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Motivational Interviewing: Tools for Behavior Change in Healthcare

Learn how motivational interviewing can address ambivalence in patient care, and gain practical techniques to elicit change talk and confidently use motivational interviewing in your practice.

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Motivational Interviewing: Tools for Behavior Change in Healthcare

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  1. Motivational Interviewing: Tools for Helping with Behavior Change WA AAP Population Health Forum – June 8, 2019 Alicia Dixon Docter, MS, RDN University of Washington Division of Adolescent Medicine/UW LEAH

  2. Introductions Introduce yourself to someone in the room you don’t know really well. Form teams of 3 – you will be working together during the session. • Name • Role • Where from • Pick one topic that you want to work on (personal or work); this will be used throughout

  3. Objectives • Discuss how motivational interviewing can be used to address ambivalence in patient care • Demonstrate at least one method to elicit change talk • Increase your ability to confidently use motivational interviewing techniques in your practice

  4. Case • Maria is a 16 year old coming to see you because parents are concerned about weight loss • You excuse parents from the room • Emphasize confidentiality when speaking with Maria alone • You begin to ask Maria questions. The responses are… • ‘I don’t know’ • Shoulder shrug Now what?

  5. MI: Helps Address Ambivalence • Ambivalence: • Feeling two ways about a thing • Common prior to and during habit change For example: • Difficulty scheduling appointments • Missed appointments • Intervention plans not being followed • Goals of family have little substance • Treatment progress uneven • Family members not forthcoming

  6. Transtheoretical Model of Change Adapted from Prochasksa (1997)

  7. Communication – 7x 7ways What’s in a Successful Change Plan? Adapted from Knoster, T. (1991) RainbowSlide-Planning for Success.pptx AD

  8. Principles of Motivational Interviewing • Instead of the expert clinician directing, there is an active collaborative conversation and joint decision-making process • Evoke from patients what they already have; activate their own motivation • Requires an acceptance that people can and do make decisions about the course of their lives

  9. O.A.R.S. Build rapport Open ended question AffirmationsReflective listening Summary statement Throughout: Ask permission

  10. O.A.R.S.Open-ended Questions Invites person to reflect and elaborate Helps to understand their internal frame of reference Creates impetus for forward movement to help the person explore change

  11. Open-ended To what extent… How often… Tell me about… What, if any,… Closed-ended vsOpen-ended Questions • Closed-ended • Did you… • Can you… • Will you… • Is it…

  12. #1 Practice Open-ended Questions • Speaker: Describe what you are working on • Listener:Goal of understanding the dilemma. Give no advice. • Why might you want to make this change? • How might you go about it, in order to succeed? • What are three reasons to do it? • Observer: Reflect on interaction and provide feedback using worksheet as a guide. • How did it go? • What did you notice (body language, tone, likelihood of change)? • How did the speaker feel? How did the listener feel? • 2-3 minutes each

  13. O.A.R.S.:Affirmations • Statements of recognition about strengths • Helps person feel change is possible • Point out strengths where only failure is perceived by individual • Consider partial successes • Use resistance • Examples: • I see you had breakfast once this week • Although you didn’t succeed, I saw how hard you worked • I see your struggling with this, but it’s shows you are interested in changing because you’re here

  14. #2 Practice Affirmations • Speaker: describe what you have tried so far even if it’s just one or two small things • Listener: Ask open-ended questions in order to uncover something positive & then affirm it. Listener needs to really focus. • Observer: Reflect on interaction and provide feedback using worksheet as a guide. • How did it go? • What did you notice (body language, tone, likelihood of change)? • How did the speaker feel? How did the listener feel? • 3 minutes each

  15. O.A.R.S.:Reflective Listening • Helps you understand what’s working or not • Statement, not question • Trust and rapport will deepen even if you don’t get it “right”

  16. Reflective Listening • Starts with: • So… • Sounds like… • You… • So, one hand…But on the other… • Use 2-3 reflections before moving on to next question • Can be a skill to use when “stuck” • If you are right, emotional intensity of session will deepen. • If wrong or person not ready to deal with, they’ll correct you and the conversation moves forward

  17. #3 Practice Reflective Listening • Speaker: Share with your group the reasons for the changes you want to make. • Listener: Each try a reflective response. • Observer: Reflect on interaction and provide feedback using worksheet as a guide. • How did it go? • What did you notice (body language, tone, likelihood of change)? • How did the speaker feel? How did the listener feel? • 3 minutes each

  18. O.A.R.S.Summaries • Communicates interest in the person and helps develop rapport • Can shift direction if necessary • How to do this: • Begin with announcement that you are about to summarize • Be selective and concise • Note ambivalence • Invitation to correct anything • End with an open–ended question

  19. #3 #4 Practice OARS • Speaker: Describe what you are working on • Listener:Goal of understanding the dilemma using open-ended questions, affirmations, reflective listening and summaries. Refer to handout. • Observer: Reflect on interaction and provide feedback using worksheet as a guide. • How did it go? • What did you notice (body language, tone, likelihood of change)? • How did the speaker feel? How did the listener feel? • 2-3 minutes each

  20. Change Talk • If you hear anything close to: • Desire (want, like, wish) • Ability (could, can, might be able to) • Reasons (argue for change) • Need (ought to, have to, really should) This will open the door to talk about commitment and possible plan/goals.

  21. Elicit-Provide-Elicit (EPE) • Ask permission prior to beginning • Elicit - what the patient already knows and wants to know. • Provide - information in a neutral manner. • Elicit - the patient’s response to, interpretation of the information

  22. Case – an update • You begin by engaging Maria using OARS • Weekly visits over the next few months have lead to… • Eating breakfast as well as more regular meals • Decrease in rate of BMI increase • Spending more time with friends • Significantly reduced household stress!

  23. Reflections on patient care • MI takes practice • It’s easy to go back to ‘old habits’ • Patient engagement is a good indicator of effective MI

  24. How to engage in culturally appropriate care? • What aspects of MI fit with your patient population? • What things might not work? • How might the cultural background of your patients shape the clinical encounter?

  25. Discussion/Questions

  26. References References • Miller, WR and S Rollnick, Motivational Interviewing, 3rdedition, Guildford Press, 2013. • Prochaska, JO and Velicer, WF, The Transtheroretical Model of Health Behavior Change. Am J Health Promot, 1997, 12(1)38-48.

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