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Solution Focus and Smokefree Pregnancy Ali Reid
Senior Public Health Development Advisor Tobacco
Control Pregnancy Manchester Stop Smoking
Service Manchester Public Health Development
Service
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True positive People think better
throughout if the very first thing they do is say
something true and positive about their work or
how the work of the group is going Nancy Kline,
Time to think
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Solution Focus

• Steve de Shazer Insoo Kim Berg
• Brief family therapy centre, Milwaukee
• 1986, paper published
• - outlining revolutionary, new way of working
• Evan George, Brief, London (www.brieftherapy.org.u
  k)
• Sycol, Cardiff
• (www.sycol.co.uk)

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Principles of Solution Focus

• If it works do more of it, if not do something
  different
• Small changes can initiate a solution
• People have the resources to make changes
• A focus on future possibility enhances change
• No sign up no change
• Cooperation enhances change
• The problem is the problem not the person
• People have unique ways of solving problems
• Possibilities are infinite
• One foot in acknowledgement of pain, one foot in
  possibility of change

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History of our sparkling momentsBeginnings

• Heard about SF in informal discussion with
  educational psychologist
• Evan George, Brief, London (www.brieftherapy.org.u
  k)
• Introductory training
• ...word of mouthseveral staff
• leadership training

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Use in the team

• As an approach by specialist advisors
• More asking potential quitters questions about
  benefits of being smokefree
• - Preferred futures, scaling questions
• Rewriting of resources
• Less information about dangers of
  smoking/significance of smoking in life
• More stimulating picture of a smokefree life

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Wider team developments

• Integrated into leadership style
• Team meetings preferred futures, development of
  shared goals, harnessing of energy, skills,
  resources
• Integrated approach to PDP
• Training with whole of Public Health Development
  Service 80 staff
• e.g. alcohol, mental health, sexual health, older
  people, health trainers

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Cascading to partners

• Incorporation in training
• Model approach with clients
• Principles do more of what works, build on
  skills resources, picture desired future
• Exercises miracle, scales, pleasing progress
• Development of scripts
• (e.g. for the person who has cut down including
  many pregnant women)
• Soon a scale of 0-10 where 0 is youre smoking
  like you were before 10 is youve stopped
  completely, where do you see yourself now? What
  makes you there, not 0? What would make you one
  point higher?
• (could you do that?)

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Highlighting changein pairs

• Scale your job/hobby/parenting
• On a scale of 0-10, where 10 is the worker/tennis
  player/parent you aspire to be 0 is the
  opposite, where do you see yourself at present?
• What tells you that youre there, not at 0?
• What do others notice that contributes to that?
• How will you know when youve moved up a point on
  the scale?
• What will you notice yourself doing differently?
• What will others notice you doing differently?
• What will be good about that for you?

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Development of tools

• Care pathway for pregnancy
• Care pathway for Manchester Acute Trusts
• DVD for use in training
• Midwives handbook

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Midwifery

• Integration of SF in training
• ANC, community some ward midwives trained to
  support those going smokefree
• Care pathwayscript
• Midwifery handbookscript
• Streamlined access to NRT (SF plan)
• Smokefree pregnancy leaflets sent to pregnant
  women at booking
• Smokefree pregnancy information pack

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• And
• SF meetings with ward managers
• SF meetings with link workers
• Presentations of work highlighting SF principles
  e.g. Trust Clinical Governance board
• SF meetings with midwives

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• 2005/06 - 2006/07
• Prevalence of smoking in pregnancy in Manchester
  PCT area fell by 4 (fifth best fall in country)
• 8 drop in South Manchester
• area of great deprivation, high level of
  Childrens Centre staff trained in addition to
  midwives.
• 2007/08 Further 1 fall

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Management / the PCT

• Engagement with the Director of Provider Services
  in PCT
• Presentation to 45 senior managers PCT with short
  exercises and suggestions for applications
• Next day feedback of application in senior meeting

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Describing a preferred futureIn pairs

• Imagine the best possible service you could have
  for promoting smokefree pregnancy
• Imagine you wake up tomorrow that you have
  something more like it
• Whats the first thing youll notice yourself
  doing differently?
• the next small sign?
• Describe the differences through the day
• Who else will notice? What will they notice?
• What difference will it make?
• How will that be good for pregnant women who
  smoke? Their partners families? For you?

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Thank youAlison.reid_at_manchester.nhs.uk
www.stopsmokingmanchester.co.ukwww.manchesterpub
lichealthdevelopment.org