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 Tools in 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. Understanding Patients’ First Reactions Helps With Change.
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 own motivation for and commitment to 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? Engagement ~ Retention
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. Ambivalence CONFUSION DENIAL PROCRASTINATION DILEMMA
Barriers to change
Ambivalence
CONFUSION 
DENIAL  
PROCRASTINATION
DILEMMA

13. PACING: Readiness to Change
Combinations of Issues,
Chronic Conditions,
Practices, and Mindfulness.
Not at all Important Extremely Important 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
Planning
Evoking
Focusing
Engaging
Kate Speck, PhD, LADC

17. Yet another metaphor The M.I. Hill
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. Now, For Those Frustrating Situations !
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
Importance of Change
Confidence in Ability
Low
High
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.
Group 3 – Believe they could change, but not interested right now.
Group 4 – Want to change and believe they have the ability.

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. It is Responsible to Change !
Motivation
It 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!”

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