MassPRA Annual Conference 2014 Supporting Health and Wellness to Enhance Recovery CPRP Domain: SUPPORTING HEALTH & WELLNESS

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1 CPRP Domain: SUPPORTING HEALTH & WELLNESS Task A. Assist individuals in identifying and accessing specialized services. Task B. Assist individuals in identifying and developing strategies for improving various dimensions of wellness. Task C. Support individuals in developing the knowledge, skills, and attitudes necessary to maintain his or her health and wellness. Task D. Promote the importance of mind, body and spirit connections, the need for satisfactions and valued purposes, and a view of wellness as more than non-illness. Task E. Assist individuals in developing and sustaining a wellness lifestyle Contact information: Peggy Swarbrick, PhD, CPRP, FAOTA Pat Nemec, PsyD, CRC, CPRP Amy Spagnolo, PhD, CPRP pswarbrick@cspnj.org patnemec@patnemec.com spagnoam@shrp.rutgers.edu References and resources Baumeister, R., & Tierney, J. (2013). Willpower. NY: Penguin Books* Druss, B. G., & Reisinger Walker, E. (2011). Mental disorders and medical comorbidity. Available online at Based on content in Katon WJ (2003), Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry, 54(3), Duhigg, C. (2012). The power of habit. New York, New York: Random House. Dunn, H. L. (1961). High-level wellness. Arlington, VA: Beatty Press. Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54(7), McClave, A. K., McKnight-Eily, L. R., Davis, S. P., & Dube, S.R. (2010). Smoking characteristics of adults with selected lifetime mental illnesses: Results from the 2007 National Health Interview Survey. American Journal of Public Health, 100, 12, Retrieved from: Rollnick, S., Mason, P. & Butler, C. (2005). Health Behavior Change: A Guide for Practitioners. Edinburgh, Scotland: Churchill Livingstone. Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21 st century. Health Promotion International, 15(3), Retrieved from Parks, J., Svendsen, D., Singer, P., & Foti, M. E. (Eds.). (2006). Morbidity and mortality in people with serious mental illness. Alexandria, VA: National Association of State Mental Health Program Directors ( Schroeder, S. (2007). We can do better- Improving the health of the American People. New England Journal of Medicine, 357, Swarbrick, M. (2013). Introduction to Wellness Coaching. Freehold, NJ: Collaborative Support Programs of New Jersey Inc., Institute for Wellness and Recovery Initiatives. Swarbrick, M. (January 19, 2010). Defining wellness. Words of Wellness, 3(7). Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29(4), Swarbrick, M., D Antonio, D., & Nemec, P. (2011). Promoting staff wellness. Psychiatric Rehabilitation Journal, 34, Swarbrick, M., Hutchinson, D., & Gill, K. (2008). The quest for optimal health: Can education and training cure what ails us? International Journal of Mental Health, 37(2), Institute developed by Peggy Swarbrick, Pat Nemec, Amy Spagnolo 1

2 Why wellness and health? Significant health disparities: Early mortality, co-occurring medical conditions, smoking Low health literacy Connection between wellness and recovery Overview of the Wellness Model Domains of Physical Wellness Physical activity is any body movement that works your muscles and uses more energy than you use when you're resting. Sleep is defined as a natural state of rest for the mind and body. It involves getting a proper night s sleep, which varies based on the individual. Most people require 7-8 hours a night. Stress management / relaxation includes techniques developed to help you cope with or lessen the physical and emotional effects of everyday life pressure, refreshing the body and mind. Eating well includes healthy foods, such as lean meats, vegetables, fruits, whole grains, and low-fat dairy products. Healthy habits and routines are automatic behaviors like showering, brushing your teeth and hair, and keeping your environment clean. Habits can also be harmful and include smoking or use of nicotine, drinking too much alcohol, sugared beverages or caffeine. Medical care and routine, preventative services can keep you up to date on where your health is, and prevent more major diseases in the future. From The Physical Wellness Booklet available from Institute developed by Peggy Swarbrick, Pat Nemec, Amy Spagnolo 2

