Motivational Interviewing: Motivating Youth to Change Behavior Training of Trainers September 21 - 23, 2008 Margaret

DownloadMotivational Interviewing: Motivating Youth to Change Behavior Training o...

Advertisement
Download Presentation
Comments
libitha
From:
|  
(3927) |   (1) |   (0)
Views: 158 | Added: 08-05-2012
Rate Presentation: 0 0
Description:
2. Workshop Objectives. Participants will be able to name the core elements of motivational interviewingParticipants will be able to name at least two techniques used in motivational interviewing.Participants will be able to demonstrate the steps in conducting a motivational interview session..
Motivational Interviewing: Motivating Youth to Change Behav...

An Image/Link below is provided (as is) to

Download Policy: Content on the Website is provided to you AS IS for your information and personal use only and may not be sold or licensed nor shared on other sites. SlideServe reserves the right to change this policy at anytime. While downloading, If for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.











- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -




1. 1 Motivational Interviewing: Motivating Youth to Change Behavior Training of Trainers September 21 - 23, 2008 Margaret Bavis, DNP, FNP-BC Sue Murray, RN, MPH In collaboration with Sharon Stephan, PhD Center for School Mental Health Handouts for this presentation include: PowerPoint presentation Brief negotiation interview template sheetHandouts for this presentation include: PowerPoint presentation Brief negotiation interview template sheet

2. 2 Workshop Objectives Participants will be able to name the core elements of motivational interviewing Participants will be able to name at least two techniques used in motivational interviewing. Participants will be able to demonstrate the steps in conducting a motivational interview session.

3. 3 What does Motivational Interviewing look like? Video clip Video clip from BNI/ARTVideo clip from BNI/ART

4. 4 Stephen Rollnick, a developer of Motivational Interviewing, stated that the technique ?was developed from the rather simple notion that the way clients are spoken to about changing addictive behavior affects their willingness to talk freely about why and how they might change?. Motivational interviewing was originally developed for use in the addictions field, and has now been applied to several areas for behavior change. Do you know of any other areas which motivational interviewing has been applied to? Stephen Rollnick, a developer of Motivational Interviewing, stated that the technique ?was developed from the rather simple notion that the way clients are spoken to about changing addictive behavior affects their willingness to talk freely about why and how they might change?. Motivational interviewing was originally developed for use in the addictions field, and has now been applied to several areas for behavior change. Do you know of any other areas which motivational interviewing has been applied to?

5. 5 Introspective Exercise #1* What expectations do health trainees, who come into contact with clients for the first time, have about promoting behavior change among patients/clients? *Adapted from Presentation by Edward Pecukonis, PhD University of Maryland School of Social Work Ask the audience the question. Examples of responses: Rapid change, Agreeability, Ease of change, Advice leads to change, Knowledge leads to change, etcAsk the audience the question. Examples of responses: Rapid change, Agreeability, Ease of change, Advice leads to change, Knowledge leads to change, etc

6. 6 How Does Behavior Change? Behavior A Behavior B Let?s talk about what we actually do know about what leads a person to change their behavior? Ask group: How does behavior change? (Examples of responses: Time, knowledge, motivation, support, etc.)Let?s talk about what we actually do know about what leads a person to change their behavior? Ask group: How does behavior change? (Examples of responses: Time, knowledge, motivation, support, etc.)

7. 7 Introspective Exercise #1 (continued) What feelings do you experience when working with patients/clients to promote behavior change? Ask group question. Examples of responses: Frustration, Burn out, Anger, Hope/Hopelessness, etcAsk group question. Examples of responses: Frustration, Burn out, Anger, Hope/Hopelessness, etc

8. 8 Introspective Exercise #1 (continued) Think of a behavior you?ve tried to change Ask the audience to think (silently) about a behavior they have tried to change ? anything from biting nails, to quitting smoking, to eating less french fries!Ask the audience to think (silently) about a behavior they have tried to change ? anything from biting nails, to quitting smoking, to eating less french fries!

9. 9 Introspective Exercise #1 (continued) How much time elapsed between: the first time you engaged in the behavior, and the first time you recognized risk or negative consequences?

10. 10 Read these responses aloud, and Ask the audience to raise their hands for the time period that applies to them.Read these responses aloud, and Ask the audience to raise their hands for the time period that applies to them.

11. 11

12. 12 Read these responses aloud, and Ask the audience to raise their hands for the time period that applies to them.Read these responses aloud, and Ask the audience to raise their hands for the time period that applies to them.

