Good afternoon everyone. Happy Thursday, and welcome to today's webinar hosted by Patagonia Health. Today's webinar topic is on the stages of change.
If you are not quite familiar with the Zoom webinar platform, take a look at the control panel at the bottom of your screen. It is here you can configure your audio settings, send chat messages, and ask questions.
And without further ado, I am going to pass it off to our clinical director, Jonathan Strange.
Jonathan:
Awesome. Thank you, Denton. Good afternoon everybody. My name is Jonathan Strange. I'm the clinical director here at Patagonia Health. My specific duties include working with our behavioral health customers and specifically our providers, helping them to be successful in their workflows and helping their clients.
My background is as a clinician. I have my master's degree in counseling. I was a certified drug and alcohol counselor and addictions counselor, as well as a mental health therapist for many years. I worked in various inpatient and outpatient settings. I have worked in MICA mental health treatment facilities specific to the criminal justice population. I have worked in school settings as well as jail settings. So I have a history in various aspects of the behavioral health side.
What we wanted to do today is share some of our knowledge and our experiences in trying to affect change, whether that be for yourself or for people you may be assisting as a helper, catalyst, or therapist.
What we want to do today is go through what the stages of change are, and give examples of how we can get to that end goal more effectively, whether for yourself or your clients.
With me today is my counterpart, Phil Hickman. Phil and I work very closely together. I am going to kick it over to Phil, let him talk about himself, and then we will jump into the presentation.
Phil:
Thanks John, and thanks everybody for joining. I have worked in behavioral health for over 20 years in various roles, starting from the bottom as a direct support professional and ending as a CEO for several large behavioral health companies.
I changed directions about four years ago to help addiction and behavioral health organizations like yours choose the right path for their technology needs.
Before John gets started, I want to tell a story about change. Change is the one constant that can strengthen us or break us. My story is about understanding that we all doubt ourselves. I know I have. It is natural to think like this. It is critical thinking for us, not error thinking.
A sliver in my memory starts in 2008. I was struggling with what I wanted to do with my career. The economy was bottoming out and I was working as a Clubhouse PSR manager for a community mental health authority. I had security and I liked my job. I was being mentored by the CEO of that mental health authority, but my passion for behavioral health and helping others was waning. I wanted to do more for communities and people, and I had a desire to do that. So I worked hard and planned everything out to a T to find the biggest challenge and change I could.
Most of what I call my lighthouses or mentors said I was crazy. I do not think they use that term today, but that is what they said. Still, I knew I needed change, so I took the biggest leap I could. I moved halfway across the country and took a big job in Arizona. I was alone in a very different environment.
But that was not enough change. I was now leading the Urgent Psychiatric Center in Arizona, now called Connections Health. It was one location, 120 staff, a 13-million-dollar budget, serving a thousand clients per month with about 20,000 covered lives in Maricopa County. We had a no wrong door policy, and it was the only crisis umbrella service for individuals needing a secure and safe service. More or less, it was a diversion center from a hospital.
Change and challenge were constant. We had political backlash for managed care, community pressures, a new managed care organization, major staff shortages, and a lack of resources. We needed better processes because we were about to go into joint accreditation. Most importantly, I needed to take care of my staff who would ultimately take care of our clients.
So what do you do when faced with insurmountable tasks, anxiety, and fear? What I did was focus on the purpose of what we do. Everything I did was to make larger impacts to serve more people. That has always been my mission.
I remember calling a mentor of mine and saying I had no idea what I was doing. I was terrified. I needed help. I turned to people I could trust and asked for help. Working tirelessly to learn with the team, we came together as an organization and overcame through change.
That was a big moment for me in changing my mind and perspective. I never stopped being honest with myself, accepting feedback, and mentoring others. In summary, the goal is to understand that change can help you grow, and to be consistently humble. Complacency was surely the catalyst for my change, and I had to admit it.
So that is a little bit about my journey and how I handled change. Thanks again for joining today and listening. I am going to kick it back to John now.
Understanding the Need for Change
Jonathan:
Appreciate that, Phil. As Phil mentioned, we have all experienced times in our lives where we need to change. Sometimes we do not know it, and sometimes we do know it and want to change. Today is about how we can effectively accomplish that, whether personally or for the clients you work with every day.
Some of the things we talk about today can be used in both settings. Change can be very serious in nature. It can be life or death if you do not change. Other times, it is simply wanting to be healthier, get in shape, or change a habit.
The stages of change are something I incorporate in all aspects of my life. Phil and I have used our behavioral health experience to work in electronic health records, and I still use these terms when working with prospects. I say, they are in this stage of change regarding their practice.
We will talk about specific examples. We will talk about how to know what stage you are in or, if you are a provider, where your clients are. We need to know what prevents us or our clients from changing, how goal setting works, mindset, triggers, feelings, and responses.
Our brains are powerful. They can play tricks on us, whether as defense mechanisms trying to protect us or simply steering us based on learned behavior. So some of this is relearning and reteaching your brain to think differently, behave differently, and therefore change.
We are going to talk about getting to consistency, which is where we begin to see effective change pay off.
Stages of Change Overview
I myself live mostly between preparation and action, often bouncing back to contemplation. I am notorious, like many people, for saying, Monday. I will start Monday. I go Monday, then slip Tuesday, and by Friday say, I will start again Monday.
