1. Brief Overview of Motivational Interviewing August 17, 2012 SBIRT Training Peg Dublin, RN, MPH ACCESS Community Health Network Member of Motivational Interviewing Network of Trainers

2. TWO TRIALS

3. Motivational Interviewing MI is a collaborative, person- centered form of guiding to elicit and strengthen motivation for change by allowing them to articulate reasons for and against change… Adapted from: William Miller & Stephen Rollnick, 2002, Motivational Interviewing.

4. OARS Change Talk MI spirit MI principles OARS MI Principles MI Spirit Change Talk MI

5. Spirit of MI Positive or Success Priority—belief that humans develop in the direction of what is best for them (health and adaptive behavior) if given support. Empathic—able to put oneself in their shoes, listening so well to be able to enter their world Safe Environment—creates trust & rapport Collaborative/Egalitarian—treats client as an equal and as their ally.

6. Spirit... Non-Judgmental—accept person as they are, does not give opinion Honors Autonomy—makes clear that control and choice is clearly theirs regarding change Builds on Theoretical Underpinnings— self- perception, self-determination and self-efficacy

7. Dancing instead of Wrestling

8. Underlying Concepts of MI People are ambivalent about change Providers who push for change elicits “resistance” from the client/student. Resistance predicts lack of change Evoking the client’s own change talk will enhance behavior change

9. Is MI Evidence-Based? Literature search found 230 randomized controlled trials Studies addressed wide range of behavioral problems and diseases, such as obesity, alcohol use, smoking, HIV risk behavior, pain management Meta-analysis showed significant effect for MI Using MI in brief encounters of 15 min., 64% of studies showed effect Rubak, Sandboek et al., 2005

10. Evidence … Other Studies:  Martins and McNeil (2009) reviewed 39 studies, 24 focused on diet and exercise, 9 on diabetes, 4 on oral health: MI effective in bringing about change in all areas  Floyd (2007) studied MI with non-pregnant women to reduce risk of fetal alcohol exposure through use of contraception and reduced alcohol consumption: women in intervention twice as likely to have reduced risk

11. Theoretical Underpinnings Bem’s Self-Perception Theory (psychologist Daryl Bem) Self-Determination Theory Bandura’s Self-Efficacy Theory (Albert Bandura, 1986)

12. How to Start? Got the Spirit? Behavioral Focus Establish Rapport

13. Establishing Rapport Body language Collaborative language Time (be patient, let brain work) When in doubt – Ask permission!

14. FIVE BASIC PRINCIPLES OF MI Express Empathy – “Fence-sitting is pretty normal!” Develop Discrepancy – “Who do you want to be?” Avoid Argumentation/Roll with Resistance – “Go with the flow” Support Self-Efficacy – Honor their ability Tread Tactfully – Ask permission & apologize if wrong.

15. Emphasizing Personal Choice & Control  Perceived threats to one’s freedom can lead to natural resistance.  Assure person of truth – that they are ultimately in charge of whatever they decide to do - or not to do.

16. Skill #1: OARS O= open-ended questions A= affirmations R=reflections S=summaries

17. Open-Ended Questions  “Tell me how what a typical day looks like for you with regards to drinking alcohol.”  “What are your goals regarding your health.”

18. Affirmations Acknowledge effort, values, skills, strengths… Examples  “You really care about your future.”  “Look at how well you’ve cut back on drinking.”

19. Reflections Simple Reflection  Paraphrase, short  Examples  “You’re frustrated.” Complex Reflection  Picking out the change talk or unstated emotion

20. Simple & Complex : Client: I barely drink at all anymore. I find it helps settle my nerves. I don’t think it’s really a problem. Simple Reflection: You’re not concerned about your drinking at this time because you only drink to settle your nerves.. Complex Reflection: On the one hand you don’t think there is a problem with your drinking, and on the other hand you do care if there is an effect on your health.

21. Summaries Metaphoric bouquet of flowers Review of what’s been said Targeting “change talk” Transition to next steps

22. Practice Reflections in Pairs Person 1: Talks for 1 minute about the first time they did something challenging, fun or memorable. Person 2: Using reflections, respond to either what has been said or how they must have felt…emotionally at the time.

23. MI in a Nutshell Talk less than the client Offer 2-3 times more reflections than questions Ask 2 times more open than closed questions Listen empathically through complex reflections

24. Skill #2: Eliciting Change Talk DARN-CAT Desire Ability Reasons Need Commitment Activation Taking Steps

25. Skill #3: EPE for Giving Information Elicit-Provide-Elicit Ask what they know (Elicit) Ask or get permission to Provide Information/Options (Provide) If advice, offer several options rather than one (for some people…) Ask what they think now (Elicit)

26. HTTP://WWW.YOUTUBE.COM/WATCH?V=0Z6 5EPPMFHK&FEATURE=EM- SHARE_VIDEO_USER DVD demonstration

27. The MI Path to Change MIMI Change Talk (Desire, Ability, Reasons, Need) Commitment Change

28. Eight Stages of Learning MI 1.Overall Spirit of MI 2.OARS 3.Recognizing Change Talk and Resistance 4.Eliciting and Strengthening Change Talk 5.Rolling with Resistance 6.Developing a Change Plan 7.Consolidating Commitment 8.Transition and Blending

29. Next Steps Sign up training opportunities as they come available Building Motivational Interviewing Skills: a Practitioners Workbook by David Rosengren (2009). Motivational Interviewing: Preparing People for Change (2 nd Ed.) by William Miller & Stephen Rollnick (2001) www.motivationalinterview.org www.casaa.unm.edu (Center on Alcoholism, Substance Abuse, and Addictions) www.casaa.unm.edu

31. Contact Information Peg Dublin Peg.dublin@accesscommunityhealth.net 312-526-2216