having healthy conversations · domestic / psychological abuse financial worries mental health...
TRANSCRIPT
in Nottinghamshire
Making Every Contact Count
Having Healthy Conversations
A wellbeing handbook for frontline staff
SECTION 1: THE IMPORTANCE OF WELLBEINGThe World Health Organisationdescribes health as:
This is what is meant by WELLBEING.
“a state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity”
There are many dimensions to wellbeing:
PHYSICAL wellbeing (having healthy habits, keeping as well as we can)
EMOTIONAL wellbeing (how we cope, share, feel)
SOCIAL wellbeing (how connected we are to others)
ENVIRONMENTAL wellbeing (where we live and work, air quality etc)
SPIRITUAL wellbeing (having peace and harmony in our lives)
OCCUPATIONAL wellbeing (feeling we are doing something valuable, fulfilment)
INTELLECTUAL wellbeing (keep learning)
Every day, frontline practitioners have millions of interactions with the public where they could support them to make positive changes to their physical and mental health and wellbeing.
But every person has got their own needs which are different from everybody else’s.
Each person will have their own priorities for wellbeing.
It is important to put yourself in the shoes of the person that you are trying to help – what is the person thinking, feeling and experiencing?
How do you spot the signs that someone may be struggling and needs advice or support?
What are the key issues that could be affecting an individual?
How do you have ‘that’ conversation that may make a difference?
SECTION 2: WHAT ARE THE KEY ISSUES THAT EVERY FRONTLINE STAFF SHOULD CONSIDER?
1. Lifestyle2. Living
Circumstances/ Environment
3. Relationships 4. Employment
• Does the customer smoke or drink heavily?
• Is the customer overweight? Do they eat unhealthily?
• Does the customer appear to be depressed or confused (which may signify anxiety / depression or dementia)?
• Does the customer ever do physical exercise?
• Is the customer living in poverty and/or hardship?
• What is their housing situation? Are they in rent arrears or about to lose their tenancy?
• Is the customer in debt?
• Can you see signs of hoarding?
• Is the customer living in damp, mouldy or cold conditions?
• Is the customer complaining that noise is bothering them?
• Can you see trip hazards?
• Is the customer lonely or socially isolated?
• Has the customer indicated that they are a victim of domestic abuse?
• Is the customer a carer? Or a lone parent?
• Is the customer recently bereaved?
• Is the customer unemployed?
• Is the customer in part-time employment and entitled to benefits?
• Is the customer a victim of discrimination in the workplace?
• Did the customer recently retire?
• Is the customer involved in education or training?
• Is the customer involved in volunteering?
SECTION 3: WHAT SHOULD FRONTLINE STAFF LOOK FOR AS A SIGN THAT A CUSTOMER IS NOT COPING?
Observations in the home:
• Physical mobility problems• Depression• Isolation / loneliness• Lone parent struggling• Substance Misuse• Financial concerns
Overgrown, messy, littered garden
• Depression• Substance Misuse• Dementia• Hoarding• Self-neglect
Unpleasant smell, unwashed bodies, animal smells, stale urine etc
• Depression• Isolation / loneliness• Lone parent struggling• Bereavement• Substance Misuse
Curtains closed
• Depression• Isolation / loneliness• Dementia• Hoarding • Financial Problems• Substance Misuse
Generally dirty/messy home(piles of stuff everywhere, unopened mail lying around, dirty dishes piled up)
• Depression• Isolation / loneliness• Lone parent struggling• Substance Misuse• Physical/domestic abuse• Financial Concerns• Unsuitable/inadequate housing
House in disrepairdented door, broken, dirty windows, broken doors on outside gas/electricity meters
Observations in the home:
• Overcrowding• Unsuitable / inadequate
housing• Financial worries• Fuel poverty
Smells damp and / or obvious visual damp
• Financial worries• Poor diet• Unhealthy eating
Empty pizza boxes / fish and chip papers
• Physical mobility problems
• Depression • Isolation / loneliness
Takes a long time to answer the door
• Physical health problems• Mental health problems• Dementia
Medication spread around
• Financial worries• Unsuitable / inadequate
housing
Obvious overcrowding, family member sleeping in living room
• Heavy Smoker• Substance Misuse • Depression / Anxiety• Domestic Abuse
Full ash trays, empty alcohol bottles
• Diabetes• Hypothyroidism• Raynaud’s• Dementia
Feels overbearingly hot (heating on all day) / client complaining that feeling cold
• Financial worries• Fuel Poverty
Feels cold lient or family member wearing coats, scarves, lots of layers
• Physical mobility problems• Depression / anxiety• Unsuitable / inadequate
housing
Client sleeping downstairs(heating on all day) / client (pillows / blankets stacked up) or clothes piled up
Face-to-face observations:
• Obesity• Unfit• Asthma• COPD• Heart problems• Lung problems
Breathlessness, overweight, propping self up
• Depression / Anxiety• Physical health problems (in pain)• Isolation / loneliness• Bereavement• Lone parent struggling• Financial difficulties• Overcrowding• Domestic Abuse• Psychological abuse• Unsuitable / inadequate housing
Tearful / Crying
• Domestic Abuse• Physical Abuse• Physical mobility
problems
Bruises / cuts• Heavy Smoker• Substance Misuse • Depression / Anxiety• Domestic Abuse
Slurring speech, unsteady on feet, shakes / clammy, smell of tobacco / alcohol
SECTION 4: WHAT SHOULD FRONTLINE STAFF LISTEN FOR AS A SIGN THAT SOMEONE IS NOT COPING?
