught didn’t get forgotten. For
example, as MECC was built into the 2014 Homeworks contract as essential training
Southdown Housing Association were keen to put all Homeworks staff through the MECC
training programme and ensure that Homeworks staff knew the right organisational
pathways to access guidance and support on how to build MECC into their work. The MECC
Trainer worked closely with Southdown Housing Association Training Manager and
Homeworks Team Leaders to ensure the right information was shared with frontline staff
during the MECC training. Presentation slides were added to the MECC training which
detailed how MECC fitted in with current support methods carried out including Coaching
and Person-Centred Planning. Participants were also told during each MECC training session
where they would be able to access support and advice in relation to MECC within their
organisation – 1-1 supervisions, team meetings, staff days, new client recording structures
being built etc. These methods ensured that the MECC training principles were not
approached in silo and reflected back other aspects of work practice already carried out by
Homeworks staff.
Information sharing and advice
Training evaluation feedback consistently highlighted that the Delegate Pack was viewed as
the third most useful aspect of the training, after practicing Health Chats and Motivational
Interviewing. Participants from all organisations (apart from the Homeworks team who used
had iPads during their support sessions and were knowledgeable on healthy living service
provision in East Sussex) regularly voiced that they did not know enough about what healthy
living services were available for referral in East Sussex. In particular, participants knew of
the Health Trainer service, but did not know what kind of support they were able to offer
clients – a hand-out explaining the Health Trainer role was included in the MECC Delegate
Pack in response to this. Furthermore, the MECC Trainer picked up on questions raised by
participants during training sessions and provided short and concise information and advice
on local healthy living service provision when discussions were raised, rather than simply
refering participants to the Delegate Pack. Participants said they did not know enough about
physical activity and healthy eating services as these were less specialist than alcohol and
smoking reduction services and thus more likely to be run in the community by social

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enterprises and community interest companies who may not have the capacity to produce
large numbers of marketing flyers and publicity.
The MECC Delegate Pack detailed local healthy living service providers and was divided into
4 sections on smoking, alcohol, physical activity and healthy eating. The Pack also gave
details of local and national sources of healthy living information and research, as well as
details of Mobile healthy living Apps and opportunities for participants to develop further
skills in other areas of healthy living support. Overall, the MECC Delegate Pack provided a
useful source of information to participants, which gave them another tool to be able to
provide opportunistic Brief Advice and signpost clients to healthy living services immediately
after completing the MECC training.
We ensured that healthy living links and service information was shared between
organisations, we did this by creating an e-mail group of participating organisations and e-
mailing health research and healthy living services and activities when they became known
by the MECC Trainer. We also shared resources with participating organisations so they
could expand their own capacity and knowledge of healthy living services including linking
organisations in with East Sussex 1Space and the East Sussex Public Health service mailing
list. We also promoted local organisations for use including East Sussex Disability
Association as a low-cost charity that provided a training venue; both Freedom Leisure and
Family Mosaic used this training venue in Eastbourne following recommendations from the
MECC Trainer. We advised Together on BME services in East Sussex for their client
conference and helped them identify staff for the MECC training who were based in a
residential unit. We also worked with Sussex Oakleaf and referred them to free healthy
living training in East Sussex and provided a 1-day refresher Counselling training course to
staff working for Sussex Deaf association. We have also worked in partnership with the East
Sussex Libraries Equalities Service by adding service publicity to our Delegate Packs. These
links and partnership working also developed our own capacity as an organisation and
improved our reach to individuals and communities wanting to access alcohol support and
Behaviour Change training throughout East Sussex.
Social Exclusion
During a MECC Review Seminar we supported Sussex Deaf Association to explore gaps in
British Sign Language Service Provision in East Sussex. This seminar was held 6 months after
staff had taken part in the MECC training and was designed to explore MECC in the
Workplace. However, other key disability access issues were relayed back to the MECC
Trainer during this session. Participants told us that there were language barriers between
Deaf communities and all services Sussex Deaf Association clients were referred to including
NHS, Third Sector and GPs. Participants argued that unless there are on-call British Sign
Language (BSL) Interpreters it can take weeks, or even months in some instances, to secure
a BSL Interpreter to support a Deaf person to access a support service. Many Deaf people
remain excluded from services because they cannot make a preference to which BSL
Interpreter they can work with and often end up with a stranger they have no relationship
of trust built up with, which deters many Deaf people from taking up healthy lifestyle
services. Furthermore, internet support and information although good is still not in easy-
read format and too difficult to understand by people from Deaf communities who do not
understand complicated words and long sentences. BSL is a very basic language, for

