GM Approaches to MECC Meeting Kings House Conference Centre, Seminar - - PowerPoint PPT Presentation

Welcome to the

GM Approaches to MECC Meeting

King’s House Conference Centre, Seminar Room 3/4, Manchester, M1 7HB Tweet us @NWPHPN #GMMECC2019

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Lesley Jones

DPH Bury & GM HSCP Public Health Workforce lead

Welcome, Introductions and purpose of the meeting 9:30am – 09:50am -

The journey so far

Opportunities for MECC in Greater Manchester

Lesley Jones Director of Public Health, Bury Council Lead GM DPH for Public Health Workforce

A GM Mayoral Ambition

Towards a GM Population Health System

Development of a strong core strategic Public Health function Developing the workforce critical in delivering the PH Plan Organisational Development & System leadership for population health

• Shaping a GM and locality core Public Health function which operates to

support the whole local system in maximising its positive impact on population health

• Implementing a networked arrangement as part of a unified GM Population

Health systems

• Defining, articulating and addressing the workforce development needs

critical for delivery of the GM Population Health Plan in the context of the GM workforce strategy

• Establishing a population health focus through system leadership
• Promoting a culture of ‘Population Health is everyone’s business’
• Embedding population health values, principles, approaches and practice

into new & emerging organisational forms e.g. LCOs, Neighbourhood Working and SCFs

• Embedding ‘Making Every Contact Count’ (MECC) across GM and localities

Population Health Workforce priorities

8

9:30 – 9:50

(20 mins)

Welcome, Introductions – context and purpose of meeting Lesley Jones 9:50 – 10:50

(60 mins)

Setting the scene & regional case studies:

• Cheshire & Merseyside MECC Approach
• MECC Link
• Healthy Ireland MECC programme
• LWAB Funding Bid Lancashire & South Cumbria

10:50 – 11:10

(20 mins)

Refreshment Break 11:10 – 12:00

(50 mins)

Greater Manchester MECC Updates 12:00 – 12:30

(30 mins)

Interactive Planning Workshop Group Discussion: Opportunities for a GM MECC approach? What would it look like? Who do we need? How can we achieve it? 12:30 – 12:45

(15 mins)

Potential funding for GM MECC approach 12:45 – 13:00

(15 mins)

Session summary and Next Steps 13:00 Finish

Agenda

09:50am – 10:50pm

– Setting the scene & regional case studies;

• Cheshire & Merseyside MECC Approach - Louise Vernon (Champs

Public Health Collaborative)

• MECC Link - Richard Phillips Public Health Workforce Lead, PHE NW
• Healthy Ireland MECC programme - Karan Thomas (Zen)
• LWAB Funding Bid Lancashire & South Cumbria - Caroline Holtom,

Public Health Development Manager, PHE

Louise Vernon

(Champs Public Health Collaborative)

Cheshire & Merseyside MECC Approach 09:50am – 10:05am -

Progress update on implementing MECC at scale and pace in Cheshire &Merseyside

Presented by Louise Vernon Greater Manchester MECC Exploratory Meeting

10th April 2019

The Cheshire & Merseyside (C&M) approach

• In August 2017, the C &M Directors of Public Health endorsed a paper with a series of key

recommendations to upscale and strengthen MECC activity across C&M

• C&M DsPH supported key recommendations to help drive the delivery of MECC at pace and

scale across the sub-region using a systems leadership approach with partners

• The Champs Public Health Collaborative are working with key partners (PHE, HEE, SCN,

NHSE) to create a new innovative and large scale approach to (MECC) across C&M

• The Cheshire and Merseyside Health Care Partnership (C&M HCP) recommended MECC as a

cross–cutting theme across prevention priorities

• C&M Population 2.5M, 12 CCG’s, 18 acute trusts, 9 local authorities

The C&M ambition - creating a culture shift and focus on prevention using MECC

• We want to see MECC flourish in every place, building on great existing local work and new

innovative approaches created

• We want MECC to become normal, every day practice and integral to organisational policy

and commissioning processes

• Our ambition goes beyond increasing MECC training opportunities to creating a culture shift

and focus on prevention embedding a sustainable model

Systems leadership workshop – April 2018

Partners from across C&M met to establish a shared vision and the key elements of a strategic framework to make the ambition a reality. The partners agreed key recommendations including:

