Self Management

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People often think that Self-Care is an automatic skill or innate process and indeed that is not the case for many. It is a concept rife with complexity and although Self-Care at some level exists for everyone most people are simply not aware they are doing it or have the skills in place.

Investment in people, skills development and the recognition and development of assets is absolutely vital - this is a piece of work; some refer to the later as Asset Based Community Development (ABCD).

THE RELATIONSHIP

There are several terms that have become closely associated and sometimes confused.

The phrases Self Management, Self-care, Patient Activation and Social Prescribing are those that we commonly come across.

One way to look at this is that Self Management and Social Prescribing are at the base of a triangle with Self-Care at the peak (see Fig1).

As people develop Self Management skills they develop increasing capability recognising the importance in managing their lives and confident to do it. Once they have attained a threshold of competence they have achieved Patient Activation. This can become the glue that makes everything 'stick'.

THE CONNECTION

Fig1:

To have the capability to Self-Care effectively people benefit greatly from developing Self Management skills.

To also enhance ones ability to Self Care effectively this is supported by Social Prescribing.

You can now see the relationship and connection growing.

PATIENT ACTIVATION

We often wonder how we know that someone is an effective Self Manager. What we essentially mean is that someone is empowered, in control and has developed the skill set that will help them with every aspect of their lives more effectively. They go on to also manage their ill health and long-term conditions better. Remember that many people who are effective self-managers often say that my life is not my illness it is simply a part of it.

When people have become effective Self Managers we quite often use the term Patient Activation. There are measures that can be used to identify this; they are usually referred to as Patient Activation Measures (PAMs).

Useful reference points on patient activation are [1] and [2]

ACCESS AND ASSETS

However, having the skills alone is not enough. To be able to have good access, be referred or be signposted to services is absolutely vital. It is true to say that self-managers often want to seek out these services for themselves. Quite often these are people are already using alternative services and community connections other than the traditional ones such as GPs, hospitals and social workers, for example. However, this is not always the case. To remedy this we need to ensure that these alternative assets exist and that there are no barriers to access them.

As noted earlier it is important to invest in our community assets (ABCD).

THE ASSETS

Social Prescribing, as described on another page, unlocks the door to a myriad of organisations:

  • Charities
  • Voluntary sector
  • Communities
  • Religious and faith groups
  • Cultural groups
  • Self Help groups
  • Carers support and development organisations
  • Mental health organisations
  • Training organisations

- All these may have either local or national placement or both -

This rich resource is often referred to as the other Assets in the System. We have also heard of the active process of developing this and some people use the phrase Asset Based Community Development or ABCD as noted earlier. I am not the greatest fan of the term assets but if it is framed with recognition, respect, sensitivity, motivation compassion, investment and connection then it works much better. Also if we acknowledge that many times we are NOT the expert in the system where often coproduction works much better.

VISIBILITY

One of the other important element is to remind ourselves that these services exist and are currently available in one way or another. They are already being used and we may simply need to help to become visible or more visible. We should also invest in them and be aware of the effect that they are having. Investment can, of course, come in the shape of money but it can also come in the form of skills, training, people, new contracting and strong relationships. We must always remind ourselves that these can be very small organisations whilst having a huge impact.

So now you can see how the triangle works for in terms of the relationship and connection between Self Management skills and how once someone is Activated, and hand in hand with Social Prescribing, this utterly enhances a persons ability to Self-Care.

This is a piece of work.

SELF MANAGEMENT SKILLS

The basic skills are simple and yet powerful. The joy of these is that they are applicable to almost everything you do in life. Some say they recognise the similarities of the tools with coaching as a style.

  • Being able to set an agenda which may be working out the list of challenges in one's life
  • Being able to set goals, realising what you want to achieve
  • Being able to problem solve
  • And therefore being able to come up with solutions and actions to achieve one's goals

The Expert Patient Programme (EPP), originally developed in Stanford University, sets one of the highest standards around Self Management training. It comes in a variety of modalities, to include multiple languages, which tend to relate to long-term conditions or in a more open generic format, any condition or challenge. The EPP has a track record of demonstrable evidence sets and impacts which has a pre-built governance structure that cascade trains new trainers; the programme itself feeds your area or region with new potential trainers. There are other programmes out there and it is worth looking at the resources based at the Health Foundation also mentioned on this site.