In that example, I move from contemplating getting in shape, to preparing by getting a gym membership or new sneakers, to action when I actually go. But I have not changed until I reach maintenance.
One of the hardest transitions is from pre-contemplation to contemplation, especially when someone does not want to change. Pre-contemplation is when a person has no intention of changing.
As a former addictions counselor, I saw this often. People were sent to treatment by court mandate or a spouse. They did not believe they had a problem. An external factor got them into the room, but now the work is moving them from pre-contemplation to contemplation.
Asking questions like:
- What brings you here today
- What would it look like if you did not drink
- What would it look like if you got in shape
Questions like these create imagery that sparks a thought process. That helps with movement into contemplation, where the person is aware of a problem and admits it.
From there we move to preparation and then action. But we do not truly see change until maintenance. We hope to avoid relapse, but relapse does not mean failure. It means restarting.
I told a story earlier about my gym closing unexpectedly for three months. I used that as an excuse to move backward. When it reopened, I slowly moved myself back through contemplation, preparation, and action.
A Story to Illustrate Change
Chapter one through five demonstrate a learning process:
Chapter One:
I walk down the street, there is a deep hole. I fall in. I am lost and helpless, and it is not my fault. It takes forever to get out.
Chapter Two:
I walk down the street. There is a deep hole. I pretend not to see it. I fall in again. I cannot believe I am in the same place, but it still is not my fault. It takes a long time to get out.
Chapter Three:
I walk down the street. There is a deep hole. I see it, I still fall in. It is a habit. I know where I am, and it is my fault. I get out immediately.
Chapter Four:
I walk down the street. There is a deep hole. I walk around it.
Chapter Five:
I walk down another street.
This is how our brain works through awareness, acknowledgment, responsibility, behavior change, and finally choosing a different path altogether.
Tools for Determining Stage of Change
How do we figure out where we are? How do providers know where clients are?
You might use screening tools, such as the University of Rhode Island “Eureka” stages of change tool. After answering a series of questions, you or the client receive a score indicating the stage of change they are in. Tracking these scores over time allows you to see their movement through stages.
Motivational interviewing is another method. Exploring what a client wants to change and why helps move them from contemplation to preparation and into action.
When establishing goals, we must select goals that are realistic. For example, if Phil came to me wanting to work on self-esteem, we would explore behaviors, goals, objectives, and interventions that match his needs and abilities.
SMART Goals
SMART goals help create structure:
- Specific: clear numbers, deadlines, or actions
- Measurable: something you can track
- Attainable: realistic and achievable
- Relevant: aligned with the person’s vision
- Time-bound: deadlines that create accountability
Deadlines matter. Without them, we often push things off indefinitely.
The Challenge of Time and Realistic Expectations
Many of you in the chat mentioned struggling with time, routine, sleep, being physically active, eating habits, boundaries, and more. These are incredibly common challenges. A lot of us struggle with the same things.
Some examples mentioned:
- Creating a nighttime routine
- Having a positive attitude
- Being more physically active
- Changing eating habits
- Setting boundaries
- Managing diabetes
- Meal prep
- Staying off the phone
- Home organization
All of these require realistic expectations, small steps, and consistent practice. Trying to leap too far too fast often leads to setbacks.
Understanding Cues, Triggers, and Responses
Last night, my wife came home after a stressful day. She had agreed to go to the gym with me, but after a long day and having a drink at happy hour, she said she was stressed. I used that moment as my own excuse not to go to the gym. Stress was the trigger. The feeling was wanting relief. The behavior was skipping the gym and having a drink.
We all have learned associations. Stress equals drink. Stress equals avoidance. But stress could instead equal gym. It is not the cue or the feeling we control. It is the response.
People, places, and things influence our triggers. Changing our environment can change our outcomes. A different route home can change the entire rest of your evening.
The habit loop is:
- Cue
- Craving or feeling
- Response
- Reward
We may not control the first two. We control the response. The response determines whether we repeat the cycle or break it.
Creating Your Own Relapse Prevention Plan
Relapse prevention is not only for addiction. It applies to:
- Eating habits
- Exercise
- Phone use
- Sleep
- Organization
- Stress responses
A relapse prevention plan includes statements like:
- When I feel stressed, I will do X instead.
- When I feel overwhelmed, I will try Y.
- When I am tempted to abandon my goal, I will choose Z.
We want to stay in action and maintenance as long as possible, but relapse happens. It is part of the process, not a failure.
Phil:
I have been listening intently. I can identify so many things I want to change. I talk to so many people each day, and we all want to believe we can take on huge change at once. But one of the biggest lessons of my life was realizing I could not do it alone. I needed support.
Some people turn to therapists, mentors, friends, or family. Change often requires help. The message I am taking away today is about response. How do we respond When we respond poorly, how do we change that response?
I appreciate everyone’s participation today. The chat was wonderful.
Jonathan:
Yes, thank you everyone. And with football season starting, many of us may soon need even more change in our lives because we will be eating nachos and burgers instead of working out.
Triggers are everywhere. Responses are what matter.
If you would like to learn more about Patagonia Health, you have our website, patagoniahealth.com. Feel free to email myself or Phil. You will receive a copy of this webinar via email.
We truly hope each of you can accomplish the change you want.
Thank you everybody.
