‘Changing risky behaviours in families,by helping them run out of ways of doing it wrong’

Dr. Alan Curley, PhD

June 2014 Early Help Conference-‘Lifestyles and Risky Behaviours’

2

1=Brief history of what i do & what i think works well at helping complex clients change behaviours.

2=To inspire & motivate the delegates that it will be ‘worth it’ to keep working with complex clients.

3=Provide a couple of quick, easy strategies to help delegates working with complex families.

4=To help delegates develop new innovative ideas/approaches in their work with complex families.

Outcomes i was asked to deliver in the Workshop

1=What do you do, what team do you work in ?

2=What type of Clients do you work with ?

3=How frequent or long do you work with them ?

4=What is the ’aim’ of the work you do with them ?

5= What do you hope to get from todays workshop ?

About You

1=Brief history of what i do & what i think works well at helping complex clients change behaviours.

Outcomes i was asked to deliver in the Workshop

1=Smoking2=Alcohol3=Drugs4=Gambling5=Eating6=Sex

Risky behaviours-What do they all have in common?

They are all ways of socially bonding & interacting and to help us feel better in the present?

Question: What types of things can we spend our daily time & energy on?

Work

Sleep

Family

Bills

House

Present Functional tasks

TV

Socialising

Sport

Travel

Computer

Pleasure/enjoyment

paidhobby

Studying

Gym

children

Potential future benefits

Moisturising

We need the support, skills and insights in order to get the balance correct?

2=To inspire & motivate the delegates that it will be ‘worth it’ to keep working with complex clients.

Outcomes i was asked to deliver in the Workshop

Helping complex clients with health & social inequalities is like eating a trifle

The deeper the level of inequalities, the bigger the spoon you need to reach them.

Every Mary that you support to change against the odds, Will make you feel happier & more proud than a 1000 Allistair’s and she will be your career highlight.

MARY ALLISTAIR

Exercise Question: What has Allistair got more of which makes him most likely to make successful

changes in Life?

-Expectation levels-Self-Motivation levels-Self-Confidence/Belief-Experiences of self-success-Awareness of what helps-Planning & Preparation-Ability to absorb & retain information (education)-Learning rates-Goal-Setting-Commitment/will-power-Good Role models/Examples-No. Coping strategies/self-efficacy-Attending/requiring support-Adhering to Medication-Self-encouragement-Keeping positive Focus-Results/benefits obtained-View of relapse/prevention-No. and frequency of attempts needed

People either Generate these by themselves INTERNALLY (Allistair) or they have to get them

nurtured EXTERNALLY (Mary) by us or others

10/16/1310/16/13

Difficulty level

12 weeks support and medication

Letting people smoke in your house

Going out drinking alcohol with people who offer you cigarettes whilst you are drinking

Not telling people that you are trying to quit

Going out every break/lunch-time with smokers who offer you cigarettes

Not taking your medication properly for the proper length of time

Keeping cigarettes in the house

Not having a plan for when you get a craving

Not attending your support sessions

Mary needs to boomerang many times, to physically learn what makes it easier and what helps her to cope better?

Why does Mary need to boomerang so many times before she can make a change?

10/16/1310/16/13

Mel B-Started to smoke age 12Began to quit at age 13Needed 12 attempts Quit at age 29

Emma-Started to smoke at 14Began to quit at 16Needed 9 attempts Quit at age 25

Gerri-Started to smoke at 15Began to quit at 18Needed 6 attempts Quit at age 28

Victoria-Started to smoke at 16Began to quit at age 18Needed 2 attemptsQuit at age 46

Question: 4 young female smokers who took part in different quit programs. -Which program gave the NHS the worst outcome

Question: How do I keep motivated working with Mary when she has been boomeranging without success for a couple of years?

Answer: Think of Mary as the Chinese bamboo Tree

Mark Twain said:‘The best way to motivate someone is to be motivated yourself’

3=Provide a couple of quick, easy strategies to help delegates working with complex families.

Outcomes i was asked to deliver in the Workshop

Relapse rates with Patients is linked to lobster-syndrome.Question:Why Can Fisherman leave Lobsters in a bucket & they don’t manage to escape?

The biggest Influence on the relapse rates in any addiction is the amount of other addicts that are still in their social networks.

‘We need to start Writing a lot more Social Prescriptions.’(Worklessness is the biggest public health problem in the UK)

Because:-People are influenced by other people more than anything else ( facts, data etc..)

-Groups help build connectedness & resilience & sometimes competitiveness

-Groups increase level & frequency of support that mary can get.

-You get multiple boomerang experiences at same time.

Always try and put Mary into a Group: -Either physically, -Theoretically -In cyber-space

Predictors for future success• In a large European trial with > 3,500 patients it was found that:

• First week success (1,698) = 25.1 % still quit 1-year• First week smokers (1,877) = 2.7 % quit at 1-year

Tønnesen P, et al. Eur Resp J 1999; 13:238-246.

You are ~9 times more likely to change if successful in week 1

We need quick results, so should we do more sessions in change week

Question:What things will people feel when they stop-smoking?

West, R (1999) Tobacco Withdrawal Symptoms extract from Manchester Stop Smoking Training Manual 2007 edition page 24

Possible withdrawal symptoms for Nicotine

BLOODY BRILLIANT

We need to keep thinking positive, to keep them focused on staying positive.

Mood scores over time from the day of change. Tønnesen P, et al. Eur Resp J 1999; 13:238-246.

We need to make first week of changing as easy as possible and be aware that it will be 8 weeks before it begins to naturally get easier and take less effort. This is why pointing out compliments, results, benefits and keeping them

focused on the positives is so important for the first week and up to 8 weeks at least.

1. A guide to smoking cessation in Scotland 2010. Planning and providing specialist smoking cessation services. NHS Health Scotland 2010 pg 27.

Efficiency of different support & medications on 4 week quit rates 1

People are more successful at making changes, when they are part of a group.

4=To help delegates develop new innovative ideas/approaches in their work with complex families.

Outcomes i was asked to deliver in the Workshop

People make changes for Life-improvement not health-improvement.

Use What motivates complex clients?Nelson Mandela and the ANC members & Robben Island

-MONEY-FAMILY-SOCIAL-HEALTH

People only change for the 3 E’s in Life

Less effort andLess time required

Less pain or discomfort

Get quick results or benefits

EASIER ENJOYABLE EFFECTIVE

The goal

“People are generally better persuaded by the reasons which they themselves think they discovered, rather than by those which have come from the minds of others.”

–because some people need to feel in control of the decisions they make.

Blaise Pascal (17th C French Mathematician/ Philosopher)

• Don't tell them to do anything just use stories about other people like them who have said they have got the 3E’s. ’