Staff Training

A set of competencies23 can be defined which are necessary to carry out change counselling, involving specific attitudes, knowledge and skills. Doherty et al.23 trained a multidisciplinary team in a set of change counselling competencies. They found that the trainee staff very quickly acquired the essential attitude and the necessary knowledge. However, it took intensive training over several months to develop the skills, as evidenced via observation of interactions with clients, role play exercises and completion of a competency checklist. Doherty et al. 23 note that it was difficult to determine the extent to which competencies were applied in the clinic situation, but self-report and video evidence suggested that it did not readily generalize to routine clinics. Whilst the authors had hoped that a training manual might be an effective training method, as it could be widely disseminated, the staff reported this to have been the least useful of the training methods attempted. Personal supervision with video examples of staff's work was rated as the most useful method. This is consistent with the way staff learn other significant psychologically-based therapies, such as counselling, behaviour therapy and cognitive therapy.

Doherty et al. 23 also noted, based upon staff ratings of efficacy and use, that in the range of change counselling competencies some were more difficult to acquire and apply than others. The core style and counselling skills were more readily implemented, whilst the most difficult skills to acquire were those dealing specifically with emotion, such as rolling with resistance and dealing with loss and adjustment. Staff also found it difficult to replace well-rehearsed skills and strategies, such as informing people or providing solutions with new skills, i.e. eliciting thoughts and feelings and patient-generated solutions to problems.

Given the time and commitment needed for training, staff involved in diabetes care may want to develop some basic skills in change counselling, with a smaller number acquiring change counselling competencies in greater detail, thus offering a specialist role. This would be consistent with the finding that although staff are enthusiastic about change counselling methods, it probably takes more time and continued supervision than is currently conceived for the skills to be demonstrated in clinics on a routine basis118. It is likely that a series of increasingly complex change counselling skills will need to be defined and taught in smaller learning units, such as the 'Readiness to Change Ruler'51. The training methods are likely to involve manuals to provide the basic knowledge component. However, there is a need for workshops that use video- or computer-generated models to facilitate skills learning via practice and feedback.

Finally, explicit attention is needed to ensure that the competencies are then used in patient consultations by reviewing cases and observing clinics, via audio and video recordings within the context of peer or individual supervision.

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