13. 13

14. 14 Introspective Exercise #1 (continued) What conclusions would you draw from the group?s responses?

15. 15 Possible Conclusions Behavioral issues are common Change often takes a long time The pace of change is variable Knowledge is usually not sufficient to motivate change Relapse is the rule

16. 16 Possible Conclusions (continued) Our expectations of patients/clients regarding behavior change are unrealistic Unrealistic expectations can lead to frustration and burn-out

17. 17 Benefits of Learning About the Transtheoretical Model & Motivational Interviewing More realistic expectations Greater recognition of small accomplishments Greater success over time Less frustration and burn-out As health providers, the benefits of learning about the Transtheoretical Model and Motivational Interviewing include: Gaining more realistic expectations about client behavior change; developing greater recognition and appreciation of the small accomplishments made by clients; Having greater success at assisting clients with behavior change; and, having less frustration and burn out while trying to assist clients with behavior change. Sound good?As health providers, the benefits of learning about the Transtheoretical Model and Motivational Interviewing include: Gaining more realistic expectations about client behavior change; developing greater recognition and appreciation of the small accomplishments made by clients; Having greater success at assisting clients with behavior change; and, having less frustration and burn out while trying to assist clients with behavior change. Sound good?

18. 18 Transtheoretical Model (Prochaska & DiClemente) Individuals progress through stages of change Movement may be forward or backward Movement may be cyclical The Transtheoretical Model, developed by Prochaska and DiClemente, starts with the notion that individuals progress through stages of change, that their movement may be forward or backward, and that the movement may be cyclical. Let?s illustrate?The Transtheoretical Model, developed by Prochaska and DiClemente, starts with the notion that individuals progress through stages of change, that their movement may be forward or backward, and that the movement may be cyclical. Let?s illustrate?

19. 19 The Transtheoretical Model identifies stages that people progress through as they make a behavioral change. The stages are as follows: Pre-contemplation: The person has no intention to change. Contemplation: The person is ambivalent about change and sees both pros and cons to the behavior. Determination/Preparation/Decision-making: This is typically a brief stage as the person resolves ambivalence and decides to make a change. Action: The person takes some action toward resolution of the problem behavior. Maintenance: The client maintains successful behavior change, typically for at least 6 months, but is still at risk for relapse. Relapse: This is the resumption of the original behavior. Relapse is a normal, expected part of behavior change. Exit/Termination: In this stage, relapse is highly unlikely and the client?s new lifestyle is stable.The Transtheoretical Model identifies stages that people progress through as they make a behavioral change. The stages are as follows: Pre-contemplation: The person has no intention to change. Contemplation: The person is ambivalent about change and sees both pros and cons to the behavior. Determination/Preparation/Decision-making: This is typically a brief stage as the person resolves ambivalence and decides to make a change. Action: The person takes some action toward resolution of the problem behavior. Maintenance: The client maintains successful behavior change, typically for at least 6 months, but is still at risk for relapse. Relapse: This is the resumption of the original behavior. Relapse is a normal, expected part of behavior change. Exit/Termination: In this stage, relapse is highly unlikely and the client?s new lifestyle is stable.

20. 20 Motivational Interviewing can be used at all Stages of Change: DURING: MI can: Precontemplation ? raise awareness Contemplation ? help decision making Action and Maintenance - enhance and remind of resolution to change Relapse - enables reassessment Motivational Interviewing is designed to move someone forward in their readiness to change behavior, and can be used in all stages of change (refer to slide)Motivational Interviewing is designed to move someone forward in their readiness to change behavior, and can be used in all stages of change (refer to slide)

21. 21 Spirit of Motivational Interviewing A ?way of being? with a client The spirit of MI is characterized by: a warm, genuine, respectful and egalitarian stance supportive of client self-determination and autonomy Before we review specific techniques, let?s discuss the SPIRIT of Motivational Interviewing. Motivational Interviewing, like client -centered counseling has been described as a ?way of being? with a client. The ?spirit? in which it is delivered is as important as the techniques that are used. The spirit of MI is characterized by a warm, genuine, respectful and egalitarian stance that is supportive of client self-determination and autonomy.Before we review specific techniques, let?s discuss the SPIRIT of Motivational Interviewing. Motivational Interviewing, like client -centered counseling has been described as a ?way of being? with a client. The ?spirit? in which it is delivered is as important as the techniques that are used. The spirit of MI is characterized by a warm, genuine, respectful and egalitarian stance that is supportive of client self-determination and autonomy.