3 Wellness Coaching Wellness is a conscious, deliberate process that requires a person to become aware of and make choices for a more satisfying lifestyle. Creating a lifestyle centered on wellness means continually seeking more information about our strengths and about how we can improve ourselves and realize our full potential in all of our wellness dimensions (physical, social, occupational, mental/emotional, intellectual, spiritual, environmental, and financial). A Wellness Coach has had special training in helping other people to make positive changes on health issues through the use of knowledge of health and wellness, health literacy, effective communication skills, coaching principles, and strategies to motivate and inspire. Orienting Describe what wellness coaching is and what it is not, roles of coach and coachee, duration, steps including assessing wellness, goal setting, and accountability. Clarify expectations. Orienting Assessment Review wellness status to clarify an area of focus. Use open-ended questions, reflective listening, ask change talk questions, and brainstorm. Orienting Goal Setting Use SMART method to set a goal. Transform ideas into specific measurable time-limited actions. Clarify the reason for the goal and motivators for change. Planning and Accountability Create a plan to succeed including steps to take in the next 7, 14, 21, and 30 days. Set accountability steps, methods, and time frame. What? How? By when? How will it feel to accomplish the goal and plan? What can a wellness coach and other supporters do to provide help and support? Mentoring and Support Provide support and guidance. Help person maintain momentum. Assist as needed with modification of goals, plans, and/or accountability steps. Institute developed by Peggy Swarbrick, Pat Nemec, Amy Spagnolo 3

4 Engagement and Motivation There are many definitions of motivation, but when it comes to health and wellness we are asking, What does it take for someone to go from thinking about a change to actually making a change to improve health or wellness? Building a person s sense of internal motivation requires exploring a person s own reasons for the change based on his/her values, resolving any uncertainty or ambivalence, building readiness, and creating a plan for change. Giving advice does not build personal investment or motivation. A wellness coach must find out the things that are important to a coachee and what serves as motivation. When helping a person identify his/her sources of motivation, is important to understand: Personal values, priorities, and goals Culture and beliefs Readiness, interest, or investment Ambivalence, fears, barriers; potential costs, risks, and benefits of change Match your approach to the person s stage of change Stage of change The person might: What you might do Prefer the current situation Explore perceptions Pre-contemplation Defend the right to live as is Offer information Argue that negative consequences are Provide feedback not serious or not likely Express concern Blame others for any difficulties Negotiate harm reduction Express a wish that things be different Weigh pros and cons Contemplation from how they are now Emphasize free choice Emphasize barriers to change Elicit change talk Acknowledge negative consequences to living as is Summarize selfmotivational statements Describe more pros than cons Validate commitment Preparation Identify a goal for change but seem Generate options unsure about how to proceed Explore feelings and Express a need to change, while seeming unsure about ability to do it expectations about different options Key components of effectively helping someone address health and wellness issues Listen!!!!! Recognize human nature issues (don t blame mental illness) Use a strengths-based approach Build on the person s values, interests, and priorities Keep the goals small and short-term: small wins! Plan carefully in achievable steps Provide support and encouragement, but don t take charge Institute developed by Peggy Swarbrick, Pat Nemec, Amy Spagnolo 4

5 A Wellness Lifestyle A wellness lifestyle includes a self-defined balance of health habits such as adequate sleep and rest, participation in meaningful productive activity, good nutrition and physical activity, social contact, and supportive relationships. * It is important to note that this balance is self-defined because everyone has individual needs and preferences, and the balance of activity, social contact, and sleep varies from person to person. Wellness is the process of creating and adapting patterns of behavior that lead to improved health in all of the wellness dimensions. What are your positive health habits (things you already do daily or weekly)? Physical activity Any body movement that works your muscles and uses more energy than you use when you're resting. Sleep A natural state of rest for the mind and body. Requires good sleep hygiene. Stress management / relaxation Techniques developed to help you cope with or lessen the physical and emotional effects of everyday life pressure, refreshing the body and mind. Eating well A balanced diet that includes healthy foods, such as lean meats, vegetables, fruits, whole grains, and low-fat dairy products. Healthy habits and routines Automatic behaviors like showering, brushing your teeth and hair, and keeping your environment clean (as well as harmful habits, like smoking). Medical and dental care Keeping appointments for routine, preventative services that can keep you up to date on where your health is, and prevent more major diseases in the future. * Swarbrick, M. (1997, March). A wellness model for clients. Mental Health Special Interest Section Quarterly, 20, 1-4 Institute developed by Peggy Swarbrick, Pat Nemec, Amy Spagnolo 5

