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Slide 1 - Motivation in Rehabilitation - Getting Good Ideas into Practice Aspects of Practice Standards in the Private Hearing Care Sector Barry Downes for BSA Professional Practice Committee Study day – 22nd June 2010
Slide 2 - Motivation at three levels/layers:- The professional (Hearing Aid Audiologist/Dispenser) The client (adult) Those supporting the client (family/close friends) How to ensure that all three parties constructively interact and contribute to successful rehabilitation outcomes. The relevance of HPC standards and BSHAA guidance on professional practice. Motivation in Rehabilitation
Slide 3 - Sources of practice standards and guidance are:- Regulator – Health Professions Council (HPC). Professional body – British Society of Hearing Aid Audiologists (BSHAA) Although not in this context, the BSA. Motivation in Rehabilitation
Slide 4 - Some of the challenges:- Reluctance of hearing impaired to take early action. Consequences of advanced hearing loss:- Adaptation – modified lifestyle Compensatory tactics – reliance on others Auditory deprivation effects Age-related effects – dexterity and cognition Unrealistic expectations (client and supporters) Technology limitations Perceived value/affordability (technology level, bilateral v unilateral) Limited/negative attitudes – no other option than the unacceptable one of hearing aids / misinformation/ previous experience Motivation in Rehabilitation
Slide 5 - Motivation in Rehabilitation HPC Standards of Conduct, Performance, Ethics & Proficiency BSHAA Standards & Guidance on Professional Practice In the context of the private sector’s standards and guidance on professional practice, is there anything of relevance to motivation in rehabilitation? Oh yes….and more than time today allows!!
Slide 6 - What elements of professional practice standards and guidance recognise the dependence of successful rehabilitation on motivation? Client-centred practice Outcome measures Ensuring informed decisions Involvement of ‘significant others’ Post-fitting aftercare Motivation in Rehabilitation
Slide 7 - Client-centred practice is fundamental to establishing a positive and constructive relationship with clients and their support. If there is no trust and confidence in the professional, advice will not be taken seriously and encourages premature rejection. No trust = No relationship = No Motivation Motivation in Rehabilitation
Slide 8 - HPC & BSHAA standards include a number of references to acting “in the best interests of clients at all times”. Specifically, the practice guidance covers:- Acquiring and recording information so that advice is always the “best possible”. Advice about hearing aid system must include any predictable limitations…..no unrealistic expectations! Ensuring fully informed decisions based on complete and accurate information….all questions answered. Motivation in Rehabilitation
Slide 9 - Outcome measures…. the practice element which can be the most influential on client motivation. HPC and BSHAA practice standards include the clear statement that:- ”Registrant hearing aid dispensers must be able to evaluate intervention plans using recognised outcome measures and revise plans as necessary in conjunction with the client.” Several other standards refer to monitoring the “effectiveness of planned activity” and “evaluating client responses to their care”. Motivation in Rehabilitation
Slide 10 - Motivation in Rehabilitation The proper use of a pre-fitting outcome measure questionnaire can be invaluable to building motivation and answers some key questions:- Are they capable of making an informed decision? Are they ready to listen to advice about hearing aids? At what level of acceptance of their hearing loss are they? Is there enough motivation to say “YES!” to hearing aids? Are they capable of a enough commitment to persist with the rehabilitation process? Do they have the right expectations so that, after fitting, there are no foreseeable disappointments risking rejection?
Slide 11 - Outcome Measure Questionnaires or Self Reports of Outcome Open-Ended: COSI GHABP Involve situations of hearing difficulty identified by the individual client Closed APHAB HAPI HHIE IOI-HA SSQ Involve pre-set questions
Slide 12 - Outcome Measure Questionnaires or Self Reports of Outcome Open-Ended: COSI GHABP Closed APHAB HAPI HHIE IOI-HA SSQ
Slide 13 - A very useful combination…….. COSI and IOI-HA Easy to administer Easy to achieve a measure of outcome Help to keep the client engaged with the rehabilitation process Measure satisfaction, benefit and improvement in quality of life
Slide 14 - H. Dillon (NAL) et al
Slide 15 - The COSI Outcome Measure The advantages of COSI are:- Simplicity. It is concerned only with situations in which the individual client has hearing difficulty. Effectively, it’s an extension and a proper record of questions which are asked in a routine consultation but with much more purpose and value. It doesn’t involve too many questions and is not time consuming.