22. 22 Principles of Motivational Interviewing Express Empathy Roll with Resistance Develop Discrepancy Support Self-efficacy Avoid Argumentation There are some general principles of motivational interviewing to consider. Express Empathy: Accurate empathy conveys understanding of the client through the skill of reflective listening. It clarifies and mirrors back the meaning of client communication without distorting the message. Roll with Resistance: In Motivational Interviewing ?Resistance? is defined as a misalliance in the counselor-client relationship and not an inherent ?symptom? of addiction. Client ambivalence is accepted as a natural part of the change process. Client ?resistance? is decreased through the use of non-confrontational methods. MI advocates ?rolling with? and accepting client statements of resistance rather than confronting them directly. Develop Discrepancy: Arguments clients themselves make for change are more effective than arguments offered by others. It is the counselor?s role to elicit these arguments by exploring client values and goals. Discrepancies identified between the client goals, values and current behavior are reflected and explored. The counselor focuses on the pros and cons of the problem behavior and differentially responds to emphasize discrepancies identified by the client. Support Self-efficacy: Key to behavior change is the expectation that one can succeed. Motivational Interviewing seeks to increase client perception about their skills, resources and abilities that they may access to achieve their desired goal. Avoid Argumentation: It is easy to fall into an argument trap when a client makes a statement that the counselor believes to be inaccurate or wrong. MI takes a supportive and strength-based approach. Client opinions, thoughts and beliefs are explored, reflected and clarified, but not directly contradicted. There are some general principles of motivational interviewing to consider. Express Empathy: Accurate empathy conveys understanding of the client through the skill of reflective listening. It clarifies and mirrors back the meaning of client communication without distorting the message. Roll with Resistance: In Motivational Interviewing ?Resistance? is defined as a misalliance in the counselor-client relationship and not an inherent ?symptom? of addiction. Client ambivalence is accepted as a natural part of the change process. Client ?resistance? is decreased through the use of non-confrontational methods. MI advocates ?rolling with? and accepting client statements of resistance rather than confronting them directly. Develop Discrepancy: Arguments clients themselves make for change are more effective than arguments offered by others. It is the counselor?s role to elicit these arguments by exploring client values and goals. Discrepancies identified between the client goals, values and current behavior are reflected and explored. The counselor focuses on the pros and cons of the problem behavior and differentially responds to emphasize discrepancies identified by the client. Support Self-efficacy: Key to behavior change is the expectation that one can succeed. Motivational Interviewing seeks to increase client perception about their skills, resources and abilities that they may access to achieve their desired goal. Avoid Argumentation: It is easy to fall into an argument trap when a client makes a statement that the counselor believes to be inaccurate or wrong. MI takes a supportive and strength-based approach. Client opinions, thoughts and beliefs are explored, reflected and clarified, but not directly contradicted.

23. 23 For which behaviors can we use motivational interviewing? Any high risk behavior! MI has been shown to be effective for: Substance use Tobacco use Sexual activity Diet and physical activity (e.g. diabetes, obesity) Truancy Chronic disease (e.g. asthma)

24. 24 Motivational Interviewing with Adolescents Teens: Hardwired for Risky Behaviors? Emotion/Social Interaction ? active in puberty Behavior regulation - still maturing into early adulthood. Just because we are giving teens the facts, that doesn?t mean we are changing their behavior! What about Motivational Interviewing with Adolescents? Why not just educate them about risk behaviors? Most teens know about the dangers of risk taking behaviors?but seemingly are hardwired to ignore what they?ve learned. Emerging research on adolescent brain development supports this analysis. The section of the brain most involved in emotion and social interaction becomes very active during puberty; however the section most critical for regulating behavior is still maturing into early adulthood. The key parts of the brain involved in controlling impulses and risky behavior don?t really reach maturity until about age 25?the software hasn?t been installed yet. I?m not suggesting we should stop educating teens about the dangers of drugs, tobacco, in our case, proper diabetes control. Just because we are giving kids the facts, that doesn?t mean we are changing their behavior.What about Motivational Interviewing with Adolescents? Why not just educate them about risk behaviors? Most teens know about the dangers of risk taking behaviors?but seemingly are hardwired to ignore what they?ve learned. Emerging research on adolescent brain development supports this analysis. The section of the brain most involved in emotion and social interaction becomes very active during puberty; however the section most critical for regulating behavior is still maturing into early adulthood. The key parts of the brain involved in controlling impulses and risky behavior don?t really reach maturity until about age 25?the software hasn?t been installed yet. I?m not suggesting we should stop educating teens about the dangers of drugs, tobacco, in our case, proper diabetes control. Just because we are giving kids the facts, that doesn?t mean we are changing their behavior.