• 1. Create a consistent and standardised approach to MECC, with an online portal

to share resources

• 2. Establish a culture focused on prevention, this was seen as critical to enable

staff to fully utilise MECC training

• 3. Produce an effective Communication and Engagement Strategy and ensure

senior leadership ownership

• 4. Establish a Partnership Board to oversee the work on behalf of the broader

network

• 5. Develop robust and standardised evaluation methods

Baseline Mapping of MECC Activity 2018

• Mapping exercise completed in May 2018 across C&M to understand MECC

activity across the sub region

• Cyclic relationship with MECC
• SWOT analysis identified assets and opportunities and also identified common

challenges across C&M

• Best practice identified, now building on this to strengthen the approach

Partnership Board & Partnership Groups

C&M MECC Partnership Board

• C&M MECC Partnership Board established and meets quarterly
• Co-chaired by leaders from C&M HCP and PHE
• Provides oversight of the C&M strategic framework (ratified)
• Programme dashboard and governance feeds into C&M DsPH Board
• MECC is the delivery mechanism for the prevention programme C&M HCP
• 3 T&F groups support the board to progress training, evaluation and communications &

engagement

Partnership Groups & Progress

• 1. Up scaling MECC training across C&M
• An accredited MECC Face to face training programme developed, flexible to local needs,

delivering consistent, high quality training across the sub-region

• Offer of 1x training session per trust/place initially, developing a train the trainer model

to increase capacity at pace and scale 2 X pilot training sites completed and positively evaluated at the end of 2018

• 1 X place (Cheshire West Local Authority 0-19 service)
• 1 X Trust (Alder Hey Foundation Trust)
• Official rollout commenced January 2019

Partnership Groups & Progress

• 2. Maximising impact through effective communications and

engagement

• Stakeholder analysis completed
• Commissioning a Cheshire & Merseyside approach to develop a communications &

engagement strategy;

• An engaging C&M MECC brand
• A C&M MECC Campaign
• An online resource portal delivering a suite of resources for supporting frontline

staff

• Signposting
• Resources; e-learning, national guidance, comm’s & evaluation toolkits
• Case studies
• Building a network of champions
• Regular stakeholder briefings

Partnership Groups & Progress

• 3. Evaluation
• Pre and post evaluation framework of face to face training established
• Further development of the framework to include long term follow up of delegates
• C&M Guide to MECC Evaluation in draft
• Comm’s pre and post evaluation framework in development to measure impact of

campaign

Securing additional resources

• DsPH and the SCN co-fund a programme lead post
• Halton Health Improvement Team contribution to support MECC training

delivery

• The majority of C&M provider trusts have made a commitment to MECC and a

small financial contribution

• Successful HEE LWAB bid for £120K
• Operational insight work led by PHE to explore the organisational landscape

across NHS trusts

Next Steps

• Accredited, high quality face to face training programme rollout across C&M (Jan 19)
• Train the trainer programme development and rollout (Sept 19)
• Communications strategy delivery and rollout (May 19)
• On-line shared resources portal launch (May 19)
• PHE Insight work shared with key senior leaders (DoN’s, HRD’s)
• C&M HCP Prevention Pledge to include key organisational asks
• Primary Care pilots development (2019)
• Dental Programme – Mouth Care Matters programme (2019-20)
• Utilising Behavioural Sciences to Improve Health & Wellbeing Event (May 19)

Thank you Any questions

Richard Phillips

Public Health Workforce Lead, PHE NW

MECC Link 10:05am – 10:20am -

MECC Link…Simple signposting to better health and wellbeing

Origins of MECC Link…

• Started as an informal MECC network
• MECC Community of Improvement in September 2016
• Membership - 15 LA’s, Community Pharmacy, NHS

Acute, Emergency Services…still growing Workplan

• To build capacity and capability for MECC across

Yorkshire and Humber

• To share best practice and learning
• To develop and promote the high impact resources for

MECC

• To be an advocate for MECC
• To support and develop evaluation of MECC

Origins of MECC Link…

The issues:

• Needed to build confidence in
• pening a conversation
• Needed to promote access to a range
• f self-care resources
• Needed to support signposting to

national and local support services

• Previous attempts to create

signposting leaflets failed The answer:

• A simple online tool that provided VBI

support and signposting information – We call this ‘MECC Link’ 26 Presentation title - edit in Header and Footer

MECC COI

Partnership Workplan e.g. Improve Signposting and Referral Task & Finish – MECC Link Digital solution Share output product/service for system

So what does MECC Link do and how does it help the user?