Mention of health issues
Mention that they never go out
Conversation about high living costs e.g. heating, groceries,
Mention that they have no support / friends locally
Say that they can’t find things / feeling confused / asking questions repetitively
Mention of work problems / having nothing to do
Mention that they have no space / house is crowded
Mention that only use one room in the winter
Use of words like worries / dreads /fears / concerns
Untreated physical or mental health problems
Physical mobility issuesIsolation / LonelinessBereavementLone parent strugglingDepression / anxietyDomestic / Psychological abuse
Isolation / lonelinessLone parent strugglingDepression / anxietyDomestic / psychological abuse
Financial worries Mental health problemsDepression / Anxiety
UnemploymentDiscrimination / bullying in the workplace
DementiaMental health problems
OvercrowdingUnsuitable / inadequate housing
Fuel PovertyFinancial worries
Isolation/LonelinessBereavementLone parent strugglingDepression / anxietyDomestic AbuseFinancial worriesUnsuitable / inadequate housing
SECTION 5: ANYTHING ELSE I SHOULD BE LOOKING FOR?
Sometimes more serious things can be going on in people’s lives that aren’t always obvious such as physical and/or mental abuse of adults and/or children. There are many signs that an adult or child is being abused – some of which are included in the signs /triggers section.
All frontline workers have a responsibility when it comes to the safeguarding of adults and children. Abuse can be carried out by anyone including family members, friends, carers, volunteers or strangers.
If you suspect that an adult or child is experiencing, or at risk of abuse or neglect, please contact the Multi Agency Safeguarding Hub (MASH) on
0300 500 80 90 or go to www.nottinghamshire.gov.uk/care/safeguarding/mash
IF YOU SUSPECT THAT A CHILD OR YOUNG PERSON IS BEING HARMED OR IS AT RISK OF BEING HARMED THEN YOU HAVE A DUTY TO REPORT IT IMMEDIATELY. IF OUT OF HOURS, CALL 999.
SECTION 6: CONDUCTING A BRIEF INTERVENTION
ASK:
ASSESS:
ADVISE:
ARANGE:
Remember the 4 ‘A’s
A brief intervention is a short, time-limited interaction / conversation.There are two levels of brief interventions:Brief Advice typically last no more than 5 or so minutes.
Extended Brief Intervention is based on brief motivational approaches typically lasting 20-30 minutes.
A brief intervention should:• Take from 3-15 minutes
• Follow a simple structure
• Be supportive
• Be encouraging
• Provide information – including signposting to other services when appropriate
Raise the issue neutrally and non-judgementally.
How is the client feeling about making a change?
What does the client already know about the issue and what do they want to know?
Discuss what the client wants to do next and how you can support them.
P PERMISSION O OPEN QUESTIONS
E EXPLORE M MOTIVATE
SECTION 7: CONVERSATION SKILLSYou can use this simple acronym to guide you through a conversation about wellbeing POEM
Always ask permission before going ahead with a MECC Intervention. It shows politeness and sensitivity.
Open questions usually start with words like How? What? Who? Why? When?
Use of open questions and open statements to explore what the client:- Thinks is important and why- Wants to prioritise- Wants to do about it- Needs to support them change
Most people are already motivated to make changes to some degree but sometimes people can get stuck in their habits, and change can seem hard to achieve. What can a practitioner say to increase motivation? Helping people to imagine the BENEFITS of making change helps.
Would you like to talk about how we can address some of your financial worries?
May I just ask how things are going at work?
What first steps do you think you can make to help you become more active?
Are you able to tell me what is upsetting you today?
What concerns you about your health and wellbeing right now?
Tell me more about what sort of support you feel you need?
What would be the biggest benefit for you if you made this change?
I’ve known quite a few people who have used Citizen’s Advice Bureau for help around debt and found it really helped them – what do you think about giving them a call?