25. 25 Motivational Interviewing Techniques Now let?s talk about some of the actual techniques that you will use in Motivational Interviewing. First, we?ll go through the techniques, then we?ll do a step-by-step example of how to use this counseling style in a brief office intervention.Now let?s talk about some of the actual techniques that you will use in Motivational Interviewing. First, we?ll go through the techniques, then we?ll do a step-by-step example of how to use this counseling style in a brief office intervention.

26. 26 Assessing Stage of Change What question(s) would best assess stage of change? First, we want to assess the student?s stage of change. What question(s) would best assess the stage of change?First, we want to assess the student?s stage of change. What question(s) would best assess the stage of change?

27. 27 Assessing Stage of Change (continued) Sample initial questions: How do you feel about your [behavior]? What do you think about your [behavior]? How does [behavior] fit into your life? When assessing a student?s stage of change, you want to ask questions that are non-leading, non-judgmental, and respectful. For example?When assessing a student?s stage of change, you want to ask questions that are non-leading, non-judgmental, and respectful. For example?

28. 28 If you are unclear after listening to the student?s response, you may need to follow up?If you are unclear after listening to the student?s response, you may need to follow up?

29. 29 3 Stages of Techniques* Opening Strategies Responding to ?Sustain Talk? Eliciting ?Change Talk? Once you?ve assessed the student?s stage of change, you will use different strategies to engage the student, respond to ?Sustain Talk? and elicit ?Change Talk?.Once you?ve assessed the student?s stage of change, you will use different strategies to engage the student, respond to ?Sustain Talk? and elicit ?Change Talk?.

30. 30 Opening Strategies (OARS) Open-ended Questions Affirmations Reflections Summaries

31. 31 Opening Strategies (OARS) Open-ended Questions Close-ended question (one that can be answered yes/no/maybe): ?Have you had anything to drink today??; ?Would you like to quit smoking?? Open-ended question: ?What is a typical drinking day like for you??; ?How do you feel about your smoking?? Open-ended questions are questions that you cannot comfortably answer with a yes/no/maybe answer. Open-ended questions are questions that you cannot comfortably answer with a yes/no/maybe answer.

32. 32 Opening Strategies (OARS continued) Affirmations An example of an affirmation is, ?I really like the way you are approaching this problem, I can see that you are very organized and logical and I am sure this will help you to succeed in our program.? An affirmation can be used to reframe what may at first seem like a negative. ?I can see that you are very angry about being here, but I?d like to tell you that I am impressed that you chose to come here anyway, and right on time!? An affirmation identifies something positive about the client and gives credit or acknowledgement. It may be a trait, behavior, feeling or past or present accomplishment. An affirmation must always be genuine and never condescending. An affirmation identifies something positive about the client and gives credit or acknowledgement. It may be a trait, behavior, feeling or past or present accomplishment. An affirmation must always be genuine and never condescending.

33. 33 Opening Strategies (OARS continued) Reflections Statements made to the client reflecting or mirroring back to them the content, process or emotion in their communication. Reflective listening says: ?I hear you.? ?I?m accepting, not judging you.? ?This is important.? ?Please tell me more.? Student: ?My girlfriend gets really angry when I get stoned and pass out.? Provider: ?She gets mad when you do that.? A reflection is always a statement and as such the inflection at the end of a reflection goes down. You can turn a statement into a question by ending it with a inflection upward. Try it with this statement. ?You are trying to stop using drugs.? Hear the difference? With the inflection up the statement becomes a question. When using MI the counselor wants the majority of their communication to be in the form of reflections and not questions. A reflection is always a statement and as such the inflection at the end of a reflection goes down. You can turn a statement into a question by ending it with a inflection upward. Try it with this statement. ?You are trying to stop using drugs.? Hear the difference? With the inflection up the statement becomes a question. When using MI the counselor wants the majority of their communication to be in the form of reflections and not questions.

