PATIENT SKILLS
PROGRAMME

Facilitator Manual

Module B
[Document heading]
[dd mmm yyyy]

1About this Manual

This manual contains materials to support the delivery of the Patient Skills Programme. It includes:

  • overview of the Programme
  • standard programme for each session
  • materials for the delivery of all Module B activities
  • explanation of the icons and charts used in the materials

Additional materials to support the programme are

  • materials for the delivery of all Module A activities
  • materials for the delivery of all Module C activities
  • participant Workbook and Handouts
  • guide for Facilitators
  • guide to Facilitator Training, Skills and Assessment
  • guide to Quality Assurance
  • guide for Programme Leads

2Overview of the programme

2.1 The purpose of the Patient Skills Programme

The core focus of the programme is to enable people to better manage their own health, through increasing their self confidence, increasing theirskills and supportingpositive changes in health related behaviour, leading to activated patients who feel in control of their health choices.

2.2 How this programme relates to wider health services

The Patient Skills Programme does not, and should not; exist in isolation from the wider health services that people use. The Health Foundation, through its Co-Creating Health programme, believes that people with long term conditions are best able to manage their own condition when:

  • they have the necessary skills, knowledge and confidence
  • they are being supported by clinicians proactively using self management support skills and techniques
  • the systems and processes of the healthcare service are designed to support self management

3Course structure

The Patient Skills Programme is normally run over six weeks, with a workshop a week. Each workshop consists of a series of activities, each lasting 20 minutes, which are put together to create a single session lasting 2 hours 40 minutes.

However, the programme is designed to be adaptable, and may, for example, be spread over longer by running (particularly the last two or three sessions) at fortnightly, rather than weekly, intervals, or by creating new workshops.

2.4Course delivery: co-facilitation

What makes the programme unique is that it is co-delivered by a health professional and a person with experience of living with a long term condition working in partnership. This collaboration between the professional and lay tutors is a model for the collaborative relationship the programme is promoting between health professionals and patients.

Feedback from previous participants has shown that they find the different perspectives, experience, knowledge and skills that the tutors from different backgrounds bring extremely valuable.

2.5 Course content

The programme is made up of three sets (Modules) of activities, containing a range of different components and activities:

  • Module A: Core Repeated Activities: Goal-setting, Goal Follow-up and Problem solving

–These activities are core to health related behaviour change and should be included and repeated in every workshop.

  • Module B: Core Generic Self-management skills

–These activities are also considered core self management activities or core to the group process. Each activity should be covered at least once in the course of Patient Skills Programme.

  • Module C: Optional Self-management skills and topics

–These activities are optional and may be included as needed. Additional module 3 activities may be created for specific diseases and communities.

3Standard programme

All the modules are designed to be delivered flexibly, in the order and at the pace that best suits the group, however, we have set out below a standard programme for each of the six workshops.

Programme for workshop 1
Module / Activity / Time (minutes)
B / B1 / Getting to know one another / 40
B / B2 / Understanding self-management / 20
B / B3 / Recognising and accepting change / 20
A / A1 / Introducing goal-setting / 40
A / A2 / Setting the agenda and close
Programme for workshop 2
Module / Activity / Time (minutes)
Welcome / 5
A / A3 / Follow-up / 30
B / B4 / Challenging unhelpful beliefs / 20
C / C1 / Helpful breathing (optional) / 20
A / A4 / Sharing and agreeing agenda / 20
A / A5 / Working on a self-management goal / 30
A / A2 / Setting the agenda and Close / 10
Programme for workshop 3
Module / Activity / Time (minutes)
Welcome
A / A3 / Follow-up / 30
B / B5 / Working together in partnership / 20
A / A6 / Problem-solving / 20
C / C2 / Eating Well (optional) / 20
A / A7 / Weekly goal setting / 30
A / A2 / Setting the agenda and close / 10
Programme for workshop 4
Module / Activity / Time (minutes)
Welcome
A / A3 / Follow-up / 30
B / B6 / What happens next? Follow-up options / 20
B / B7 / Anxiety, relaxation and your health condition / 20
C / C3 / Managing fatigue, helpful rest and sleep(optional) / 20
A / A7 / Weekly goal setting / 30
A / A2 / Setting the agenda and close / 10
Programme for workshop 5
Module / Activity / Time (minutes)
Welcome
A / A3 / Follow-up / 30
B / B8 / Planning / 20
B / B9 / Communicating our needs and feelings / 20
C / C4 / Being thankful for what’s going well (optional) / 20
A / A7 / Weekly goal setting / 30
A / A2 / Setting the agenda and close / 10
Programme for workshop 6
Module / Activity / Time (minutes)
Welcome
A / A3 / Follow-up / 30
B / B10 / Becoming a resourceful self-manager / 20
B / B11 / Recognising and managing set-backs / 20
C / C10 / Accepting and asking for support from others (optional) / 20
A / A8 / Setting Longer term goals / 30
Close and evaluation / 10