• Provides a simple but

flexible resource to support the competence and confidence of users to deliver healthy lifestyle messages, to help encourage people to change their behaviour…and it does this all in one place.

So what does MECC Link do and how does it help the user?

• Provides sample VBI

style questions using the ASK, ASSIST, ACT model

So what does MECC Link do and how does it help the user?

• Provides key links to

self-care resources within the ACT section, including telephone numbers, websites and apps

So what does MECC Link do and how does it help the user?

• Provides signposting

information to national and local services that can support people throughout the Y&H region

So what does MECC Link do and how does it help the user?

• It’s a responsive website designed to be used on a PC,

mobile or tablet

• Easily updated by WYSIWYG editor by Local Authority

MECC representatives

• Usage tracked with google analytics (May - Nov)
• 13,807 page views since May 2018
• Top topics – Smoking, Mental WB, Health Diet/Healthy Weight
• Top adopters – Bradford, Leeds, Doncaster

MECC Link rollout

• Approval given by the Y&H ADPH network for use outside of Y&H
• Successful funding bid to the General Practice Nursing Board (North ) for a

North of England rollout.

• Opportunity to enhance the website at same time
• Search function
• Print function
• Multiple Risk Factors collation function (CVD, Cancer Diabetes & Diabetes)

Thank you Any questions

Karan Thomas (Zen)

Healthy Ireland MECC programme 10:20am – 10:35am

Making Every Contact Count & Workforce Development Ireland

• MECC + Me
• My Role
• Facilitator KRG’s
• Trainer
• Specialist writer

Key Strategic and Policy Drivers

Healthy Ireland - Government-led programme which aims to encourage and support everyone living in Ireland to have the best possible physical and mental health and wellbeing. http://gov.ie/en/read/healthy-ireland- 6746/

Making Every Contact Count

• Key objective - Chronic disease prevention
• Brief Interventions become part of routine

clinical care.

• Health professionals recognise the role and
• pportunities they have through daily

interactions with patients in supporting them to make health behaviour changes.

• Healthier choices: smoking, alcohol and drug

use, physical activity and healthy eating. 80% of GP consultations & 60%

• f hospital bed days

are related to chronic diseases

Long term vision

5 Key Principles

• Part of everything we do
• Compassionate person

centred culture

• Service- user empowerment
• Staff Engagement
• Innovation and Evaluation

5 Year Implementation Plan 23 High Level Actions

Success will result in patients expecting to be asked about their lifestyle behaviour PDF version of the Framework:

http://www.hse.ie/healthandwellbeing/mak ingeverycontactcount

www.makingeverycontactcount.ie

Key Actions to date

Key actions to date

Training for Healthcare Professionals

Making Every Contact Count Recording Tool Undergraduate Curriculum for healthcare professionals Key partnerships – GPs, Royal Colleges

Further information available from: www.makingeverycontactcoun t.ie

Developing Brief Interventions Skills

Introduction to Behaviour Change Skills into Practice Train the Trainers Enhancing your Brief Interventions

5As Communicat ion Skills Language of Change Demonstrati

• ns

Learn Now, Extend My Learning 6 x 30 minute core learning modules Real, Work- based Learning Developing skills, practice & reflection Different styles & types of learning Practitioner stories, realistic role-plays, patient stories Learning Environment Modular, Extendable

Initial Workshop: Common model Scripting the Content (less is more) Reviewing & Refining

A process

The Challenge – Keeping Going!!

• Contacts details maria.obrien@hse.ie k.thomas@zen.co.uk

Caroline Holtom Public Health Development Manager, PHE

LWAB Funding Bid Lancashire & South Cumbria 10:35am – 10:50am

Lancashire & South Cumbria MECC Programme

Caroline.holtom:@phe.gov.uk

The story so far ………….

50 GM MECC Meeting

• The Lancashire and South Cumbria Prevention and

Population Health Board endorsed MECC as a priority deliverable for 2018/19 on the 19th June 2018.

• The Board endorsed key activities including a

mapping exercise and the submission of a funding bid to the Local Workforce Action Board (LWAB) to fund a MECC coordinator role, a communication plan and a training budget

• Lancashire and South Cumbria MECC steering group

was established in 2018.

• Recruit MECC coordinator & commission training

Lancashire and South Cumbria MECC

1. Vision “For all of us in Lancashire and South Cumbria to be more informed, motivated and empowered to maintain and improve our own health and wellbeing through delivery of consistent health messages and support to access services”

• 2. Approach

Train the Trainer (PDSA) multidisciplinary approach Settings based approach (starting with NHS contracts) Place Based (asset based community approach)

• 3. Lancashire & South Cumbria Pledge/ Charter

50% of Healthier Lancashire and South Cumbria organisations sign up to consistent approaches to MECC with commitments made by organisations to further adopt a health and wellbeing promoting culture.

• 4. Communications and Marketing and MECC Link

51 GM MECC meeting

PDSA Train the Trainer model

Wave 1 20 applicants attend 2 day learning workshop and agree to deliver 5 MECC level 1 very brief or brief intervention training Further support could also be offered by developing a community of learning with monthly skype calls and webinars. Wave 2 , 3 and 4 Would replicate the approach of the first wave 6 month later with a further 20 applicants Training budget 40 training days development of resources for train the trainers accommodation/venue charges Expected Outcome At least delivery of 400 sessions by 80 MECC trainers (over 2 year period) 52 GM MECC meeting

• 1. PDSA Methodology

53 https://www.nice.org.uk/sharedlearning/making-every-contact-count-for-physical-activity-in- musculoskeletal-outpatient-physiotherapy-a-service-improvement-project-to-implement-nice-public-health- guidance-ph44

Useful resources

• HEE free E- Learning for Healthcare training website https://www.e-lfh.org.uk/
• A MECC Implementation Guide has been developed to support people and
• rganisations when considering or reviewing MECC activity.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachm ent_data/file/769488/MECC_Implememenation_guide_v2.pdf

• A self-assessment checklist is available to support organisations including a set of

quality markers to develop new training materials and to evaluate existing training https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachm ent_data/file/769489/MECC_Training_quality_marker_checklist_updates.pdf

• MECC website to update latest tools, resources and support a community of learning

https://www.makingeverycontactcount.co.uk/

• There are a range of linked resources to support the programme including pages on

health coaching, MECC plus, social prescribing and more. https://www.makingeverycontactcount.co.uk/linked-resources/

54 GM MECC meeting

10:50am – 11:10am – Refreshment break

Greater Manchester MECC Updates

 All GM localities give a brief update around MECC  Using the template already completed –

• What is the offer?
• What is working well?
• What do we need support with?

11:10am – 12:00pm

Local Authority: Wigan

57 Something to celebrate/share (what is going well):

• Champions (Workplace / Community) – Health, Cancer, InMind
• Healthy Living Framework – Pharmacies, Dentistry
• Dementia Friendly Communities, Dementia Friends, Dementia Friendly

Town of the year (2017)

• Energy Champions (Fuel poverty) roll out
• Locally developed InMind (1 hour mental wellbeing)
• 3 year funded Papyrus Training (Suicide Prevention)
• CICA – Communities in Charge of Alcohol
• Deal Training – locally developed

Major concerns/risks (need support from colleagues):

• Staff utilising the skills once trained
• Referral / access points – multiple

services Top actions to do next:

• Healthy Living Salons / Barbers
• Embedded within contracts /

providers to support

• One front door

Making Every Contact Count Local - Rochdale

58 Something to celebrate/share (what is going well):

Long standing Health Chats programme –over 3000 trained (MECC) ‘Connecting You’ – our integrated prevention model – core team trained Focus on the Big Six MECC ++– money management, employment and training, housing, connecting people in local community, healthy lifestyles, link to prevention services (e.g. screening, health checks) System wide workforce development programmes PCCA and MECC +++ – rolling programme including the Big 6, strength based conversations (PCCA) Health Chats training and forums, community brief intervention training, primary care workforce training in GP practices, adult care workforce programmes, Relationships Matter workforce programme, E learning on brief interventions in secondary care focused on tobacco and alcohol, neighbourhood workforce development plans etc. Connect 5 from may 2019

Major concerns/risks (need support from colleagues):

