An overview of how the Flinders model works and its challenges and benefits. This presentation was given at the AFAO Positive Services Forum in June 2009.

1. THE FLINDERS MODEL OF CHRONIC CONDITION SELF-MANAGEMENT Presenter: Nada Ratcliffe AIDS ACTION COUNCIL OF THE ACT

2. The ‘Flinders’ ModelWhat is it? “A generic set of tools & processes that enables clinicians & clients to undertake a structured process.....for assessment of self managing behaviours , collaborative identification of problems and goal setting the development of individualised care plans” (Flinders Human Behaviour & Health Research Unit, 2006) 2

3. What does it mean? Collaboration Personalised Care Plans Self-management education Adherence to treatments Follow up and monitoring

4. What is self-management? Involves engaging in activities that protect & promote health, monitoring & managing the symptoms & signs of illness, managing the impact of illness on functioning emotions & interpersonal relationships & adhering to treatment regimes (Centre for Advancement of Health)

5. Self-management is enabling.... Make informed choices Gain new perspectives Gain new skills Practice new health behaviours Maintain or regain emotional stability

6. Patients are already the primary source of care “People with chronic conditions are the principal care-givers Health care professionals should be consultants supporting them in this role Each day, patients decide what they are going to eat, whether they will exercise and to what extent they will consume prescribed medicines.” Bodenheimer et al, JAMA 2002

7. The 6 principles of Self-Management Knowledge of one’s condition Follow a care plan Actively share in decision-making Monitor and manage signs & signs & symptoms Manage impact on physical, emotional & social life Adopt lifestyles that promote health

8. AIM OF THE FLINDERS MODEL Improve relationship between client and health professionals Collaboratively identify problems Target interventions May lead to ongoing behaviour changes Be motivational Allows for measurement over time Has a predictive ability

9. Desired outcomes IDENTIFICATION OF ISSUES DEVELOPMENT OF INDIVIDUALISED CARE PLAN MONITORING AND REVEWING

10. The Care Plan................. Identified issues & main problem Agreed goals Agreed interventions A sign off Review dates

11. Applications Education module in chronic condition self-management – each state and territory 3 Indigenous projects “SHARING HEALTH CARE”

12. Targeted Groups Culturally & Linguistically Diverse Aboriginal & Torres Strait Islander Low socio-economic groups

13. workshops Courses are available for health professionals to understand & use the model Post graduate study: -Graduate Certificate in Health (Self-management) -Grad. Diploma in Chronic Condition Management

14. Case study 45 year old single man, living alone. Client of mental health service for 20 years - paranoid schizophrenia. History of violence (2 worker home visits), cigarette smoker, benzodiazepine dependent – doctor shopper, treatment order Problems with planning, concentration, memory and problem solving, persistent paranoia Goals: Better body image/decrease weight, decrease benzo’s, better financial state, better care of self and dog

15. Outcomes.......... Cleaning contract for 5 weeks to feel better about house so could do weights and to be able to invite friends into house – boost self esteem and challenge view of being dangerous to others Reduced benzodiazepines – 1 doctor – more disclosure with GP Poor knowledge of condition and treatment addressed One worker visit Has begun next goal of cigarette reduction More social interaction, less paranoid

17. Integration between hospitals and primary care of chronic care and self-management

18. Flinders vs. Stanford Models? What’s the difference ?

19. Stanford............... Utilises a group setting Trains & uses peer educators Standardised structured sessions

20. Flinders........... Underpinned by Cognitive Behavioural Therapy (CBT) Generic approach Client centred Between the individual & health professional/s One on one model

21. Local initiatives.............

22. 3 year project “The interprofessional learning in primary health care to encourage active patient self-management of Chronic Disease”

23. ACT CHRONIC CONDITIONS ALLIANCE Identify & present issues of concern Promote information exchange To lobby for relevant health services Bridge the gap between govt and ngo’s Collaboration in the development of health services Be a communication channel for organisations to engage with chronic conditions groups & services

24. …..OTHER CHALLENGES Medical practitioners & allied health professionals undertake comprehensive training involving both personal commitment to the process & outcomes and a commitment to the significant time required Practitioners need to work within an holistic framework

25. Contacts Flinders Human Behaviour and Health Research Unit Sharon.lawn@fmc.sa.gov.au Malcolm.Battersby@fmc.sa.gov.au Ph (08) 8404 2323 Fax (08) 8404 2101 http://som.flinders.edu.au/FUSA/CCTU/Home.html

26. thankyou Any questions.........................?