6 Six Strategies for Changing Behavior and Developing New Habits Important: It s easier to achieve a do more goal than a do less goal. 1) Develop awareness of cues, routines, rewards a) Location: Where does it (or should it) happen? b) Time: When do you do it? When do you need to do it? c) Emotional state: How do you feel at the moment you do it (or need to do it)? d) Other people: How do other people get in the way? How do they help? e) Antecedent behaviors: What comes right before you do it (or need to do it)? 2) Explore interest and desire a) Personal values that drive your choices b) Reasons for making a change 3) Strengthen beliefs (hope) a) What are your beliefs about the behavior? Are they accurate/rational? b) What are the norms for health? What are the norms in your community or group? c) Build self-efficacy d) Find role models and inspiration 4) Identify payoffs a) What are the real concrete benefits (not your fantasies) of the desired behavior? b) What are the payoffs of not changing? Can you get these some other way? 5) Analyze patterns a) Strengths: What do you do now to take care of yourself? b) Problem habits: What are you doing now that seems unhealthy to you? c) Keystone habits: What foundation changes would set you on the path? d) Possible actions/habits for linking or sandwiching the new behavior 6) Develop a change plan a) Goal/objective: Actions within your control to be accomplished in about one month b) Steps: Daily and/or weekly actions c) Rewards: Low cost contingent rewards for accomplishing steps d) Supports: Sources of practical as well as emotional help e) Implementation intentions: Exactly what you will do if say, When X then I will Y My Commitment: Tomorrow,, at, I will (write date) (write time) (write action) because (write important personal reason or value for taking this action) Institute developed by Peggy Swarbrick, Pat Nemec, Amy Spagnolo 6

7 Creating a Wellness Culture at your Agency If you are working, what does your employer do now to support your wellness? What does your agency or program do to support the wellness of people using its services? What information is readily available at your agency about living a healthy lifestyle? What information is readily available at your agency about common health or medical conditions experienced by people using its services (like diabetes, COPD, metabolic syndrome)? What support does your agency offer for people who want to quit smoking? What does your agency or program usually serve when food is offered? What changes would make your agency or program more of a Wellness Culture? Institute developed by Peggy Swarbrick, Pat Nemec, Amy Spagnolo 7

8 Health Literacy Literacy 1 is more than just the ability to read and do basic math (also known as functional literacy 2 ). It also includes the ability to access and evaluate information, as well as the interactive literacy skills 2 required to really comprehend and use health information. Communication skills are critical for interacting with health care providers. Other valuable skills include problem-solving skills, synthesis and analysis of information, abstract thinking and reasoning, the capacity to recognize patterns, and the ability to generalize from those patterns. These skills, and the development of a broad general knowledge base, are the foundation of health literacy, but attitudes, beliefs, self-efficacy, and motivation also play a part in being able to apply what you know to good self-care. Service providers need to be aware of health literacy issues in order to: Be sensitive to any limits experienced by service users in finding, understanding, evaluating, and using health information, as well as appreciating the potential consequences of those limits. Improve communication with people using their services to maximize their ability to understand and use relevant health information. Build their own health literacy as well as the health literacy of the service user. Reasons for Limited Health Literacy 1. Language proficiency other than in English 2. Lack of educational opportunity - people with a high school education or lower 3. Learning or intellectual disabilities 4. Cognitive processing issues related to age, symptoms, and/or side effects of psychotropic medication 5. Reading abilities are typically three to five grade levels below the last year of school completed. Therefore, people with a high school diploma, typically read at a seventh or eighth grade reading level. 3 Most health information is delivered at a 12 th grade level or higher. 1 Source: National Network of Libraries of Medicine 2 References: Dennis et al. (2012). Which providers can bridge the health literacy gap in lifestyle risk factor modification education: A systematic review and narrative synthesis. BMC Family Practice, 13. Retrieved from Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21 st century. Health Promotion International, 15(3), Retrieved from Taggart et al. (2012). A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Family Practice, 13. Retrieved from pdf 3 Reading level is determined by the length of the sentences, number of syllable words, and technical terms, among other things. To check the reading level of any paragraph, cut and paste into the box on readability-score.com Institute developed by Peggy Swarbrick, Pat Nemec, Amy Spagnolo 8