SECTION 8: WHAT IS YOUR ROLE AFTER IDENTIFYING AN ISSUE?Provide informationThere are some key messages about the main advice areas that are important to give to clients. Healthy Eating and Healthy Weight Key Messages:
Infographics giving details on recommended physical activity levels for children, young people, adults, older adults, pregnant women and disabled adults can be found on https://www.gov.uk/government/publications/start-active-stay-active-infographics-on-physical-activity
Adults should aim to be active daily. Over a week, activities should add up to around 2½ hours (150 minutes) of moderate intensity activity in bouts of 10 minutes or more. This means doing something that makes you breath harder, get warmer and heart beat faster.
All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours a day.
Adults should also take physical activity to improve muscle strength on at least 2 days a week.
Walking is a great way to be more active in day to day life.
All children, young people and adults should minimise the amount of time spent being sedentary (sitting) for extended periods.
Visit Active notts for more information - https://www.activenotts.org.uk/a-z and Nottinghamshire Help Yourself - https://www.nottshelpyourself.org.uk/kb5/nottinghamshire/directory/home.page
Physical Activity Key Messages:
Adults should aim to be active daily. Over a week, activity should add up to around 2½ hours (150 minutes) of moderate intensity activity in bouts of 10 minutes or more.
All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours every day.
Adults should also undertake physical activity to improve muscle strength on at least two days a week.
Walking is a great way to be more active in day to day life.
All children, young people and adults should minimise the amount of time spent being sedentary (sitting) for extended periods.
Stop Smoking Key Messages:
You are four times more likely to quit with a Stop Smoking service than going it alone.
There are a range of products available on prescription to help people quit including: Nicotine Replacement Products (such as patches, gum and others), Champix®.
Stopping smoking in pregnancy will protect the baby from harmful effects of smoking - stop smoking in pregnancy services are available. Stopping for good will protect children in the long term.
It’s never too late to think about stopping, it will be of benefit whatever your age.
Stopping smoking is possible; there are 11 million ex-smokers in the UK.
PAYMENT DUE
PAYMENT OVERDUE
BILL££
££
BILL
BILL
BILL
BILL
Financial Concerns Key Messages:
Don’t put off dealing with debt. The earlier you deal with/tackle financial difficulties the better.
It is possible for you to take control of your finances – budgeting and planning can help or there are other solutions. If you can’t manage, get advice.
Don’t ignore calls or letters from the people you owe money to (your creditors). Contact them to explain why you’re having problems.
It’s not just the unemployed who get benefits and tax credits – you may be entitled to receive more support than you realise.
Relationships Key Messages:
Loneliness and social isolation are harmful to our health: research shows that lacking social connections is as damaging to our health as smoking 15 cigarettes a day (Holt-Lunstad, 2015). Tackling loneliness and social isolation may reduce unnecessary visits to the GP, reduce the incidence of falls, reduce the likelihood of developing depression and reduce the chances of suicide.
1 in 4 women in England and Wales will experience domestic violence in their lifetimes and 8% will suffer domestic violence in any given year (BCS, 2013/14). Be aware of the signs e.g. physical injuries, fear of partner, anxiety, unusually quiet, reference to partner’s ‘temper’, ‘jealousy’ or ‘possessiveness’ etc.
It is important for frontline staff to recognise the potential impact that providing many hours of care each week may have on carer’s own quality of life and their physical and mental health and wellbeing. Many carers do not identify themselves as carers therefore do not seek help and support when needed.
Housing Key Messages:
Having a suitable home is important for your health and wellbeing – look after it and it will look after you.
Damp houses can contain more mould spores, which can cause or worsen existing respiratory diseases, including asthma.
Every year there are approximately 6,000 deaths as the result of a home accident. (RoSPA).
Cold houses cause over 9,000 deaths per year each winter in England and Wales.
There may be other things to look out for in homes, for example, overcrowding, fire hazards, overheating, very old or broken boilers, not connected to gas and electricity, noise, inadequate lighting and hoarding.
Housing can be improved in lots of ways, for example, improved insulation, boiler checks and replacements and warm home discounts.
Employment & Work Key Messages:
Being employed is good for your wellbeing – it helps you feel valued and boosts self-esteem – and often it is the best way out of financial difficulties.
Being a working parent also improves children’s wellbeing – it helps them aspire to work when they are older.
Having an up to date CV ready for job applications is important. Get advice on the types of skills and qualifications you need for the job you are interested in and how to make a strong application.
Starting work doesn’t always mean that all benefits will stop. If wages are low, ‘in work’ benefits can ensure people are not worse off in work. Also, depending on which type of benefit they are claiming, people with health conditions or disabilities can ‘try out’ paid work for a time and keep their benefits under a scheme called ‘permitted work’.