4Using the Module C Activities

Module Ccontains a library of optional activities which may be generic or condition-specific. There is time allocated in each workshop, with the exception of Workshop 1, for one or two of these activities to be included. At the end of workshops 1-5 there is an opportunity for the participants and facilitators to negotiate the agenda for the next workshop. Further condition-specific activities may be developed by individual organisations delivering the programme. These can be added to the Module Three library.

This list of the Module Three options and a brief description can be used by facilitators to help them during this Agenda-setting process.

Module C Options
Activity Name / Activity Description
Fatigue, rest and sleep / Helps us to recognise and identify ways that fatigue can be managed by effective planning, rest, relaxation and sleep.
Eating well-making choices, making changes / Allows us to identify some small changes in the food and drink choices we make and to consider and find solutions to the barriers to making these changes.
Helpful breathing / Introduces and practices helpful breathing and explains how it may help to regain control of symptoms and reduce anxiety.
Mixed feelings about being active / Explore our own ideas about the importance and benefits to us of becoming more active and allows us to consider our own mixed feelings about it.
Acknowledging and managing unhelpful emotions / Recognises and acknowledges that negative emotions (fear, anxiety, worry, and guilt) frequently accompany a health condition, reflects on your experience and to consider ways that these emotions can be handled positively.
Making a self-care plan in partnership / Introduce the Care-planning process which can be done with a member of the health care team and considers how it is being introduced locally.
NB check local relevance.
Making and sharing plans for future health care / Considers the subject of planning for future, when we may be more unwell and unable to make our own decisions, and how to communicate these plans with family, friends and the health care team.
Using our minds as a self-management tool / Introduce the concept of the mind as a self-management tool, the mind body connection and some helpful techniques to manage symptoms leading to more optimal self-management.
Being Thankful for what’s going well / Enables us to feel less anxious and more relaxed by allowing us the opportunity to show gratitude for, and share with others simple events and experiences which have made us feel good.
Accepting and asking for help and support from others / Explores reasons why asking for help can be difficult and considers ways to access varying types of support from family, friends and colleagues.

5Layout of the materials

Scripted and Unscripted Facilitator Instructions

There are two pages which cover exactly the same workshop content:

  • Upper page provides structured but unscripted notes which an experienced facilitator can use to deliver the programme content. The clouds which can provide suggestions for free-thinks and discussions can be completed by facilitator beforehand
  • Lower page provides structured and scripted textwhich an inexperienced facilitator can use to deliver the programme content. The clouds which offer suggestions for free-thinks and discussions are provided.

It is expected that, over time and with greater experience, facilitators will confidently move from a scripted to an unscripted delivery style. When a facilitator uses the unscripted notes they should take care to ensure that the materials are delivered in a suitably non-directive style with careful attention to the use of language which supports self-determination.

Fonts

  • The activities for each workshop use Arial 11 black, this is chosen as it is clear and easy on the eyes.
  • Comic Sans13 Blue is used to identify discussions as it denotes a more informal tone.

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6Guide to Icons

Icons are used throughout this manual as a visual reminder to facilitators and to back-up the Facilitator Instructions

