9 Core Principles & the Evidence Base

1. 9 Core Principles & the Evidence Base • Individual-centered • Collaborative • Respects right of not changing • SMART • Commitment statement • Behavioral menu • Measure confidence • Follow-up • Occurs in every interaction

2. Core Principle #1 Action planning is individual-centered, i.e. what the person wants, not what he/she is told to do. “Spirit” of Motivational Interviewing: Evocation “Spirit” of Motivational Interviewing: Evocation Miller W, Rollnick S. Motivational Interviewing: Preparing People for Change, Guilford Press, 2002

3. Persuasion • Work in pairs, not with your boss or supervisor • Speaker: Think of something you are considering, something you are thinking about changing in your life but definitely haven’t decided. It might be something you think will be good for you or that you should do. Something you feel comfortable sharing. Tell this to your partner.

4. Persuasion, cont. Partner: your task is to try as hard as you can to convince the speaker to make the change they are considering. Do these five things: • Explain why they should make the change • Give at least three specific benefits that would result from making the change • Tell the person how they should make the change • Emphasize how important it is for them to make the change. This might include the negative consequences of not doing it. • Tell the person to do it.

5. Debrief What did the speaker feel or think while their partner was talking to them?

6. A Taste of MI • Work with one other person • Not with your boss or supervisor • One will be the speaker and the other will be the listener • If time permits, you can reverse roles. • Subject: something you are ambivalent about

7. The speaker • TOPIC: something about yourself that you • Want to change • Need to change • Should or ought to change • Have been thinking about changing • But you haven’t changed yet • i.e., something that you are ambivalent about

8. The listener • Listen carefully with a goal of understanding the dilemma • Give no advice • Ask these four open-ended questions: • Why would you want to make this change? • How might you go about it, in order to succeed? • What are the three best reasons for you to do it? • On a scale from 0-10, how important would you say it is for you to make this change? • Why is it a ___ and not a zero?

9. Debrief What did the speaker feel or think while their partner was talking to them?

10. Core Principle #2 Action planning is collaborative. “Spirit” of Motivational Interviewing: Partnership MillerW,RollnickS. MotivationalInterviewing: PreparingPeopleforChange,GuilfordPress,2002;Heisleretal,JGIM,2002 “Spirit” of Motivational Interviewing: Partnership

11. Core Principle #3 After the plan has been formulated, the clinician/coach elicits a final “commitment statement.” Strength of the commitment statement predicts success on action plan. . Miller W, Rollnick S. Motivational Interviewing: Preparing People for Change, Guilford Press, 2002

12. Core Principle #4 Action Planning is “SMART”: Specific, Measurable, Achievable, Relevant and Timed Based on the work of Locke (1968) and Locke & Latham (1990, 2002); Bodenheimer, 2009 .

13. Core Principle #5 After the plan has been formulated, the clinician/coach elicits a final “commitment statement.” Strength of the commitment statement predicts success on action plan. (Aharonovich, 2008; Amrhein, 2003)

14. Core Principle #6 Offer a behavioral menu when needed or requested “Spirit” of Motivational Interviewing: Autonomy Rollnick, Miller & Butler, 2008. Motivational Interviewing in Health Care

15. Behavioral Menu “Here are the things we have talked about. Which one is most important to work on right now?” (write others here) Smoking Exercise Avoiding triggers Taking meds Adapted from Stott et al, Family Practice 1995; Rollnick et al, 1999, 2010

16. There are many things people do to improve their health. Here are some things you might want to talk to your health care team about. • Consider the items in circles and add other concerns in the blank circles. Monitoring your health Taking medications Activity Avoiding health problems Mood Eating habits Meaningful Activities Smoking

17. Core Principle #7 Confidence levels are evaluated and problem-solving utilized for confidence levels less than 7. Higher self-efficacy is associated with healthier behaviors and better outcomes. (Bandura, 1983; Lorig et al, Med Care 2001; Bodenheimer review, CHCF 2005; Bodenheimer, Pt Ed Couns 2009.)

18. Self-efficacy People’s beliefs about their capabilities to perform specific behaviors and their ability to exercise influence over events that affect their lives. Self-efficacy beliefs determine how people feel, think, motivate themselves and behave. • Albert Bandura

19. Core Principle #8 Action planning includes arranging follow-up or other accountability. (Resnicow, 2002; multiple condition specific studies)

20. Core Principle #9 Action planning is considered in all chronic, planned, or preventive visits. Non-physician staff are 9 times more likely to engage in goal-setting than clinical staff. Technology (such as howsyourhealth.org) is an option. (Bodenheimer, 2009)