‘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. ’
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