Icon Name / Icon / What it means
Self-Management Circles / / When the Optimal Self-management circles are shown, the facilitator should refer to the fact that self-management requires attention to all three areas of the Bio-psychosocial model of health.
Small Group Discussion / / This should be for groups of three or four individuals. The facilitators can and should circulate amongst the small groups to offer support and clarification.
Whole Group Discussion / / This is an opportunity to discuss issues as a whole group. There are open questions in the notes which can be used to stimulate the discussion. However these may or may not be required. There are also ideas in the clouds which may be helpful to guide the discussion. If any discussion becomes negatively focussed the facilitator should initiate a problem-solving approach and ensure that solutions are identified before the discussion ends.
Problem Solving / / Opportunities for problem-solving occur throughout the workshops; during Goal-setting, Goal Follow-up and during individual activities. Any opportunity to problem-solve should be seized when time allows. Problem-solving can use either a formal process where ideas are captured on a flip-chart, or an informal process where the facilitator verbally collects ideas from the group and offers them back to the participant who voiced the problem to enable them to choose a solution which is helpful to them.
Pair and Share / / This is an opportunity for individuals to briefly ‘pair-up’ with another participant, so they can share their experiences safely. Should there be an uneven number of participants, it works best if one of the facilitators makes up a pair. Do not allow these ‘pair and share’ conversations to last more than 2 or 3 minutes.
Freethinking / / It can be helpful to head the Group free-think chart beforehand. Both facilitators are involved in a free-think, one acts as a scribe whilst the other generates and manages the ideas from the group and feeds them to the scribe at a pace they can write. Ask the questions and allow the group time to come up with their ideas. Be prepared to rephrase the question if you feel this will help the group to generate more ideas. The clouds provide other ideas. With permission from the group you could add a few of these if they are finding it difficult. Scribe the ideas from the group, using the words of the participant. If the idea is rather long-winded, ask “How would you like me to write this down?”
Role Modelling Box / / There are many opportunities to role-model your own experience of self-management. Prepare these beforehand and identify examples which will be relevant and helpful to the group, and which you feel comfortable to share. When talking about your own experience you should be brief, approximately 30 seconds, and always finish by describing the solution which worked for you.
Role Play / / During a role-play, both facilitators act out a short interaction between two people. Briefly explain beforehand that this is what you are doing. It can be useful to tell the group when you are starting the role-play and again when the role-play has stopped.
Refer to / complete Workbook / / In many activities reference is made to completion of materials which is in the work book that accompanies the workshops. Some of these, like Goal-setting, are for completion during the session; others are for use at home, like Guided Imagery, whilst others are for reference only.

7Guide to Charts

These Charts are used through the workshops.

Self-management circles

Materials to support activities

Module BActivity B1: Getting to know one another

ULE B: Core generic skills

  • Welcome the group and go through the house keeping:

–toilets

–fire alarms

–finish time

–refreshments

–mobile phones off or on silent mode

–any other issues

  • Remind them that this programme is about self-management and that they should take care of
    themselves and their health condition throughout
  • Ask the group to fill in their name labels/cards and introduce themselves to the people sitting either
    side of them
  • Mention the workbook on the resource table
  • Explain your role and say why you are here

It is really good to welcome you all to this first Self-Management workshop.

In a few minutes, we will be able to get to know one another a little, then after that you will be able to find out about the workshops and more about self-management of a health condition. Let’s start with some housekeeping:

–toilets

–fire alarms

–finish time

–refreshments

–mobile phones off or on silent mode

–any other issues

These workshops are about Self-Management, so please do whatever you need to do to feel comfortable, and to look after your health while you are here.

Please write the name you would like to be called on your labels/name cards. While you are doing this please also introduce yourself to the people sitting either side of you. There is a workbook which accompanies this programme - please take one from the resource table during the break.

Now we’d like to tell you a little bit about ourselves and why we are here to facilitate these workshops.

  • Talk a little about Self-Management making sure you acknowledge that they are already managing their life with their condition to some extent. You can make your own notes, using the scripted version to help.
  • Ask the group to introduce themselves to 3 new people, by holding a short conversation to find out:

–Their name

–Their health condition(s)

–An everyday problem of living with their health condition

–Something they are already doing to take care of their health

The idea of self-management might seem new to you now, but, whether we call it that or not, we all self-manage every day. We make decisions about what we eat, how much we exercise and rest and whether or not to take our medication. These workshops are not about telling you what to do; instead they are about finding out some information, learning from each other, and finding some new solutions to the everyday problems that life with a health condition brings.

We all have choices in how we manage life with a health condition. We can:

  • Carry on living the same way as before we had the condition, make no changes, ignore it and the
    advice of health professionals. In this case our condition gets worse and we may become more disabled.
  • Constantly worry about the condition and allow it to control every aspect of our life. In this case we are
    likely to become frustrated, anxious, depressed and even defined by our condition.

Another way is to accept the changes that are brought about by the health condition, make helpful adaptations in the way we live and enable family, friends, health professionals and colleagues to support us. In this way we are in control – the condition is a part of us not us a part of the condition. This is what these workshops are all about.

In these workshops you will find out how to accept the changes we need to make and learn from others about the adaptations they have made. We have all found things that did and did not work for us and this group allows us all to benefit from each other’s experiences.

To help us to get to know one another we will now do a short exercise. We would like you to speak to three new people in the room. Please find out:

  • Their name
  • Their health condition(s)
  • An everyday problem of living with their health condition
  • Something they are already doing to take care of their health

Stimulate a group discussion, using the suggested questions below: