CCSM support – capabilities

The World Health Organization report  ‘Preparing a health care workforce for the 21st century: The challenge of chronic conditions’ outlines how the global shift from acute to chronic health problems is placing new and different demands on the health care workforce.  It identifies 5 new core competencies for health providers:

  • Person-centred care
  • Partnership approach
  • Quality improvement
  • Information and communication technology
  • Public health perspective

The Human Behaviour and Health Research Unit at Flinders University, South Australia documents 19 core capabilities to provide effective CCSM Support in their seminal work  'Capabilities for Supporting Prevention and Chronic Condition Self-management' (Lawn, S. & Battersby, M., 2008).

In WA, the document CCSM support capabilities – training, resources and references for health providers (PDF 1MB) has been compiled to facilitate quick access to training options, resources and references suitable for a time-limited workforce.

The document provides information for 37 different CCSM support skills, capacities and knowledge areas, adapted from the above Flinders University capabilities.  These are grouped under the headings:

Section A: Overview of strategic context

Section B: Strategic knowledge

Section C: Person-centred skills

Section D: Behaviour change and lifestyle skills

Section E: Organisation/systems knowledge and skills

Index of CCSM support capabilities

Section A: Overview of strategic context

  • Chronic Condition Management
  • Chronic Condition Self-Management
  • Evidence for CCSM
  • WA Models of Care
  • CCSM assessment tools
  • Safety, quality and accreditation and CCSM
    • Standard 2: partnering with consumers
    • Standard 12: provision of care
  • CCM within a primary health care approach (WACHS)

Section B: Strategic knowledge

  • Person-centred care
  • Health literacy
  • Adult learning
  • Cultural awareness – Aboriginal
  • Cultural awareness – multicultural
  • Health Promotion approaches

Section C: Person-centred skills

  • Communication skills
  • Assessment of self-management capacity
  • Psychosocial assessment and support skills
  • Assessment of health protective and risk factors
  • Collaborative care planning - agendas, goals, problem solving and action plans
  • Linking with peer support

Section D: Behaviour change and lifestyle skills

  • Models of health behaviour change
  • CCSM and behaviour change approaches
  • Motivational interviewing
  • Brief interventions
  • Coaching
  • Stanford – Chronic Disease Self-Management Program
  • The Flinders Program
  • CCSM program development

Section E: Organisation/system knowledge and skills

  • Working in multidisciplinary teams, Inter-professional learning and practice
  • Information, assessment and communication management systems
  • Organisational change techniques
  • Evidence-based knowledge and practice
  • Conducting practice based research, quality improvement
  • Awareness of community resources


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Chronic Condition Self-Management