Post on 24-Dec-2015
THE LANGUAGE OF CHANGE: MOTIVATIONAL INTERVIEWING
An Introduction to Patient – Provider Communication Enhancement
Kate Speck, PhD, MAC, LADCUniv. of Nebraska Public Policy Center
Paula Pillen, MPA, NHAHealth Center Association of Nebraska
CIMRO CONFERENCE 2012
OBJECTIVES Engage in Effective Behaviors of Health Have Tools in Your “Backpack” for
Patients Learn About Cultural Sensitivity
Triggers Discuss the application of
Motivational Interviewing to enhance the Behavior Change process.
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?
YOUR TOP TRIGGERS
Cultural Differences? Ageism? Thought Processes?
+/+, +/-, +/+-, +/-+ Understanding Patients’ First
Reactions Helps With Change.
TRADITIONAL APPROACH TO HEALTH BEHAVIOR CHANGE
Client/Patient Education
Client/Patient
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)
MI: WHAT’S IT FOR?
Motivational interviewing is a
collaborative conversation to
strengthen a person’s own motivation for
and commitment to change.
MI: WHY WOULD I USE IT ?
Motivational interviewing is a person-centered communication
method for addressing the
common problem of ambivalenceabout change.
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.
Managing important in-session behaviors of client,
using MI Spirit and Skills
M.I.: HOW IT WORKS
10
Interaction ofPractitioner and Client
Leads to
Increase Change Talk
And
Decrease Sustain Talk
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
Ambivalence CONFUSION
DENIAL PROCRASTINATION
DILEMMA
BARRIERS TO CHANGE
PACING: READINESS TO CHANGE
Combinations of Issues,
Chronic Conditions,
Practices, and Mindfulness.
Not at all Important Extremely Important
5 6 7 8 92 101 3 40
STAGES OF CHANGE
STAGES OF READINESS TO CHANGE
Kate Speck, PhD, LADC
Kate Speck, PhD, LADC
FOUR FOUNDATIONAL PROCESSES
Planning
Evoking
Focusing
Engaging
Prepara
tory Change Talk Mobilizing Change Talk
Contemplation Preparation Action(Pre-)
The M.I. Hill
Yet another metaphor
SAMPLE BEHAVIORAL CONSULTATION
Assess
Assess Importance & Confidence
Arrange Follow-Up or ReferralBuild
Confidence
Explore Importance
10-30 minutes
Advise & Provide Options
MOTIVATIONNow, For Those Frustrating
Situations !
MOTIVATIONAL SKILLS O.A.R.S.
Open -Ended Questions Affirmative Statements Reflective Listening Summarizing
SAMPLE BEHAVIORAL CONSULTATION
Assess
Assess Importance & Confidence
Arrange Follow-Up or ReferralBuild
Confidence
Explore Importance
10-30 minutes
Advise & Provide Options
Simplified Motivational Categories
Importance of Change
Confidence in Ability Low High
Low
Group 1 – Little interest in change; don’t think they could even if they wanted to.
Group 2 – Want to change, but don’t think they are able.
High
Group 3 – Believe they could change, but not interested right now.
Group 4 – Want to change and believe they have the ability.
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?
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.
MOTIVATIONAL SKILLS O.A.R.S.
Reflective Listening• “So you feel . . .” • “It sounds like you . . .” • “You’re wondering if . . .”
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?”
MOTIVATIONIt is Responsible to Change !
When asked “would you rather
work for change, or just complain?”
81% of the respondents
replied, “Do I have to pick? This is
hard!”
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.
QUESTIONS