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example a simple English sentence like “I am from London, but I live in Hastings.” would be
roughly translated in BSL as “London live Hastings.” This means that simple English language
will still be more complex than language structures used in BSL and yet this is largely
unknown by ‘speaking’ community and those developing information on healthy living
resources. Furthermore, participants argued that a large majority of Deaf people also have
learning difficulties which compounds language barriers already in place.
Sussex Deaf Association have cited 3 key improvements that would improve referrals into
healthy living services:
1. Deaf awareness training for commissioners, service providers, NHS staff, GPs and the
Third Sector. This training must help people develop a deeper understanding of
some of the key issues faced by Deaf communities and not simply be based around
“service providers having a bit of fun and learning how to say hello in BSL.”
2. More funding and commissioning needs to be allocated to provide BSL support so
that Deaf people can access services equally. Deaf people, particularly older Deaf
people belong to one of the most socially excluded communities across the country.
3. Service Providers from both the Public and Third Sector need to be more proactive in
finding out what Deaf support provision there is in their area and refer clients into
these services. Deaf support providers also need to produce up-to-date publicity to
market their services to local support providers to ensure the referral process “works
both ways”.
4. Evidencing MECC in the Workplace
An important part of the MECC training programme involved measuring the impact of MECC
Competencies, principles and work practices applied in the workplace. A number of
methods were used to collect information on how participants who took part in the MECC
training utilised the skills and knowledge learnt in the workplace.
Feedback on MECC in the workplace methodology included:
1. Delegate Workbook
2. MECC Review Seminars
3. Workplace Questionnaires
4. Staff Focus Groups
5. MECC Lead Interview Questionnaires
MECC Workbook
Part of our ‘Memorandum of Agreement’ asked that participating organisations record
Health Chats undertaken and monitor the overall progress of the training programme within
respective organisations. This enabled Action for Change and participating organisations to
begin to measure the impact of the MECC training and also provide a quantative record of
Health Chats received by clients. In the MECC Workbook staff and volunteers were asked to
complete sections on case studies and record of Health Chats given so each participant who

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has completed the MECC training would have their own record of Brief Advice support
carried out and also be asked to share these on a regular basis with their line manager. This
resulted in paper records being kept of Health Chats undertaken including number of Health
Chats, a selection of qualitative case studies to provide anecdotal and experiential evidence
and areas of participant learning and reflection on the MECC programme overall. Such
measures will ultimately benefit clients as the MECC Workbook would act as a reminder for
participants to carry out Health Chats and provide a structure of record and evaluation in
which to do so. Furthermore, areas for learning reflection and improvement would also be
identified by participants and their line managers and be explored during 1-1 supervisions or
team meetings.
Key Learning
The MECC Workbooks were generally well received by participating organisations after
initial trepidation about staff being asked to ‘fill out another piece of paper’. It was
important to emphasise to participating organisations that the MECC Workbook was the
only system currently in place that could record Health Chats and it was vital for staff to be
able to start to recognise when they had given a Health Chat and what action had been
agreed and progress made etc. The MECC Workbook also gave participants the opportunity
to explore learning and reflection of Brief Advice and come up with their own methods on
how to apply this new style of support to their work with clients.
The Trainer worked with MECC Lead to support and encourage the development of their
own organisational mechanisms for the record of Health Chats that could fit within current
frameworks. For example, Sussex Deaf Association added a Health Chat tick box to their
client contact forms, whist Southdown Housing adapted their client records systems on a
number of different levels to record Health Chats where staff were given a drop-down menu
to provide details of Health Chats and action to be taken. This was largely due to the fact
that MECC had been added to the Service Specification for the Homeworks contract and
thus it was essential that the Homework staff team all took part in MECC training and Health
Chats were being recorded and evidenced. Sussex Oakleaf were so happy with the MECC
Workbook that they incorporated the framework into their own client recording structure.
MECC Review Seminars
Half day seminar which asked participants to feedback on 3 key areas;
2 Seminars were held – dropped after staff struggled to commit half a day to review and
feedback training. The MECC Review Seminars were replaced with MECC in the Workplace
Interview Questionnaires held at team meetings with participants from Southdown Housing,
EXPAND
Workplace Questionnaires
Staff Focus Groups
MECC Lead Interview Questionnaires