There are other things related to work and employment that could be causing issues such as redundancy, retirement, discrimination in the work place, stress in the workplace etc.
Drinking Sensibly Key Messages:
It is easy to let drinking sneak up on you and you may be drinking more alcohol than you realise.
Reduce your risks by knowing how much alcohol you are drinking and make sure you don’t drink more than the lower risk guidelines:
• For men and women this is 14 units of alcohol a week.
• This is the same as 6 pints of average strength beer a week
or 1 bottle of typical wine.
• Spread your drinking over three or more days if you regularly drink as much as 14 units a week.
Have at least 2 non-drinking days each week.
Pregnant women should not drink any alcohol and alcohol should be avoided when trying to conceive.
There are lots of benefits to cutting back on alcohol. The most important one is the reduced risk to your health, but there are also immediate benefits, like improvements in your physical and mental wellbeing.
Know your limits. Everyone has a different tolerance level, so don’t try to keep up with your friends.
Mental Health and Wellbeing Key:
You’re not alone. Research suggests that one in four of us will have problems with our mental health and emotional wellbeing at some point in our lives.
Having someone to talk to who will listen is a good way of protecting mental health.
If you feel unable to cope or you think your mental health is deteriorating, it is important to seek help. Mental health can be improved so speak to your GP. You can also contact The Samaritans who are available 24 hours a day, 365 days a year - it’s free of charge from a landline or mobile: 116 123.
Poor physical health is closely connected to poor mental health. Do not assume that poor mental health is something you should just put up with, health and support is available.
Good mental health allows us to reach our potential, cope with stresses, work productively and contribute to our community.
SECTION 9: AND FINALLY...The final stages of having a Healthy Conversation are to signpost or refer a customer for further support if appropriate.
SIGNPOST - Describes the process of giving a client the
details of other services/websites that will be able to help them.
- Useful when not a crisis situation or the customer is not quite ready to change.
- Client is capable and able to self-manage.
- Client has time to think and consider what information they have been given.
MAKING A REFERRAL - Describes the process of contacting
an alternative agency to work with the client when a frontline practitioner has reached the limit of their competence in a particular area of advice.
- Recommended when immediate help is needed or the client is unable to cope.
- Some services require a referral either from a professional or the individual themselves.
USEFUL CONTACTS
If you are concerned about the safety or well-being of a child or adult or you suspect that they may be at risk of abuse, please contact the MASH on:
0300 500 80 90 or go to www.nottinghamshire.gov.uk/MASH
but in a non-emergency call:• Police: 101• Fire: (01926) 423 231• NHS: 111• Gas/Electricity: 0800 111 999
Nottinghamshire Multi-Agency Safeguarding Hub (MASH)
Emergency Contacts Call 999 in an Emergency
Call: 0115 896 0798 Email: [email protected] via our website which is www.changegrowlive.org.ukIf you have a client who you feel would benefit from accessing our services, please send us an e-mail via our secure e-mail address to: [email protected] (Please note that we are unable to accept referrals if they are not sent via secure mail).
Nottinghamshire Community substance misuse service for adult an children - Change Grow Live (CGL)
Healthy lifestyle information and other sources of information use Nottinghamshire Help Yourself website www.nottshelpyourself.org.ukwww.nhs.uk/oneyouwww.nhs.uk/oneyou/every-mind-matters
USEFUL CONTACTS
Free, impartial, confidential, independent advice on benefits, debt, housing, employment, relationships, consumer, energy, discrimination, emergency food and much more.
www.citizensadvice.org.uk/local/mansfi eld Mansfi eld 0344 411 1444 Sherwood & Newark (New Ollerton) & Sherwood and Newark www.ashfi eldca.org.uk Ashfi eld www.citizensadvicenottingham.org.uk Nottingham & District www.citizensadvicebroxtowe.org.uk0300 456 8369 Broxtowe (Eastwood) 0300 4568369 Bassetlaw
Telephone Helpline: 03444 111 444
Whoever you areWhatever the problemWe can help Providing free advice and assistance on all Housing matters
- homelessness, tenancy rights, applying for social housing, obtaining private rented tenancies and benefits advice.
Ashfi eld District Councilwww.ashfi eld.gov.uk/residents/housing Bassetlaw District Councilwww.a1housing.co.uk Broxtowe Borough Councilwww.broxtowe.gov.uk/housingGedling Borough Councilwww.gedling.gov.uk/resident/housingMansfi eld District Councilwww.mansfi eld.gov.uk/housingNewark and Sherwood homeswww.nshomes.co.ukRushcliffe Borough Councilwww.rushcliffe.gov.uk/housing
District and Borough Council Housing Advice Teams
