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THE LANGUAGE OF CHANGE: MOTIVATIONAL INTERVIEWING

THE LANGUAGE OF CHANGE: MOTIVATIONAL INTERVIEWING. An Introduction to Patient – Provider Communication Enhancement Kate Speck, PhD, MAC, LADC Univ. of Nebraska Public Policy Center Paula Pillen, MPA, NHA Health Center Association of Nebraska CIMRO CONFERENCE 2012. oBJECTIVES.

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THE LANGUAGE OF CHANGE: MOTIVATIONAL INTERVIEWING

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  1. THE LANGUAGE OF CHANGE: MOTIVATIONAL INTERVIEWING An Introduction to Patient – Provider Communication Enhancement Kate Speck, PhD, MAC, LADC Univ. of Nebraska Public Policy Center Paula Pillen, MPA, NHA Health Center Association of Nebraska CIMRO CONFERENCE 2012

  2. oBJECTIVES Engage in Effective Behaviors of Health Have Toolsin Your “Backpack” for Patients Learn About Cultural Sensitivity Triggers Discuss the application of Motivational Interviewing to enhance the Behavior Change process.

  3. Let’s have a conversation… And, Let’s Reduce The Frustration! What Common Issues or barriers that Face You or Other Staff When Communicating With Patients?

  4. Your Top triggers Cultural Differences? Ageism? Thought Processes? +/+, +/-, +/+-, +/-+ Understanding Patients’ First Reactions Helps With Change.

  5. Traditional Approach to Health Behavior Change Client/Patient Education Client/Patient

  6. MOTIVATIONAL INTERVIEWING (mi):THE BASICS Focus on Behavior Change Motivational Interviewing Style or “Spirit” Asking Open Ended Questions Affirmation of Strengths and Change Efforts Making Reflective Statements Fostering a Collaborative Atmosphere (autonomy and personal choice)

  7. mi: What’s it for? Motivational interviewing is a collaborative conversation to strengthen a person’s ownmotivationfor andcommitmentto change.

  8. mi: Why would I use it ? Motivational interviewing is a person-centered communication method for addressing the common problem of ambivalence about change.

  9. What is MI good for? Two Elements of Motivational Interviewing are Evidence Based for Client Engagement ~ Retention Motivational Interviewing ties in with the NIDA “Principles of Effective Treatment”; engaging and retaining clients in the process enhances their experience of change and leads to successful outcomes.

  10. M.I.: How it Works Managing important in-session behaviors of client, using MI Spirit and Skills Interaction of Practitioner and Client Increase Change Talk And Decrease Sustain Talk Leads to

  11. Looking for Change Talk: • Discomfort/disadvantages of status quo • Consequences, personal concerns, others’ concerns • Advantages of change • Good things (or reduction in negatives) of change • Optimism/ability to change • Personal resources, skills, confidence • Intention/commitment to change • What change would look like, concrete or hypothetical plans

  12. Barriers to change Ambivalence CONFUSION  DENIAL   PROCRASTINATION DILEMMA

  13. PACING: Readiness to Change Combinations of Issues, Chronic Conditions, Practices, and Mindfulness. Not at all ImportantExtremely Important 0 1 2 3 4 5 6 7 8 9 10

  14. Stages of Change

  15. Stages of readiness to change Kate Speck, PhD, LADC

  16. Four Foundational Processes Kate Speck, PhD, LADC

  17. The M.I. Hill Yet another metaphor Preparatory Change Talk Mobilizing Change Talk Preparation Action (Pre-) Contemplation

  18. Sample Behavioral Consultation Explore Importance Assess Importance & Confidence Arrange Follow-Up or Referral Advise & Provide Options Assess Build Confidence 10-30 minutes

  19. Motivation Now, For Those Frustrating Situations !

  20. Motivational skills O.A.R.S. Open -Ended Questions Affirmative Statements Reflective Listening Summarizing

  21. Sample Behavioral Consultation Explore Importance Assess Importance & Confidence Arrange Follow-Up or Referral Advise & Provide Options Assess Build Confidence 10-30 minutes

  22. Simplified Motivational Categories

  23. Motivational Interviewing skills O.A.R.S. Open -Ended Questions • Would you tell me more about . . . ? • Would you help me understand . . . ? • How would you like things to be different?

  24. Motivational skills O.A.R.S. Affirmative Statements • I am really impressed with the way you . . . • That’s great how you’ve reached your goal of cutting back on your drug use. • Using protection shows that you have real respect for yourself and your partners.

  25. Motivational skills O.A.R.S. Reflective Listening • “So you feel . . .” • “It sounds like you . . .” • “You’re wondering if . . .”

  26. Motivational skills O.A.R.S. Summarizing • “Let’s see if I understand so far . . .” • “Here is what I’ve heard. • “Did I miss anything?” • “If that’s accurate, what other points are there to consider?”

  27. Motivation When asked “would you rather work for change, or just complain?” 81% of the respondents replied, “Do I have to pick? This is hard!” It is Responsible to Change !

  28. Motivation and Change • Motivation is malleable, rather than fixed. • Provider, client, and the interaction between them all influence desire to change. • Motivation includes components of estimated importance of change and confidence in ability. • How you talk to a client about changing behavior makes a difference.

  29. QUESTIONS

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