34. 34 Opening Strategies (OARS continued) Summaries Summaries are simply long reflections. They can be used to make a transition in a session, to end a session, to bring together content in a single theme, or just to review what the client has said. An example is: ?Let?s take a look at what we have talked about so far. You are not at all sure that you have a ?problem? with alcohol but you do feel badly about your DWI and it?s effect on your family. You said that your family is the most important thing to you and you would consider totally quitting drinking if you believed it was hurting them.?

35. 35 ?Sustain-talk? Clients may not want to make behavior changes, and many argue strongly against making these changes. They may: Argue Deny a problem Accuse Interrupt Disagree Passively resist though minimal answers Overtly comply due to mandate with little investment Become angry Client ?resistance? is seen as a normal part of the change process. Clients are assumed to be ambivalent about change and statements can be seen as arguing either for change or for the status quo. Clients arguing for the status quo have been historically identified as ?unmotivated? or ?resistant? to change. MI currently uses the term ?sustain-talk? to describe client communication that indicates a desire, plan or commitment to staying the same.Client ?resistance? is seen as a normal part of the change process. Clients are assumed to be ambivalent about change and statements can be seen as arguing either for change or for the status quo. Clients arguing for the status quo have been historically identified as ?unmotivated? or ?resistant? to change. MI currently uses the term ?sustain-talk? to describe client communication that indicates a desire, plan or commitment to staying the same.

36. 36 Examples of Client Sustain Talk Statements ?I don?t have a problem, it is all a mistake.? ?I don?t drink anymore alcohol than my friends do.? ?This is your job. You don?t really care if I change or not.?

37. 37 Responding to ?Sustain-talk? It was shown in a recent University of New Mexico study that the more, and the earlier a client argued for change in the treatment process, the better the treatment outcome.* Specific techniques have been shown to decrease ?resistance? or ?sustain-talk.? *Amrheim, P., Miller, W.R. (2003)

38. 38 Techniques for Responding to ?Sustain-talk? Reflective Techniques: Simple Reflection Complex Reflection

39. 39 Simple Reflection A simple reflection, mirrors or reflects back to the client the content, feeling or meaning of his/her communication. An example of a simple reflection to respond to ?sustain-talk? is: Client: ?I know I made a mistake but the hoops they are making me jump through are getting ridiculous.? Counselor: ?You are pretty upset about all this. It seems like everyone is overreacting to a mistake.?

40. 40 Complex Reflection Complex reflections typically add substantial meaning and emphasis. They can provide two sides of points of view, be metaphors, or verbalize unspoken emotion. For example: Client: ?I know that I made a mistake, but the hoops they are making me jump through are ridiculous.? Counselor: ?You made a mistake and it sounds like you feel badly about that, but you also think that people are asking you to do too much.?

41. 41 Strategic Techniques for Responding to ?Sustain-talk? Sometimes clients are entrenched or ?stuck? in ?sustain-talk?. In this case, there is another set of techniques referred to as strategic techniques. The strategic techniques include: Shifting Focus Coming Along Side Emphasizing Personal Choice and Control Reframe Agreement with a Twist

42. 42 Shifting Focus Shifting focus attempts to get around a ?stuck? point by simply side-stepping. An example, using the same client statement is: Client: ?I know I made a mistake, but the hoops they are making me jump through are getting ridiculous.? Counselor: ?You are upset by all of these hoops. Can you tell me more about the mistake you think you made??

43. 43 Coming Along Side This technique is used to align with the client. This is used when the client has not responded with a decrease in ?sustain-talk? with previous techniques. An example of coming along side is: Client: ?I know I made a mistake, but the hoops that they are making me jump through are getting ridiculous.? Counselor: ?You may be at your limit and might not be able to keep up with all this.?

44. 44 Emphasize Personal Choice and Control Clients ultimately always choose a course of action and this technique simply acknowledges this fact. Acknowledging this can sometimes help a client recognize that they are making a choice. An example is: Client: ?I know I made a mistake, but the hoops that they are making me jump through are getting ridiculous.? Counselor: ?You don?t like what others are asking you to do, but so far you are choosing to follow-through with what they are asking. It takes a lot of strength to do that. Tell me what motivates you.?

45. 45 Reframe This technique takes a client communication and gives it a different twist. It may be used to take negative client statement and give it a positive spin. An example: Client: ?I know that I made a mistake, but the hoops they are making me jump through are getting ridiculous.? Counselor: ?You are not happy about others having so much control, but so far you have been able to keep up with all their expectations and have been quite successful!?