Slide 16 - The COSI Outcome Measure More advantages of COSI are:- Helps to ensure that a client openly acknowledges their hearing problems and makes them more engaged with their auditory rehabilitation. Involves the so-called ‘significant others’. Gives early stage review more structure, more meaning, more relevance and….as if it were needed….more justification. Helps avoid premature rejection
Slide 17 - He wants to be able to watch the telly in the same room with his wife each evening – she complains it’s much too loud. He wants to be able to understand his grandchildren when he sees them once per week Following the conversation with his friends at the local pub on Friday and Saturday night He wants to be able to hear the numbers called at bingo every Monday or Thursday night. He needs to hear others at work, especially since he is now working part time (two days per week)
Slide 18 - COSI and Setting Goals and Expectations The use of COSI helps to you to establish how ready the client is to accept the use of hearing aids. When asking about the situations in which they have hearing and understanding difficulties, if the client is evasive or generalises too much, they aren’t ready for the next stage! Going to the next stage means the client has to open up! If they don’t open up, it can be too risky going any further!
Slide 19 - COSI and Setting Goals and Expectations The use of COSI helps to ensure realistic expectations. You should ask the client not only in what specific, personal situations they have hearing difficulties but also how clearly do they expect to hear with hearing aids in those prioritised situations. Provides the ideal and early opportunity to make sure that their expectations are positive but not exaggerated or unrealistic!
Slide 20 - IOI-HA …..and another useful tool to assist motivation in post-fitting rehabilitation!
Slide 21 - IOI-HA Another outcome measure is the ‘International Outcome Inventory – Hearing Aids’ or the IOI-HA. Unlike COSI, this outcome measure consists of a series of standard questions and can be completed without the involvement of the professional. Because of these differences from COSI, it is recommended as an additional measure.
Slide 22 - IOI-HA All the client has to do is to tick one of five boxes for each question!
Slide 23 - IOI-HA The IOI-HA is easy to score as each tick box can have a score from 1 to 5. So, the higher the score, the better the outcome. A score of less than 25 raises concern. This means that the IOI-HA can be used at any follow-up stage as long as it not less than about two weeks after fitting. The only drawback is that the questions do not relate to the situations which are individually important to the client…..so does not replace COSI.
Slide 24 - ppt slide no 24 content not found
Slide 25 - IOI-HA So how and where does the IOI-HA fit in? Very neatly and at the follow-up recommended to be undertaken 14 days after fitting. The IOI-HA is designed to be the client’s record of progress at 2 weekly intervals.
Slide 26 - Outcome Measures…a take home message…. “Only do verification and validation measures if you plan to do something with the data to the benefit of your client and your practice.” Catherine Palmer, PhD
Slide 27 - The supporting and motivational role of family and/or close friends is almost always indispensable. Positive support for:- Taking action initially Ensuring that the professional is fully informed about the hearing handicap Informed decisions about next stage….hearing aids?....onward referral?....no immediate action? Motivating the hearing impaired person through their earlier rehabilitation stages. Motivation in Rehabilitation
Slide 28 - HPC and BSHAA standards and practice guidance refer frequently to those who are acting in a supporting role. Overall message of the standards and practice guidance is that the involvement of such third parties is very important and they should be included at every stage. Motivation in Rehabilitation
Slide 29 - Post-fitting aftercare is considered to be sufficiently important in the BSHAA standards and practice guidance to have its own appendix. It contains recommendations which reflect the importance of supporting the recently fitted client to sustain their motivation. Frequent and structured aftercare is seen to be particularly important during the vulnerable period after fitting. But how long is that vulnerable period? Too variable to specify but rarely less than 1 month. Motivation in Rehabilitation
Slide 30 - BSHAA’s practice guidance recommends:- Personalised rehabilitation advice with supporting family or carers present. Provision of a written summary of the advice given. Create expectations about post-fitting aftercare. Telephone follow-up within 48 hours of fitting. First follow-up appointment within 30 days after fitting with outcome measure questionnaire. Preferably, first review at 14 days after fitting. Further follow-ups as required individually. Then move to regular six monthly review. Motivation in Rehabilitation
Slide 31 - Sustaining and supporting a client’s motivation may need time, effort and skill but without these… …..outcomes are less likely to be successful or life-changing….and….. ….they never have the positive experience which encourages them to become ambassadors to motivate others! Do we agree? Motivation in Rehabilitation
Slide 32 - I looked up to the sky and asked for a sign...
Slide 33 - Have I been interesting and informative today?
Slide 34 - …..and I looked up to the sky again waiting for a sign as an answer to my question....
Slide 35 - ppt slide no 35 content not found
Slide 36 - Motivation in Rehabilitation barry.downes@amplifon.com www.bshaa.com Any questions or challenges?