READY, WILLING AND ABLE: ORGANIZATIONAL AND COMMUNITY READINESS

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1 READY, WILLING AND ABLE: ORGANIZATIONAL AND COMMUNITY READINESS Carlo C. DiClemente Professor Department of Psychology University of Maryland, Baltimore County

2 HEALTH & WELLNESS, REQUIRE BEHAVIOR DISEASE PREVENTION CHANGE OBESITY PREVENTION INITIATION MENTAL HEALTH SAFETY AND INJURY PREVENTION MODIFICATION HEALTH PROTECTION SUBSTANCE USE CESSATION

3 Child Health Behaviors Multiple behaviors need to be started, stopped, or modified for Diabetes prevention and control Obesity & malnutrition prevention Asthma and Allergy Management Academic success and achievement Preventing Substance Abuse and Risk Taking Behaviors (Drinking and Driving) Prevention and treatment of Mental Illness and management of emotional trauma (bullying, etc.) HIV and STI Prevention and Treatment

4 Who Needs to Change? Most health promotion and academic achievement programs focus at the individual level (exercise, tutoring) However, individual behavior change always occurs in a context So we have to move to a larger contextual perspective: family, peers, environment, policies Hence the theme of your conference: Families, Schools, and Communities as Partners in School Health

5 FAMILIES Principals MSDE Parks & Recs Libraries YM/WCA Teachers School Board Unions Neighborhood Groups Parent Teacher Organizations

6 Some Examples to Learn From Completely changing cafeteria food to only include healthy options Clean Air Clean Lungs Campaign NYC Employee Assistance Program Implementing screening in a healthcare organization

7 WHAT DO WE NEED TO CHANGE? Change is Disruptive People, Schools, Programs, Families and Communities Do Not Want To Change everything or, at times, anything Change is most often behavior specific (this behavior or set of behaviors); Large scale change is very disruptive Defining exactly WHAT is to be changed, who needs to be involved, and what needs to be accepted if it cannot be changed is critical

8 The Broader View The process of change is important relevant for promoting change for: Multiple Health and Protective Behaviors Individuals and Organizations Providers and Patients Leaders and Those They Lead Policy Makers and Program Developers

9 WHY DON T PEOPLE OR ORGANIZATIONS CHANGE? NOT CONVINCED OF THE PROBLEM OR THE NEED FOR CHANGE UNMOTIVATED NOT COMMITTED TO MAKING A CHANGE UNWILLING DO NOT BELIEVE THAT THEY CAN MAKE A CHANGE - UNABLE

10 HOW PEOPLE, FAMILIES AND ORGANIZATIONS CHANGE

11 How Do We Change? People and organizations change voluntarily only when They Become interested and concerned about the need for change They Become convinced that the change is in their best interests or will benefit them more than cost them They Organize a plan of action that they are committed to implementing They take the actions that are necessary to make the change and sustain the change

12 Stage of Change Tasks Precontemplation Not interested Interested and Concerned Contemplation Considering Risk-Reward Analysis & Decision making Preparation Preparing Action Initial change Commitment & Creating an Effective/Acceptable Plan Implementation of Plan and Revising as Needed Maintenance Sustained change Consolidating Change into Lifestyle or Organization

13 Understanding Barriers to Change and the Tasks of the Stages of Change UNMOTIVATED UNWILLING UNABLE Precontemplation Contemplation Preparation Action Maintenance So the challenge is how to get individuals, families, and organizations To be READY, WILLING, AND ABLE to make critical changes needed for the Needs and Health of the Whole Child.

14 Systems Change Who needs to be Ready, Willing and Able? How do we influence the process of change for different players or stakeholders? How can I make a difference in the larger change process

15 Ready, Willing, and Able poised to respond (infrastructure, systems) WILLING inclined or favorably disposed in mind having sufficient knowledge, skill, or ability ABLE PROBABILITY OF A QUALITY RESPONSE McCabe, Barnett, Taylor, Links 2010

16 Key Components Ready for change Acknowledge need for change, buy in, makes sense for me in my role, benefits outweigh costs to me, my children or my program - decision to take part in change Willing to change Commitment and taking part in planning to create an acceptable plan for me and my group Able to change I have the skills and abilities to be able to do my part in the change

17 Getting Ready to Change Promoting Interest and concern Reach and Engagement Connect with important values Most people do not like change so have to sell it Risk-reward analysis and decision making Pros and Cons of status quo and change Managing ambivalence Implicit Cognitions and subtle influences Tipping Point what gets people to tip toward change (Gladwell)

18 Ready Possessing the necessary human and material resources, infrastructure, and processes Staff, structure, and stuff needed to implement change Examples at the individual level: Prepared to implement, effective, accessible and acceptable change plan, commitment to implementation Examples at family level: Engaged and knowing clearly what needs to be done and when Examples at the school level: Lesson plans, organizational policy and structure in place to support change

