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 Important5 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

Preparatory Change T

alk Mobilizing Change Talk

Contemplation Preparation Action(Pre-)

The M.I. HillYet 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 ChangeConfidence 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