Promoting Health Self Management by People Living With Mental Illness.

Arm 1 Intervention Group: Flinders Program (FP) of Chronic Condition Management (FP + health promotional materials + support as usual) Mental health workers in the non-government mental health sector typically offer non-clinical psychosocial support for up to two years. The project will train these workers in the FP so that they can offer clients assistance to learn health self management skills. The aim of the Flingers Program is the provision of a consistent, reproducible approach to assessing key components of self-management. Specifically the individual and his/her support person collaboratively identify issues which enables the better targeting of interventions. It is argued that the motivational process involved leads to sustained behaviour change and is related to improvement in health outcomes. The Flinders program is a four step intervention conducted during a consumer’s routine contact times with support workers assisting the individual to make plans and set goals. Clients, NGO support workers and mental health and primary care providers will collaborate to implement the care plans. The health promotion resource materials to be ofeered to pariticpants are chiefly life-style related printed materials (e.g. nutrition and physical activity guidelines, Quit and alcohol management guidelines, physical health screening recommendations etc.) and practical materials such as portion control plates, tape measures, pedometers, basebal caps, Recipies for Life packs, MindBodyLife Food mood diaries; toothbrishes ands toothpaste. The workers will review FP tools with clients every three months during the normal course of their interactions. It is anticipated that participants will be supported for up to two years. The four components of the Flinders Program are: 1. The Partners in Health Activity (PIH): The PIH is a Likert self-rated 12 item questionnaire that is based on the six principles of self-management completed by the person with chronic conditions to measure their current self-management knowledge, skills, capacities and the psychosocial impacts of their conditions on their quality of life. It is amenable to repeat measures at set intervals. 2. The Cue and Response Activity (C&R): The C&R interview is an adjunct to the PIH scale. The C&R interview takes approximately 30 to 45 minutes in which the worker uses a series of open-ended questions or cues to explore the individual’s responses to the PIH scale in depth. It enables the barriers to self-management to be explored. 3. The Problem and Goal Assessment (P&G): The Problem & Goal assessment enables the person to identify their greatest problem, which may or may not be related to their health issues, and to set goal(s) around this problem. The individual sets a medium term goal which if achieved will reduce the severity of the problem. The assessment takes between 5-10 minutes to complete. Both the problem and the goal are Likert self-rated by the consumer allowing repeat measure over time. 4. Collaborative Care Plan: The Care Plan contains the issues identified from the C&R interview that the individual and the worker have collaboratively agreed are areas needing work over the coming 6 months. It identifies the issues, aims, actions to address the issues, by whom, by when, including potential others within the team or other services who may assist in providing self-management support. Other measures to which all participants will be exposed are: 5. The Medical Outcomes Survey Short Form 8 (MOS-SF8) Is an 8-item self report quality of life scale 6. Physical Health Measures: All participants at the participating clinical mental health services will be tested according to the Metabolic Syndrome Screening Algorithm . The measures are blood pressure, waist circumference, blood sugars, and blood lipids. This screening will take place at the participating health services or by GP’s and will be part of the care participants routinely receive. 7. A self administered survey to assess resource use in terms of medical and inpatient visits: This survey will assess the number of GP or emergency department visits made in the previous 6 months and what treatment if any was received. The purpose of this survey is to observe whether any changes to the pattern of medical attention sought by participants occurred over time. 8. The Patient Assessment of Chronic Illness Care (PACIC) is a 20-item self-report scale assessing consumer perceptions about the quality of care they received in managing their condition, and will be administered at the end of the project.