46. 46 Agreement with a twist This is a complex technique that combines a reflection with a reframe. This gives the client confirmation that they were ?heard? and then offers another perspective on their communication. It is similar to a reframe and an example is: Client: ?I know that I made a mistake, but the hoops that they are making me jump through are getting ridiculous.? Counselor: ?You are feeling frustrated with all these expectations. You are also anxious to be successful with some things so you can keep moving forward.?

47. 47 ?Change-talk? Opposite of Sustain-talk Change talk is client speech that favors movement in the direction of change. The opposite of ?sustain-talk? is ?change-talk?. The more a client makes arguments for change the stronger the commitment. Another goal of Motivational Interviewing is to encourage as much change talk as is possible and to explore and expand on it. The opposite of ?sustain-talk? is ?change-talk?. The more a client makes arguments for change the stronger the commitment. Another goal of Motivational Interviewing is to encourage as much change talk as is possible and to explore and expand on it.

48. 48 Examples of ?Change-Talk? ?I really want to be a good daughter and I know I should make some changes.? ?I quit smoking when I decided I was ready and I think I can do this too.? ?I know I would be more motivated and do better in school if I cut down on my use.? it. it.

49. 49 Techniques for eliciting ?Change-Talk? Exploring problem Looking backward Looking forward Considering importance Exploring values and discrepancy with behavior Considering pros and cons (decisional balance) Importance/Confidence Ruler Exploring Extremes Planning and Committing

50. 50 Exploring Problem Simply asking open-ended questions, reflecting and providing opportunity to explore the problem from the clients perspective. For example: ?Tell me a little more about?? ?What do you think about ??? ?Who influenced you???

51. 51 Looking Forward/ Looking Backward Ask the client to look at what life was like prior to the current problem and explore it, in order to identify potential motivators. Also, look forward to goals and plans and explore how the current problem behavior ?fits? with these goals. For example: ?What was life like for you before this became a problem?? ?Tell me how you see your life two or three years from now? How might this current problem effect these goals or plans?? ?What kinds of things did you used to do with your time? What things do you miss??

52. 52 Considering Importance Identify reasons that a change is important to the client. For example: ?You seem pretty committed to making a change. What motivates you?? ?I can see that you have been through a lot. Tell me in what ways making a change may help.?

53. 53 Exploring Values and Discrepancy with current behavior A conflict with values is often the strongest motivator for change. Examples include: ?What is most important to you?? ?How does your drinking effect the things in your life that you value?? ?When you look at your life, what are you most proud of, least proud of?? This sometimes accounts for our misunderstanding of clients who are not changing despite many consequences to their behavior. A student who has suffered a lot of hardship financially without making a change may be strongly motivated to make change when he sees a negative consequence for his family. In this case the client may have more highly valued family than financial security.This sometimes accounts for our misunderstanding of clients who are not changing despite many consequences to their behavior. A student who has suffered a lot of hardship financially without making a change may be strongly motivated to make change when he sees a negative consequence for his family. In this case the client may have more highly valued family than financial security.

54. 54 Considering Pros and Cons Decisional Balance Help the client to weigh the costs versus the benefits of the behavior in order to identify the ambivalence and move in the direction of positive change. Examples include: ?What are the good things about smoking pot and what are the not-so-good things?? When you look at this list of pros and cons, what do you think??

55. 55 Importance/Confidence Ruler Students are asked to choose a number between one and ten to describe the level of importance they perceive about changing their behavior. They are also asked to place themselves on the scale in terms of the confidence they perceive in their ability to make that change. Examples of scaling questions include: ?On a scale of 1-10 with 10 being the most important and 1 being the least, how important is it for you to make this change?? If the client chooses a 4, a follow-up question may be- ?You chose a 4, tell me why you chose a 4 and not a 3 or a 2?? Asking the question in this way encourages ?change? rather than ?sustain? talk. ?On that same scale, how confident are you that you could make a change in this behavior if you decided to??

56. 56 Exploring Extremes The counselor asks the client to consider what is the ?worst thing? that could or may happen if he/she continues with current behavior pattern. Counselor can also ask what is the best thing or things that could happen as a result of a behavior change.

57. 57 Planning and Committing This includes talking with a client about how to make a change. Examples of questions include: ?If you were to decide to make a change, what steps might you take?? ?We have talked a lot about the reasons you think a change is important, Tell me how you will know that you are ready.?

