I. Partnering with Families January 23-24, 2016 Aaron J. Miller, MD, MPA Building Regional Alliances to Nurture Child Health branchpartners.org

Learning Objectives Find common ground with professionals from other agencies involved in protecting and caring for children. Use the baseline survey as a tool to make the curriculum locally relevant. Incorporate fundamentals of motivational interviewing into practice with families.

Patient Education: Why does it fail so often? Lack of understanding of short-term and long-term consequences. Lack of trust. Lack of motivation - families have more important things to worry about.

Helping families make positive changes: Patient Education Paradigm CostsBenefits Current Situation/BehaviorNew Situation/Behavior Adapted from handouts created by Ken Kraybill, MSW, and Motivational Interviewing by Miller & Rollick, 2002

14 23 Current Situation/BehaviorNew Situation/Behavior Benefits Costs Adapted from handouts created by Ken Kraybill, MSW, and Motivational Interviewing by Miller & Rollick, 2002 Helping families make positive changes: Motivational Interviewing Paradigm

Processes and Methods EngagingFocusingEvokingPlanning Open-ended questions Affirmation Reflective listening Summarizing Providing information and advice with permission Motivational Interviewing, Third Edition Key Processes Methods

Engagement Establishment of a trusting and mutually respectful working relationship. Agreement on goals. Collaboration on mutually negotiated tasks to reach these goals. Uses many open-ended questions.

Affirmation To affirm is to recognize and acknowledge that which is good, including the individual’s inherent worth as a fellow human being. Examples: “Look at this! You did a really good job of keeping records this week.” “Thanks for coming in today, and even arriving early!” “You learned all that information really quickly.” OARS

Guidelines for Reflecting Listen for the basic message - consider the content, feeling and meaning expressed by the speaker. Restate what you have been told in simple terms. When restating, look for non-verbal as well as verbal cues that confirm or deny the accuracy of your paraphrasing. (Note that some speakers may pretend you have got it right because they feel unable to assert themselves and disagree with you.) Do not question the speaker unnecessarily. Do not add to the speaker's meaning. Do not take the speaker's topic in a new direction. Always be non-directive and non-judgmental. OARS

Guidelines for reflecting Responding to what is personal rather than to what is impersonal, distant, or abstract. Restating and clarifying what the other has said, not asking questions or telling what the listener feels, believes, or wants. Trying to understand the feelings contained in what the other is saying, not just the facts or ideas. Working to develop the best possible sense of the other's frame of reference while avoiding the temptation to respond from the listener's frame of reference. OARS

Guidelines for reflecting Responding with acceptance and empathy, not with indifference, cold objectivity, or fake concern. Responding to what is personal means responding to things the other person says about him- or herself rather than about other people, events, or situations. If a co-worker said, "I'm worried that I'll lose my job" the reflective listener would try to focus on the worried "I" rather than on the job situation. A response such as "It’s scary" would be better than "Maybe the cutbacks won't affect you.” Don’t ask “Why?” – is too open-ended and might imply you’re looking for justification. Instead say “That’s interesting. Tell me more about it.” OARS

From focusing toward evoking 1) Benefits of Current Situation/Behavior “What is good about your current situation?” “What do you like about that behavior?” 2)Costs of Current Situation/Behavior “What is bad about your current situation?” “What don’t you like about that behavior?” Adapted from handouts created by Ken Kraybill, MSW, and Motivational Interviewing by Miller & Rollick, 2002 Enga ging Focu sing Evok ing Plan ning

As they begin to identify consequences they don’t like, ask about alternatives. If needed, help provide options People may not be aware of options People may believe other options are not “okay” People may believe other options are not realistic Ways to identify options: Provide psycho-education: Teach basic tools and give basic information Identify all possible alternatives (no matter how unrealistic or simple) Identify available services to access information on options Identify support: Family, friends, teacher, community member Provide examples of what others do

Summarizing Summarizing helps reinforce all the progress the client has made, and it demonstrates to them that you are listening and are invested. In the first session, agree on next steps that are small that they can achieve. OARS

Final Key Points Guide the conversation, but let the individual lead it. Prioritize. Don’t try to tackle it all at once. Listen & Ask. Do not tell them what they should or should not do, but help them weigh the options. Silence is a good thing – Let them sit and think. Remind them they are not alone. It often takes more than one conversation.