9 Health Information Health information can create the following challenges because it: 1. Can be complex, leaving even intelligent and literate individuals confused. 2. Is sometimes presented by healthcare providers who are rushed due to the value of their time and the pressures of their appointment schedule. 3. Involves a flood of information, including misinformation. People are bombarded with health-related information every day from various sources, with varying credibility. 4. Can be emotional. People are reasonably emotionally involved in decisions which can involve life interruptions, disability, and death. People have emotional histories of health conditions, treatments, and causes of death of others they care about. 5. Can involve embarrassment for both the person seeking healthcare and for the healthcare provider, especially issues like diet, substance use, sexual activities and intimacies. elimination (urination and bowel movements), financial constraints Evaluating Reliability of Health Information & Resources- Some Things to Consider 1 1. Who is the sponsor? 2. Who is this resource targeted for (doctors, health educators, consumers)? 3. Is the information cited? 4. Are there advertisements on the page? 5. Does this information appear useful for people you work with? Ask Me Three Useful questions for people receiving healthcare 2 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this? 1 For more information about evaluating health information, see Tutorial at Medical Library Association: Top 10 most useful consumer health sites ( 2 A campaign from the American Medical Association. Jerome Groopman, in his book, How Doctors Think, recommends the question, What else could it be? Institute developed by Peggy Swarbrick, Pat Nemec, Amy Spagnolo 9

10 What Can You Do About Health Literacy? 1. Increase your own health literacy! 2. Evaluate resources a. Reliable? b. Understandable? 3. Focus a. Single focus for any handout or teaching session b. Targets multiple behaviors, but within a logical frame (e.g., nutrition and physical activity for diabetes management) 4. Build a relationship of trust 5. Teach a. Directly about health and wellness b. To improve health literacy c. Social skills for interacting with providers 6. Assess a. Literacy in general, health literacy in particular, including comfort and ability in seeking information b. Actual knowledge relative to immediate needs (use the teach back method) c. Access to resources (e.g., a computer) d. Cultural factors and personal preferences that affect the health decision process e. Application of knowledge to own situation 7. Collect materials a. Create your own (simple, graphics, white space) b. Evaluate materials (field test with reviewers) c. Make a library d. Share resources 8. Use peer educators and self-help resources TIPS for teaching people with low literacy skills: 1. Teach in small increments of time (a few minutes to no more than 30 minutes). 2. Present one idea or topic at a time. 3. Teach essential information first. 4. Teach at a time when the person is interested - the golden moment. 5. Repeat key information. 6. Be consistent in the terms used (use operation or surgery, not both). 7. Use short, simple words, avoiding medical jargon and slang terms. 8. Use short, simple sentences. 9. Use easily understood analogies. 10. Evaluate learning often (have the people restate and/or demonstrate). *NC Health Literacy: The Teach Back Method ( TEACH BACK* 1. Provide information 2. Demonstrate (if relevant) 3. Ask the person to summarize and (if relevant) do what you just demonstrated: Example: Just to be sure I explained this clearly, tell me how you re going to do this when you get home. 4. Clarify and re-teach, if needed 5. Re-check understanding Institute developed by Peggy Swarbrick, Pat Nemec, Amy Spagnolo 10