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

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?

Understanding Patients’ First Reactions Helps With Change. 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 ambivalence about change.

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.

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

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 Ambivalence CONFUSION  DENIAL   PROCRASTINATION DILEMMA

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

Stages of Change

Stages of readiness to change Kate Speck, PhD, LADC

Four Foundational Processes Planning Evoking Focusing Engaging Kate Speck, PhD, LADC

Yet another metaphor The M.I. Hill Preparatory Change Talk Mobilizing Change Talk Preparation Action (Pre-) Contemplation

Sample Behavioral Consultation Explore Importance Assess Importance & Confidence Arrange Follow-Up or Referral Advise & Provide Options Assess Build Confidence 10-30 minutes

Now, For Those Frustrating Situations ! Motivation Now, For Those Frustrating Situations !

Motivational skills O.A.R.S. Open -Ended Questions Affirmative Statements Reflective Listening Summarizing

Sample Behavioral Consultation Explore Importance Assess Importance & Confidence Arrange Follow-Up or Referral Advise & Provide Options Assess Build Confidence 10-30 minutes

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.

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?”

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!”

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