Condition Management Programme
The RealHealth Institute offers a number of condition management programmes tailored to the needs of purchasers and clients. Mostly these are delivered as part of an NHS contract or return to work initiative and comprised 4 to 6 days of treatment delivered over a 4 to 6 week period.
The following is directed at those interested in commissioning CMPs such as Health Commissioners, public health consultants, etc.
What are Condition Management programmes?
Condition Management Programmes (CMP) are short intensive interdisciplinary cognitive behavioural programmes with the aim of enhancing self management in persons with chronic illness to enable their return to work. They may be delivered in a variety of setting but should have an interdisciplinary team at their core and utilise the well proven techniques of cognitive behavioural therapy.
In a particular they have been promulgated as part of the Department of Work and Pensions Pathways to Work initiative. It is estimated that about 10% of persons on incapacity benefit would gain from a condition management programme.
The RealHealth Institute has been delivering a range of condition management programmes for a number of years. These focus on either
- The management of physical illness
- The management of psychological problems including stress, anxiety and depression.
Assessment Process
Prior to treatment all potential clients are offered a one to one assessment with a member of the clinical team.
The purpose of the assessment process is to:
- Understand the particular difficulties and issues faced by clients referred to the RealHealth team
- Employ various psychometric tests to quantify their functional level and distress
- Assess the likely benefits of joining a condition management programme
- Decide the most appropriate programme
- Exclude those individuals not suited to treatment
The assessment process entails:
- A standardised screening pack that forms the basis of the clinical interview including various psychometric questionnaires
- These include:
- Zung depression inventory
- Self efficacy questionnaire
- Roland Morris
- SF36
- These include:
Course objectives
Domains
- Self management
- Biopsychosocial model
- Cognitive Behavioural Theory and therapy
- Health
- Assertiveness and Communication
- The worth of work
- Goals and goal setting
- Pacing and planning
- Stress and its management
Self management
The participant will learn the distinction between acute and chronic medical conditions and appreciate the difference between therapies and treatments aimed at cure as opposed to those that need management or palliation.
They will hear examples of conditions such as diabetes where the sufferer is required to take an active roll in its management and be encouraged to draw parallels with their own condition. They will be drawn to explore the ways in which self management can apply to their own conditions (persistent pain, arthritis, coronary artery disease).
They will be able to list the key elements of self management: understanding the cause and course of the illness, getting information (books & pamplets, web,) using medical systems optimally (clear communication, assertive about needs), using cognitive techniques, using practical techniques to help physical symptoms, planning for the future.
Biopsychosocial model
To understand the influence of psychological factors and situation in the way that disease or pain affects us and to appreciate that symptoms cause us to think and formulate beliefs about what is happening. If the outcome looks bad then thinking about it may provoke worry and fear. This will provoke a stress response in the person which will affect what they do and further influence how they feel.
Participants will also be helped to realise the extent to which outside systems such as the workplace, benefits etc. influence behaviours and thus the outcome from illness.
Cognitive Behavioural Theory and therapy
To appreciate the role of behaviours in the genesis of illness and incapacity and learn how they are predicated by thoughts and beliefs. To better understand the influence of thoughts on mood and feelings and learn ways to challenge unhelpful or negative thoughts.
Health
Participants will learn the components of health and appreciate that health is not just the absence of disease. They will be helped to determine the components of the WHO definition of health: a state of physical, emotional and social wellbeing.
They will be encouraged to see these in terms of a personal perspective and to look at quality of life, generating five domains of personal value emphasising that the things that make up an individuals quality are totally unique.
Assertiveness & Communication
To learn the rights of the self and the rationale and justification for assertiveness and how it can aid outcome in a number of different situations. to improve skills in assertiveness and to practice these in relevant settings and situations.
To identify the many areas in which communication is important and to learn the elements of effective communication. To appreciate the common errors in communication
The worth of work
Participants will be helped to recognise the benefits of work and conversely identify the problems of not working and the negative effects on physical health, wellbeing, social isolations and impoverishment.
To learn that fitness to work is not an absolute decided by doctors rather a three way interaction between the individual the employer and the medical advisor. Participants will learn that pain and illness are not a barrier to work and will hear of some of the techniques that enable those with imperfect health to continue at work or make a return to work. These include: change of role, modification of hours, adaptation of the workplace, the use of pacing techniques.
They will examine the barriers to making a return to work and discuss possible options.
Goal setting
Participants will explore the logic and rationale of setting goals and to understand the requirements of effective goal setting using the SMART acronym. They will be encouraged to set a number of goals relating to activities and pastimes that they have had to cease and to commence working towards them.
Pacing and planning
Group members will discuss ways of pacing tasks by breaking them down into small and manageable portions and to avoid over activity or exertion. They will practice planning daily activities and integrating goals into this framework. They will explore return to work with reference to the use of planning and pacing techniques
Stress and its management
Participants will understand that stress is pressure on a system that if it cannot be dispersed causes signs of strain. They will learn the causes of stress and its effects on the individual. Participants will learn to identify their own sources of stress and look at ways to change their response using techniques to change their emotional state, their physical response and improve control of external factors. They will be shown various relaxation techniques and learn to practice one or more of these to use to reduce stress.
Location
Courses can be delivered in a variety of settings. These can be community halls, healthclubs, training rooms, or healthcare facilities. The emphasis is on low tech non medical space.
Staff
Programmes staffed by full interdisciplinary team comprising all or some of the following
- psychologist
- physiotherapist
- nurse
- occupational therapist.
- Fitness instructor
Timetable
The RealHealth Institute CMPs are delivered over 5 or 6 days. Sessions run from 10 till 4.
Outcome
Primary outcome is return to work. Outcomes in terms of changes to mood, confidence, performance and physical function are routinely measured.