58. 58 Change-Plan When the client has increased ?change-talk? and there is little ?sustain? talk this is a signal to the therapist that the client is ready to make a decision. At this point, the therapist should shift to negotiating a change plan or strategy. This can be a formal exercise such as the change plan on the next slide or it can be a more informal conversation about the client?s options, desires, ideas about what might work.

59. 59 Change Plan Worksheet The changes I want to make are: The most important reasons I want to change are: The steps I plan to take in making this change are: The ways other people can help me change are: Person Possible ways to help Some things that could interfere with my plan are: I will know if my plan is working if: ______________________________ Client Signature ______________________________ Counselor Signature (From the MET manual NIAAA clearinghouse Publication # 94-3723)

60. 60 Motivational Interviewing Quiz!! What are the general principles of MI?: Express __________ Develop __________ Roll with __________ Support __________ Avoid ____________ What are some techniques used in MI? Have participants respond to each item. Give prize/candy for correct responses. Express Empathy: Accurate empathy conveys understanding of the client through the skill of reflective listening. It clarifies and mirrors back the meaning of client communication without distorting the message. Roll with Resistance: In Motivational Interviewing ?Resistance? is defined as a misalliance in the counselor-client relationship and not an inherent ?symptom? of addiction. Client ambivalence is accepted as a natural part of the change process. Client ?resistance? is decreased through the use of non-confrontational methods. MI advocates ?rolling with? and accepting client statements of resistance rather than confronting them directly. Develop Discrepancy: Arguments clients themselves make for change are more effective than arguments offered by others. It is the counselor?s role to elicit these arguments by exploring client values and goals. Discrepancies identified between the client goals, values and current behavior are reflected and explored. The counselor focuses on the pros and cons of the problem behavior and differentially responds to emphasize discrepancies identified by the client. Support Self-efficacy: Key to behavior change is the expectation that one can succeed. Motivational Interviewing seeks to increase client perception about their skills, resources and abilities that they may access to achieve their desired goal. Avoid Argumentation: It is easy to fall into an argument trap when a client makes a statement that the counselor believes to be inaccurate or wrong. MI takes a supportive and strength-based approach. Client opinions, thoughts and beliefs are explored, reflected and clarified, but not directly contradicted. Techniques:Have participants respond to each item. Give prize/candy for correct responses. Express Empathy: Accurate empathy conveys understanding of the client through the skill of reflective listening. It clarifies and mirrors back the meaning of client communication without distorting the message. Roll with Resistance: In Motivational Interviewing ?Resistance? is defined as a misalliance in the counselor-client relationship and not an inherent ?symptom? of addiction. Client ambivalence is accepted as a natural part of the change process. Client ?resistance? is decreased through the use of non-confrontational methods. MI advocates ?rolling with? and accepting client statements of resistance rather than confronting them directly. Develop Discrepancy: Arguments clients themselves make for change are more effective than arguments offered by others. It is the counselor?s role to elicit these arguments by exploring client values and goals. Discrepancies identified between the client goals, values and current behavior are reflected and explored. The counselor focuses on the pros and cons of the problem behavior and differentially responds to emphasize discrepancies identified by the client. Support Self-efficacy: Key to behavior change is the expectation that one can succeed. Motivational Interviewing seeks to increase client perception about their skills, resources and abilities that they may access to achieve their desired goal. Avoid Argumentation: It is easy to fall into an argument trap when a client makes a statement that the counselor believes to be inaccurate or wrong. MI takes a supportive and strength-based approach. Client opinions, thoughts and beliefs are explored, reflected and clarified, but not directly contradicted. Techniques:

61. 61 Sustain or Change Talk? ?I really need to stop using or I think my girlfriend will break up with me.? ?My girlfriend thinks everyone has a problem because her father is an alcoholic.? ?I know I need to cut down, but I can do it on my own.? ?I feel ready to make this change and I know it will be difficult, but I have a good plan. ?Talking to you makes me feel worse. When can I go back to class?? Change Sustain Change Change SustainChange Sustain Change Change Sustain

62. 62 How can you incorporate MI into your practice? Reflect on your current practice Clarify roles between MH and PC providers Develop protocols for incorporating MI into both mental health and primary care practice; Create appointment times that accommodate motivational interviews Get proper training (consult resources) Practice with your colleagues (see role play)

