Welcome

1. Welcome Minnesota WIC Program Participant-Centered Skills Training Bernadette Landers, MPA, RD, IBCLC Senior Associate Karen Deehy, MS, RD Senior Associate

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4. Participant-Centered Communication Skills • Uncover participants own inner motivations for adopting healthy behaviors • Help participants feel confident in their abilities and in their role as parents • Promote participant autonomy – what they change is up to them • Actively involve participants in goal setting and problem solving • Share information and strategies to help participants achieve their goals • Invest in relationships to build rapport, trust and connection

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6. Slide 6 Likeability

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10. Slide 10 Similarity & Familiarity

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16. Slide 16 • Think of something about yourself that you • Want to change • Need to change • Should change • Have been thinking about changing • …but haven’t changed yet

17. Ambivalence and the Righting Reflex • Most people that want to change are ambivalent • When we advocate for change – the natural human instinct is to offer the other side of the argument • People are driven to change based on what they themselves say • The more participants talk about the disadvantages to change, the more committed they are to stay the same

18. The Paradox of Change: When a person feels accepted for who they are and what they do – no matter how unhealthy – it allows them the freedom to consider change rather than needing to defend against it!

19. Experience “Not PCS” • Ask what the change goal is • Ask why they haven’t done it • Explain why the person should make this change • Tell them the specific benefits that would result from making the change • Tell the person how they should make the change • Emphasize how important it is to change If you meet resistance, repeat the above No reflective listening! This is not participant-centered. Activity courtesy of MINT

20. Most Important Communication Skill

21. Mining for Gold Change Talk

22. Change Talk • Any talk that favors movement toward change • Goal is to encourage change talk and reinforce it • Small achievable changes • The more they talk about change, the more likely they are to do it – break the cycle of ambivalence • We are convinced by what we say • What does change talk sound like?

23. Different Types of Change Talk DANCR STEPS • DESIRE: I wish; I want to; I would like to • ABILITY: I can; I could; I am able to • NEED: I need to; I can’t keep doing this; I must; It is important • COMMITMENT: I am ready to; I am going to • REASONS: There are good reasons to • TAKING STEPS

24. Activity…Drumming for Change Activity courtesy of MINT

25. Is this person ready for change? Slide 25

26. Open-Ended Questions Affirmations Reflective Listening Summaries Slide 26

27. Open-Ended Questions • When to use OEQ: • To evoke change talk • To explore reasons for change • To identify barriers • To set goals and make plans • When not to use them?

28. Driving Action …Motivation Motivation is the meeting of : • Importance • Confidence • Readiness

29. Activity: Encouraging Change Talk with Questions • Ask them what change they have thinking of making • Ask some questions to build importance and confidence: • What are some of the best reasons to make this change? (I) • What will it be like if you made the change? (I) • If you did decide to make that change, what do you think would work for you? (C) • What are the first steps you would need to take to make that happen? (c) • Give a short summary/reflection of the speaker’s motivations for change Activity courtesy of MINT

30. Affirmations“The greatest good you can do for another is not just to share your riches but to reveal to him his own.” - Benjamin Disraeli

31. Affirmations • Pointing out strengths and resources • Tie the affirmation to the behavior • “You” statements are more powerful than “I” statements • Reframe failure

32. What Do You Say To Yourself In The Mirror?

33. Slide 33 Example: A participant reports that she smokes. She knows it isn’t good for her but is fed up with people nagging her about it. At some point she will stop, but not yet. She is under lots of stress with her job and with taking care of her three kids and smoking helps to relieve her stress. She feels guilty and does not smoke around the kids much. She will quit when she is ready. Participant Strengths? Affirmations?

34. Reflective Listening

35. Reflections • Think to yourself: • What do I think she means? • What is she really trying to say? • How does she feel about this? • What is she not saying? • What is her tone / body language saying and is it different than her words?

36. When to Reflect • After an open-ended question • When you hear change talk • When you hear ambivalence or inconsistency • When you hear strong feeling • When you sense resistance

37. Getting Started… Helping Words • It sounds like… • It’s kind of like • It’s as though… • You are… • So you… • You don’t think… • You’re feeling like…

38. Types of reflections • Simple reflection : Slight rewording of what client said • Complex refection: Moving beyond what was said Meaning // Emotion // What is not said // Finishing the thought • Double-sided reflection: Highlighting ambivalence or discrepancy • Amplified reflection: Exaggerating to the point that a participant may disagree • Summary reflection: Putting together a summary of all the key points

39. Reflecting Emotion - Example P: “I am breastfeeding my baby, but she cries a lot so I wonder if she needs to start drinking formula?” C “You’re worried that she is not getting enough breast milk.”

40. Reflection with a Twist - Example P: Yeah I know exercise is important. I don’t want to get diabetes like my uncle and wind up without my leg but I hate running, I hate aerobics or any kind of team sport and I really don’t like to sweat. C: It is important to you to exercise to avoid complications from diabetes and you haven’t found a form of exercise that works for you yet. (a twist)

41. Finishing the Thought - Example P: They both never like what I make for dinner. They are so picky. They only eat a certain amount of things. The same things all the time. C: And you end up becoming a short order cook and making multiple meals.

42. Double-Sided Reflection - Example P: I want to give them healthy things, but then we are in the store and she says mommy, mommy can I have that. I can’t say no. C: You want to give her things that will make her happy and yet you worry about her health.

43. Amplified Reflection - Example P: It is not like I have time to go to the gym like other women. I wouldn’t have the time. C: There is not time for any sort of exercise or activity for you right now.

44. Activity: Practice Reflections

45. Dosey Doe Activity courtesy of MINT

46. Instructions: Dosey Doe • Round 1: Blue and Green Yellow and Red • Round 2: Blue and Yellow Green and Red • Round 3: Blue and Red Yellow and Green • Person one reads their stem 3 times. • Person two offers 3 different reflections. • Then switch • Notes: • Try different types of reflections: complex, double-sided, emotion, finish the thought. • Try to drop the helping stem

47. Purpose of the Assessment

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