19 Willingness Inclined or favorably disposed in mind Attitudes, beliefs, perceptions Depends on: Motivation and confidence Trusted relationships, political imperatives, partnership reciprocity Primarily a function of the emotional/affective dimension

20 WILLING TO MAKE CHANGE COMMITMENT TO TAKE ACTION SPECIFIC ACTION PLAN (S) TIMELINE FOR IMPLEMENTING PLAN EFFECTIVE PLAN OF ACTION ACCESSIBLE AND ACCEPTABLE PLAN ANTICIPATION OF BARRIERS

21 Building Willingness Low Concern/Low Confidence (low need/low efficacy) Educate about need or threat, build efficacy Low Concern/High Confidence (low need/high efficacy) Educate about need or threat, maintain efficacy High Concern / Low Confidence (high need/low efficacy) Improve skill, modify attitudes High Concern / High Confidence (high need/high efficacy) Reinforce comprehension of need and risk and maintain efficacy

22 Ability Actual operational capability Knowledge, competency, proficiency Assessed through observation Depends on: Innate aptitudes and traits Learned and modifiable capabilities (modified via education, training, and other preparatory experiences) Primarily a function of cognitive and behavioral dimensions Usual target of training activities

23 Being Able to Change Implementation of plan Managing initial difficulties Revising flaws in plan (Practice and Revise) Sustaining effort Avoiding overconfidence Countering Entropy

24 What are the Challenges? Ambivalence: the battle between the status quo and the hoped for future Competing Demands Conflicting Priorities Compromised Skills or Self Regulation Change requires a multidimensional process and a healthy dose of selfcontrol

25 SOME PITFALLS

26 POOR PLANNING

27 THE CHALLENGE FOR ORGANIZATIONS TO CREAT SUCCESSFUL, SUSTAINED ORGANIZATIONAL CHANGE TO MEET THE NEEDS OF CLIENTS, ORGANIZATION AND SOCIETY TO USE A PROCESS PERSPECTIVE VERSUS A CONTENT PERSPECTIVE (How not just What) THE CONTENT OF CHANGE IN A SYSTEM OR ORGANIZATION CAN BE SERVICES, SAFETY, EDUCATION, RESEARCH, OR POLICY

28 WHAT IS NEEDED: LEADERSHIP THAT INSPIRES, MOTIVATES, AND PROVIDES INCENTIVES FOR EXCELLENCE AND CHANGE NOT ONE THAT ORDERS, IMPOSES, AND PUNISHES TO ENFORCE IMPOSED CHANGE SETS A TONE, AN EXPECTATION THAT THE CHANGE IS VALUED MODELS BEHAVIORS, VALUES, ETHICS THAT SUPPORT THE CHANGE

29 CREATING A SHARED VISION TO SUPPORT CHANGE A VISION OF WHAT WE CAN BE AND WHAT WE CAN DO A VISION THAT CREATES HIGH BUT ACHIEVABLE OUTCOME AND EFFICACY EXPECTATIONS A VISION THAT STRIVES FOR EXCELLENCE AS APPROACHED NEVER ACCOMPLISHED A VISION SHARED AT ALL LEVELS OF THE ORGANIZATION

30 CREATING AND SUSTAINING CHANGE REQUIRES A TEAM CREATE A TEAM OF INDIVIDUALS WHO HAVE THE RESPONSIBILITY AND AUTHORITY TO ENGAGE IN THE PROCESS AND ATTAIN THE GOALS THESE ARE THE INDIVIDUALS WHO PERFORM THE BEHAVIORS ARE THE CHANGE TARGET LONE RANGERS RARELY CREATE EXCELLENT, SUSTAINABLE ORGANIZATIONAL CHANGE

31 CREATING THE TEAM GET AND KEEP THE RIGHT PEOPLE USE INCENTIVES (RECOGNITION, RESPECT, REINFORCEMENT) TRUST AND MONITOR PLAN AND IMPLEMENT BUILD NORMS & SUPPORT SYSTEMS SHARE RESPONSIBILITY AND AUTHORITY

32 Some Examples Fort Worth, Texas - changing mental health services for children Emergency Preparedness Program Increasing Integrated Dual Diagnosis treatment in Ohio Working Well Montgomery County drop in suspensions

33 IN MAKING AN INDIVIDUAL OR ORGANIZATIONAL CHANGE Pick a target behavior or constellation of behaviors Make a solid decision Prioritize and Prepare Make a plan and revise as needed Keep going and do not get discouraged Find and build a network of support Make the change a new norm

34 Built to Last: Successful Habits of Visionary Companies Be a clock builder an architect- not a time teller Embrace the Genius of the AND Preserve the core/stimulate progress Seek consistent alignment of core values and purpose with current practice and future goals Key Concepts Core ideology, values, purpose Envisioned Future: Big Hairy Audacious Goals Collins JC & Porras, JI (1994) Harper Business Books