Risk of overlapping programmes from GM . At a local level we need to connect all our workforce development programmes and tools, prioritise and link together. Any additional ‘MECC’ programmes would need to add value or replace a current programme. Sustainability of any GM programme

Top actions to do next:

Continue our transformation programme for prevention and access. Focus on neighbourhood team development, person centred approaches, community and voluntary sector partnerships and workforce development across the system. Consider any GM developments and assess how they would fit with our work and plans

Local Authority: Bolton

59

Something to celebrate/share (what is going well): New DPH. Re-focus. All mandatory commissions/services in place. Hospital site – plans to become a Health Hub Innovation Centre. New Integrated 0-19 service – opportunities to embed MECC. Major concerns/risks (need support from colleagues): No significant focus on MECC across current PH

• topics. How would it support child

health which is local priority e.g. ACE’s? Lack of funding to innovate/embed practice. What are the priority MECC topics? E.g. smoking, alcohol? Top actions to do next: Get GM focus? Evaluate

• pportunities in NHS Plan e.g.

smoking in hospitals. Get direction

• n MECC development within

Bolton LA from DPH.

Local Authority: Trafford

60

Something to celebrate/share (what is going well): MECC in the District Nurse Specification, ie flu vaccination, cancer screening, smoking cessation. Major concerns/risks (need support from colleagues):

• Pressure of available time with

people to deliver MECC in a meaningful way

• Local capacity to roll it out.

Top actions to do next: Engage with the LCA to embed MECC

Local Authority: Tameside

61 Something to celebrate/share (what is going well):

• Tameside’s commitment to MECC over the past 5/6 years and

sustaining an annual budget

• The Tameside MECC Programme delivered across the Education

System from 2017/2019

• The development of the Online E learning Package ‘Talking Tameside’

due to be launched in the Autumn of 2019 Major concerns/risks (need support from colleagues):

• Commitment to Talking

Tameside across the whole system to eg ICFT, PCN’s etc Top actions to do next:

• Agree and finalise the content of
• ur Talking Tameside E learning

Package

• Developing a robust Evaluation

Framework and commissioning a Provider

Local Authority: Manchester

62

Something to celebrate/share (what is going well):

• Re-designed wellbeing service, relaunch of buzz with an enhanced

focus on community development

• Increased delivery of NHS Health Checks
• Be Well social prescribing services now citywide

Major concerns/risks (need support from colleagues):

• GM support for MECC needs to

be aligned with local approaches and service delivery

• Co-production with GM on

public health programmes Top actions to do next:

• Work with re-designed buzz

wellbeing service to improve health outcomes in Manchester

• Commission further smoking

cessation services so that citywide population cover

Local Authority: Bury

63 MECC

Something to celebrate/share:

• Examples of good practice within MSK & physio services on which to

build

• Locality plan investment in LTC prevention & management

programme which has MECC at the heart

• Number of GM programmes e.g. CURE, Baby Clear, GM Moving,

Healthy Living Pharmacy being delivered locally and adding to approach. Major concerns/risks

• Lack of coordination/ siloed

approaches

• Lack of capacity to drive and

embed MECC across the system

• Sustainability of series of short

term funded projects Top actions to do next:

• Secure funding for MECC lead
• Continue to align projects under

the ‘Keeping Bury Well’ programme

Local Authority : Oldham

64

Something to celebrate/share (what is going well):

• High level endorsement from CEO
• 675 staff and 11 councillors trained with a further 15 MECC champions
• Evaluation : positive post training feedback, good case study examples
• Gaining high level interest from external partners e.g. Primary Care, Community – Social Prescribing

multi agency model

• Created an effective MECC leaflet on Oldham’s PH priorities, risks vs benefits & signposting to local

support services Major concerns/risks (need support from colleagues):

• Staff turnover – Undermines the training model of

capacity building

• Reliant on PH to drive the programme
• Competing training approaches (perception) e.g. 3

C’s model, asset based conversations and motivational interviewing

• Training capacity, sustainability
• No resource apart from PH PM
• Conversion of training to brief interventions is hard to

measure Top actions to do next:

