Motivating ChangeNina Paddock, MPH, RD

Health & Nutrition ManagerCDI Head Start Serving San Gabriel Valley

pasanina@gmail.com

Objectives• Understand the principle of Motivational Interviewing• Learn basic skills and strategies of Motivational Interviewing

• Asking Open Ended Questions• Reflective Listening• Change Talk

• Practice Motivational Interviewing Techniques

A collaborative conversation to

strengthen a person’s own motivation for and commitment to change.

What is Motivational Interviewing (MI)?

How can I use this in Head Start?

Health habits of families

Children’s behavior in

class

Parents bring in required

documentsParents

follow-up on treatment

needed

Parent involvement in

child’s education

Change in

co-workers

or work location

Abusive situations

for families

Changes in policies,

procedures, extra

Family Partnership Agreements

The Spirit of Motivational Interviewing• Interpersonal relationships

• Identify motivations for change

• Power to change is in the client

Collaboration Confrontation

Drawing Out Imposing Ideas

Autonomy Authority

VS

VS

VS

4 Principles to Practice1. Express Empathy

• See the world through the clients eyes• Think, see and feel about things as they do• Share in their experiences

2. Support Self-efficacy• The belief that change is possible• Instill hope• Focus on successes and highlight skills they have

3. Roll with Resistance• De-escalate and avoid negative interactions• Dancing rather than wrestling

4. Develop Discrepancy• Where they are and where they want to be• Difference between current behavior/circumstance and their

identified values and future goals

MI Skills and Strategies

Bring to life the MI spirit

Demonstrate the MI principles

Elicit change talk

Communication Skill - O.A.R.S• O – Open Ended

Questions• A – Affirmations• R – Reflections• S - Summaries

• Open ended questions invite elaboration and deep thinking

• Affirmations recognize strengths• Reflective listening build empathy• Summaries communicate interest

and understanding

Practicing the MI SkillsAsk Permission

• Do you mind if we talk about ____________________?

• Can we talk about ________________?

• I have noticed _____________, do you mind if we talk about this?

Elicit/Evoke Change TalkPracticing the MI Skills

• What would you like to see different about your current situation?• What will happen if you don’t change?• What makes you think you need to change?• How can I help you get past some of the difficulties you are

experiencing?• What would you have to do to make this change happen?• Suppose you don’t change, what is the WORST that might happen?• What is the BEST thing you could imagine that could result from

changing?

Practicing the MI SkillsOpen-ended Questions

• Tell me what you like about your [insert behavior/problem]?

• What makes you think it might be time for change?

• Tell me about when this first began?

• What was that like for you?

• What is different for you this time?

Practicing the MI SkillsReflective Listening

• It sounds like …• What I hear you saying …• So on the one hand it sounds like …. And, yet on the other hand …• It seems as if …• I get the sense that …• It feels as though…• It seems as though you recently became concerned about

[behavior/problem].

Practicing the MI SkillsNormalizing

• A lot of parents are concerned about their [behavior/problem].

• Most people report both good and less good things about their [behavior/problem].

• Many people report feeling like you do. They want to [change behavior/problem], but find it difficult.

Practicing the MI SkillsDeploying Discrepencies (Columbo)

• So help me understand, on the one hand you say that you want your child to be attending Head Start, and yet you fail to bring in the required documents for the program. How are you going to keep her in Head Start?

• Help me to understand, on the one hand I hear you saying that you know that your child’s speech is delayed, yet on the other hand you are telling me that you do not want to have him assessed by the district. I am wondering how you see your child’s speech improving?

Practicing the MI SkillsSupporting Self - Efficacy

• It seems that you have been working hard to ____________. How have you been able to do that?

• How do you feel about the changes that you have made?

Practicing the MI SkillsReadiness to Change Ruler

• On the following scale from 1 to 10, where 1 is definitely not ready to change and 10 is definitely read to change, what number best reflects how ready you are at the present time to change [problem/behavior]?

Practicing the MI SkillsAffirmations

• “Your commitment really shows by [insert reflection about what they are doing].”

• You showed a lot of [what best describes strength, courage, determination] by doing that.

• It is clear that you are really trying to change you [problem/behavior].

• With all the obstacles you have right now, it’s [insert what best describes behavior – impressive, amazing] that you’ve been able to [change].

Practicing the MI SkillsAdvice/ Feedback

• “Do you have a few minutes to talk about…?” [Followed by] “What do you know about…?” [Followed by] “Are you interested in learning more about?”

• “What do you know about the laws around _________?”• “I’ve taken information about _________ from the assessment, and it

is presented on this form along with graphs. Where does your child currently fall?”

• “One of the questions you answered on the screening shows that you scored your child a 7, This is how that scores measures out. How do you feel your child compares to other children in this area?”

What Motivational Interviewing is NOT• Ordering, directing, or commanding• Warning or threatening• Giving advice, making suggestions

or providing solutions• Persuading with logic, arguing or

lecturing• Moralizing, preaching, telling people

what they should do• Disagreeing, judging, criticizing, or

blaming• Agreeing, approving, or praising• Shaming, ridiculing, or labeling• Interpreting or analyzing • Withdrawing, distracting, humoring,

or changing the subject

• Avoid• This person OUGHT to

• This person WANTs to

• Challenging, Discounting, Hostility

• Talking over

• Cutting off

• Inattention, sidetracking, no response

• Blaming, disagreeing, excusing

• Minimizing, or denying

Negotiating a Plan• Set specific goals• Consider Your Options

• Discuss different choices• match individual to a strategy• Recognize that the individual

may not choose the “right” strategy

• Prepare the individual for this possibility

• Establish a Plan• Goals/strategies/tactics• Summarize the Plan with the

patient• Assess if the person is ready to

commit to the plan

Remember, Motivational Interviewing is a conversation.

However, the talking should be done by the client the majority of the time.

While you listen, reflect, summarize and affirm.