Engaging Your Patient in Change

1. Engaging Your Patient in Change Care Coordination Summit Alicia M. Ellis, LPC-MHSP April 4, 2014

2. Defining Motivational Interviewing • Motivational Interviewing focuses on exploring and resolving ambivalence and centers on motivational processes within the individual that facilitate change. • “a collaborative, person–centered form of guiding to elicit and strengthen motivation for change (2009) • A collaborative conversation to strengthen a person’s own motivation for and commitment to change. -Miller and Rollnick

3. Style and Spirit • A client centered approach • Motivation is a state or stage, not a character trait • Client’s resistance to change and change talk • Client’s defensiveness or resistance can facilitate the education process • Respect for client’s autonomy and choice • Educator’s style significantly impacts client’s behavior: collaboration, not confrontation

4. Spirit of Motivational Interviewing • Collaborative- a partnership, honors person’s expertise and perspectives • Evocative – resources and motivation presumed to reside within the individual • Empowering – honors individual’s autonomy and self-direction, facilitates informed choice.

5. Underlying Principles • Express empathy- seeing the world through the client’s eyes • Develops discrepancy-”where they are and where they want to be” • Rolls with resistance, avoiding argumentation- work to de-escalate and avoid a negative interaction. • Support self-efficacy-client’s have within themselves the capabilities to change successfully.

6. Three Critical Components of Motivation • Ready – a matter of priorities • Willing – importance of change • Able – confidence to change

7. Why do people change? Client motivation is key to change…….. And client motivation is greatly influenced by the provider.

8. Provider behavior that tend to elicit or increase resistance: • Arguing for change • Assuming the expert role • Criticizing, shaming, blaming • Labeling • Being in a hurry • Paternalism

9. A thought…. “People are not resistant to change; they resist being changed.” – Kevin Eikenberry

10. Micro-skills (OARS) • Open-ended questions – not easily answered with a “yes/no” • Affirmations – statements that recognize client strengths. • Reflective listening – Careful listening and reflective responses • Summaries – recap of what occurred in all or part of the session

11. Asking Ask ample open-ended questions to: • Establish rapport, gather information, increase understanding (assess) • Elicit what is important to person (agenda-setting) • Demonstrate respect • Affirm autonomy and self-direction • Plant seeds (guiding)

12. Asking Practical Suggestions • Ask twice as many open questions as closed questions • Keep questions clear and brief • Avoid negating open questions with closed ones – e.g. How is it going?

13. Asking Practical Suggestions • Ask questions that generate change talk Desire – “What do you want, wish…?”Ability – “What can or could you do?” Reasons – “Why would you make this change?” Need – “How important is this change?” ___________________

14. Asking Commitment – “What will you do next?” Activation – “ What are you prepared to do?” Taking Steps – “What steps can you take?”

15. Asking Practical Suggestions • Ask hypothetical questions for clients who are less ready to change – “What might it take…” “If you were to…” “Suppose you continue as is…” • If you are going to ask, then listen

16. Listening Reflective statements: Show you are actually listening – key to patient-centered care Are used to check rather than assume you know what the patient means Require thinking reflectively Appear deceptively easy to use, but take practice

17. Listening SIMPLE REFLECTIONS Repeating or rephrasing – stay close to what person said COMPLEX REFLECTIONS Paraphrasing– major restatements that infers or guesses the clients’s meaning Reflection of feeling – infers or guesses clients’s feelings; deepest form of listening

18. Listening Forming Reflective Statements A statement, not a question; voice turns down at end • Common word is “you” • Complete the paragraph You… So you… It sounds like you… You’re wondering… That would be…for you

19. Listening General considerations • Listening, even if for just a brief time, has no agenda except to understand • An invitation, opening the door, attending • Asking is not listening • Asking and listening fit naturally together

20. Informing Guidelines for informing • Ask permission – “Would it be all right if I tell you one concern I have about this plan?” • Offer choices when possible – “One option is to…, another is to…which do you prefer?” • Talk about what others do – “Some patients in your situation…” • Acknowledge the decision is the patient’s to make

21. Let’s Practice

22. Questions