• Try to influence plans to include MECC

within workforce dev across all Oldham ICO

• Explore the use of an external trainer to help

deliver a train the trainer model to the wider workforce

• Dev E-learning which is concise & localised

for HR inductions & an alternative to face to face training

• Require re-occuring funding for MECC

leaflet reprints

• Strengthen monitoring & evaluation

Stockport

65

Something to celebrate/share (what is going well):

• MECC delivered as core public health offer - Health chats programme brief intervention lifestyle
• ffer
• Healthy Stockport Website with self care pages –links to Stockport Local Directory
• Social prescribing pathway from General Practice with link to Team around the Place in

development

• Enhanced Case Management with Goals of Care (used by Integrated Health and Social care

teams and key voluntary sector partners )

• Teams starting to use Patient Activation Measure to tailor advice and intervention

Major concerns/risks (need support from colleagues):

• Health chat programme not mandated

competes with lots of other training

• Leadership commitment to deliver at scale
• Capacity to proactively deliver programme
• Need to align various programmes, MECC,

Person centred approaches, ECM, leadership

• Fresh ways to engage staff and deliver

messages to public

• Measuring outcomes

Top actions to do next:

• Need to refresh core MECC learning from

best practice

• Describe and commit to the pathways for

MECC and aligned workforce development/

• rganisational development that is required
• Explore further links to Patient Activation in
• rder to tailor advice
• Consider whether change name to MECC

Interactive Planning Workshop

Group Discussion:  Is there an appetite for a GM MECC approach? What would it look like? Who do we need? How can we achieve it? 12:00pm – 12:30pm 12:30pm – 12:45pm

Funding Bid for a GM MECC approach:

Update from Mark Brown, Programme Manager, GMHSCP

The journey so far

GM Workforce Collaborative Fund GM H&SCP application

Mark Brown Programme Manager Greater Manchester Health & Social Care Partnership

GM Workforce Collaborative Fund 2019/20

…welcomed applications adhering to the following criteria:

 Alignment to GM Workforce Strategy  Alignment to HEE investment criteria  Alignment to 19/20 funding priorities  Readiness to deliver  Stakeholder engagement  Applicability/scalability/replicability across GM  Clear financials  Foundation for further development/transformation

GM Health and Social Care Partnership application

2 Year Project across 2019/20 and 2020/21 Intended outcomes

• A single GM approach to the provision of opportunistic health

advice and guidance in a range of settings.

• A GM approach that that compliments those that currently

exist in Cumbria, Lancashire, Cheshire and Merseyside.

• Increased knowledge and understanding of the Prevention and

Population Health agenda across the wider workforce

• Increased use of healthy living / wellbeing services across

Greater Manchester of increased traffic to the online GM Health Hub. ‘Beyond MECC – A unified Greater Manchester approach to health advice, guidance and behaviour change’

GM Health and Social Care Partnership application

2 Year Project across 2019/20 and 2020/21 Outputs

• Number of staff trained as trainers
• Number of staff trained in providing brief health advice and

guidance (across 33 GM HSCP partner organisations)

• Number of opportunistic health advice and guidance

interventions

• Number of visits to GM Health Hub

‘Beyond MECC – A unified Greater Manchester approach to health advice, guidance and behaviour change’

GM MECC Funding Bid – Indicative Milestones 2019/20 – 2020/21

2019/20 (Q1)

• Establish GM MECC

Steering Group

• Recruit GM Project

Support Officer

• Procurement of Training

Partner

• Procurement of

Evaluation Partner 2019/20 (Q2)

• Project Support Officer in

post

• Development of Training

Programme

• Develop on-line toolkit

2019/20 (Q3)

• Commence training

programme (Cohort 1)

• On-line toolkit ‘go live’

2019/20 (Q4)

• Ongoing delivery of

training programme (Cohort 2) 2020/21 (Q1)

• Annual Review and

assurance process

• Interim Programme

Evaluation report

• Ongoing delivery of

training programme (Cohort 3) 2020/21 (Q2)

• Ongoing delivery of

training programme (Cohort 4) 2020/21 (Q3)

• Ongoing delivery of

training programme (Cohort 5) 2020/21 (Q4)

• Project final evaluation

report

GM MECC Steering Group GM Directors of Public Health Group GMHSCP Population Health Programme Board 2019/2020 2020/2021 Governance

Lesley Jones

DPH Bury & GM HSCP Public Health Workforce lead

Summary and Next Steps 12:45pm – 13:00pm -