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5. Secondary Gain
The MECC training worked well as an introduction and refresher of support skills for all
training participants including motivational interviewing, active listening, and goal oriented
support. Furthermore, Age UK East Sussex utilised MECC as part of their induction for staff
who had been recruited for a new service. This meant that new staff were taught MECC
competencies as part of their core training right at the start of their career with Age UK East
Sussex.
Participants were asked to complete a pre-course worksheet which asked them to think
about someone they either worked with in a support capacity or knew socially whom they
thought might benefit from Brief Advice around healthy living. These case studies were then
applied to the Making a Plan for Change Exercise carried out at the end of each training
session when participants had learnt the key skills and Competencies needed to provide
Brief Advice around healthy living. Approximately 4 clients had a Plan for Change made for
them by 3-5 support professionals during each training session. Each group chose 1-2 case
studies to work through and the key support worker then took their client’s Plan for Change
back to the workplace. It is estimated that throughout a total of 22 training sessions
approximately 100 clients directly benefitted from the MECC training as a result of their
support worker making a Plan for Change for them before participants had even made it
back to the workplace and carried out Health Chats.
Participants carried out Goal Setting and Support Assets exercises during each training
session which personalised the training for them and also gave them the opportunity to
leave the training with their own Goal for behaviour change. Part of winning the hearts and
minds of participants involves engaging training participants in the support they are being
trained to provide to clients.
Engaging hearts and minds of participants - expand
Marketing Strategy
It was important to utilise the national media attention Behaviour Change was receiving at
the start of the project and ensure that the training reflected current trends and responded
to publicity around behaviour change. For example, there has been good and bad press
surrounding Central Government’s plans to encourage behaviour change through ‘nudge’
incentives and disincentives. An important aspect involved in marketing the MECC training
package and rolling out the training was to allay any fears or misconceptions people might
have of the national and Public Health drivers behind this kind of behaviour change training
programme. The MECC training programme aims to foster behaviour change through choice
and empowerment, rather than fear of losing entitlements such as welfare or NHS
treatments if unhealthy behaviour continues. This is being re-emphasised during first
contact meetings with participating organisations and during training sessions with staff.

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Organisations Trained
The following support services in East Sussex engaged with the training programme;
1. Action for Change
Alcohol and recovery support provider: 61 Staff and Volunteers trained in MECC.
2. Age UK East Sussex
Older people support provider: 29 staff and volunteers trained in MECC.
3. Family Mosaic
Living Well support service provider: 11 staff and volunteers trained in MECC.
4. Freedom Leisure
Otago Exercise Programme and GP referral support provider: 11 staff trained in MECC.
5. Southdown Housing Association
Homeworks floating support provider: 112 staff trained in MECC.
6. Stroke Association
Stroke recovery support provider: 7 staff trained in MECC.
7. Sussex Oakleaf
Wellbeing support provider: 11 staff and volunteers trained in MECC.
8. Together
Wellbeing support provider: 16 staff and volunteers trained in MECC.
Beneficiary Satisfaction

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The MECC training programme had 5 key training objectives;
1. Understand the background to MECC.
2. Understand how Brief Advice Works.
3. Increase knowledge of health issues related to smoking, alcohol, physical activity and
healthy eating.
4. Gain the Skills and confidence to initiate a Health Chat.
5. Increase knowledge of lifestyle (healthy living) support services.
All 5 training objectives were largely met throughout the duration of the training
programme. See tables below:-

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Training evaluation Feedback – A Snapshot of Experience
Which aspects of the training did you find most useful?
Participant’s quotes here – draw from quarterly reports
Is there anything you would have liked more about?
Participant’s quotes here
How do you feel about how the training was facilitated?
Participant’s quotes here
Any other comments?
Participant’s quotes here
Key Learning
Motivational Interviewing added to training as a direct result of training feedback – expand
example.

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Training Participants Demographic
A total of 31% of training participants provided data on age, ethnicity, religion, gender,
scaring responsibilities, disability, pregnancy and maternity and sexual orientation. The
following charts provide a breakdown of participant demography.
Key Learning
Training participants were sent equal opportunities forms, via their line manager, along with
pre-course training information. This approach, which was adopted to protect participant’s
anonymity, produced low numbers for analysis; approximately 10-15% of participants
completed equal opportunity forms per training session. During the last 2 MECC training
sessions rolled out participants were asked to fill out equal opportunity forms at the start of
the training session. This approach produced 80-90% completed equal opportunity forms
per training session. In response to this evidence we now ask training participants to fill out
equal opportunity forms at the start of all Action for Change training sessions as standard.

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