63. 63 Motivational Interviewing in a Brief Office Intervention

64. 64 The BNI-ART Institute Brief Negotiated Interview and Active Referral to Treatment Boston, Massachusetts Co-Directors: Edward Bernstein, MD; Judith Bernstein, RNC, PhD Judith Bernstein from the BNI-ART Institute in Boston, Massachusetts presented at the 2007 NASBHC convention on their work to integrate motivational interviewing into their treatment of youth and adults with substance abuse problems. They have developed some helpful resources for providers and have really laid out the steps in motivational interviewing in an easy ?recipe? to follow.Judith Bernstein from the BNI-ART Institute in Boston, Massachusetts presented at the 2007 NASBHC convention on their work to integrate motivational interviewing into their treatment of youth and adults with substance abuse problems. They have developed some helpful resources for providers and have really laid out the steps in motivational interviewing in an easy ?recipe? to follow.

65. 65 Excellent Resource for SA MI Brief Negotiated Interview and Active Referral to Treatment (BNI ART Institute) http://www.ed.bmc.org/sbirt/ Information Video clips Printable handouts for students

66. The Brief Negotiation Interview Specifically, the BRIEF NEGOTATION INTERVIEW is a model that can be followed in a brief office visit. The steps include (read slide)Specifically, the BRIEF NEGOTATION INTERVIEW is a model that can be followed in a brief office visit. The steps include (read slide)

67. 67 The BNI for Adolescents: Using decisional balance tools, CRAFFT, and negotiating an action plan video Video clipVideo clip

68. 68 Resources http://www.motivationalinterview.org/clinical/ One-stop shop Resources for clinicians, researchers and trainers provide background information on the practice of Motivational Interviewing, its applications to special populations Non-English speaking materials

69. 69 Resources cont. Enhancing Motivation For Change in Substance Abuse Treatment (TIP 35) Developed by William Miller, PhD and Steve Rollnick, PhD First edition available free from www.samhsa.gov Second edition Motivational Interviewing, Preparing People for Change

70. 70 Resource for Substance Abuse Brief Negotiated Interview and Active Referral to Treatment (BNI ART Institute) http://www.ed.bmc.org/sbirt Screening, brief intervention and referral to treatment (SBIRT) toolkit Instruction on BNI Video clips Printable handouts Training opportunities Technical assistance and consultation The BNI ART Institute prepares health care providers, peer educators and social service professionals to screen patients for substance abuse and other behaviors that compromise health, motivate them to change behavior through a brief negotiated interview, and refer them to resources that will support their agenda for change (SBIRT). The BNI ART Institute prepares health care providers, peer educators and social service professionals to screen patients for substance abuse and other behaviors that compromise health, motivate them to change behavior through a brief negotiated interview, and refer them to resources that will support their agenda for change (SBIRT).

71. 71 Resource for Obesity School Nurses, School-Based Health Centers and Childhood Overweight: A report from a roundtable meeting to explore the role of school health professionals in preventing childhood overweight www.healthinschools.org/Health-in-Schools/Health-Services/Schools-and-Childhood-Overweight/School-Nurses.aspx Recommendations Barriers Sample programs

72. 72 Contact Information Margaret Perlia Bavis, DNP, FNP Instructor,?Community?and?Mental?Health?Nursing Rush?University?College?of?Nursing ?Margaret_A_Bavis@rush.edu Sue Murray, MPH, RN Program Consultant Illinois Coalition of School Health Centers smurray@ilmaternal.org

73. 73 Case Example and Role Play: Motivational Interviewing ? Obesity

74. 74 Obesity Case Example Sarah is a 14 year old 9th grade student who has come to the school-based health center for a comprehensive risk assessment. Sarah is obese and at risk for Type II Diabetes (family history). She has a history of overeating and reports that she does not engage in any physical activity. She gets short of breath when walking up stairs between classes, and feels embarrassed to go to a gym or to participate in group sports even though she would like to lose weight. Her family and friends often eat at fast food restaurants, and she usually goes with them and eats unhealthy meals. Sarah has tried to diet, but her diets have not lasted longer than about a week. Practice a motivational interview with Sarah focused on improving her motivation to change behaviors associated with obesity ? e.g., overeating, lack of activity, eating fast food. If you are incorporating an interactive component to the webcast/workshop, request that participants pair up, read case example, and then role play with one person as provider and one as studentIf you are incorporating an interactive component to the webcast/workshop, request that participants pair up, read case example, and then role play with one person as provider and one as student


Other Related Presentations

Copyright © 2014 SlideServe. All rights reserved | Powered By DigitalOfficePro