However, there are other elements to consider:

INFORMATION

Having readily available information is vital and especially material that is key to an individual's needs. This information should be accessible both in the platform that is used to verbal to paper to online. This information should also take into account language and cultural sensitivities and recognition. For the vulnerable, isolated and for those with complexity it might be that phone lines or home visiting is the only way to impart this information

CONDITION SPECIFIC TRAINING

Having condition specific training can be useful in most conditions and we know that there are many respiratory, cardiac, pain related and diabetes programmes that are well established. One of the keys, as with the EPP, is to have people talk as those with LIVED EXPERIENCE. This adds potency and authorises the information given. Also, courses that are interactive, feel personalised and allows people to explore their own challenges and goals works really well. This is the style of Self Management training. Having tutors with lived experiences, as in the EPP, further enhances the engagement and return on the training.

TRAINING FOR PROFESSIONALS

You can devise your own questions that align with your service - remember this helps with the Agenda, Goal Setting and discovering Solutions.
Fig 2: These are questions devised on behalf of Wandsworth CCG by Dr Peter Ilves, clinical lead for the Wandsworth Self Management Service

This is sometimes called Supporting Self Management Training (SSM). It is all well and good having patients who become Activated and effective Self Managers if their professionals do not get it and subsequently undermine a persons ability to self-manage; this would be a backward step and would undermine a persons ability to Self-Care. Also, professionals are in a prime position to encourage someone to take responsibility for their own health but this must be delivered compassionately and correctly. Signposting or booking someone onto a Self Management course is a great idea. To facilitate this ideally clinicians should be taught in the skills to SSM. This has been looked at by the Health Foundation some time ago in their Co-Creating Health Initiatives.

In Wandsworth, we devised cards to support someone to become a self-manager and the task facing healthcare professionals. The idea is to place these in any waiting room and see what happens. You may want to devise your own; it indeed changes the dynamic in the room (See Fig2)

TECHNOLOGY

We have the fortune to have technologies to support Social Prescribing, Self Management and Self-Care. Online searchable directories of services can be vital and are indeed an essential component of Social Prescribing. This can range from a simple hub directory through to an interactive piece of technology which may lead to health advice, signposting, online or face to face navigators or a discussion with someone on the phone if needed. These are many and varied

COMMUNITIES

To truly understand peoples needs and also concurrently to realise all the assets in your area you need to understand and engage with communities. Within those communities discovering those leaders within those ecosystems is vital and essential There will be many that you will have never of heard of until you look for them and connect with them; some will not want that connection for whatever reason and that is fine. In Wandsworth SW London, for example, there is the Wandsworth Community Empowerment Network which has created relationships and connections to a multitude of faith, religious and cultural groups.

COMMUNITY LEADERS

Although a single organisation can be the conduit, nevertheless, knowing your community leaders yourself can be invaluable. In fact, imparting skills to those leaders who themselves social prescribe, signpost or deliver a service is a significant leap forward to addressing an even wider need in your population. Trained themselves these leaders can also deliver Self Management training and teach the principles of social prescribing.

SELF HELP GROUPS

These are often peer-led which may or may not be connected to specific organisations. They usually are made up of like-minded people facing similar challenges. Some are not very well organised but others are. We can play a part in enhancing these firstly by simply knowing they exist and secondly by helping to develop groups to be more organised and better connected. Some of these groups will form with or without our attention.

CHARITY AND VOLUNTARY SECTOR

Clearly, this one of the most significant components to address as it will emerge in the plans of Self Managers as they assess their needs, Social Prescribing and the ability to Self-Care. This will be discussed throughout the wiki resource.

File:Self-care graphic PI v1.0.jpg
The relationship between self-care, self-management skills and social prescribing in a framework of the connections between elements of support
  1. [[1]]
  2. [[2]]