Motivational Interviewing for Public Health

2014
A Conversation about Change
Presentation Objectives:
•
•
•
•
Define MI
What is the spirit of MI
Describe the components of change
Identify OARS and how it is used in MI

Rollnick and Miller describe MI as
 “a
directive, client centered
counseling style for eliciting
behavior change by helping
clients to explore and resolve
ambivalence.”

Rollnick, Miller, & Butler, Motivational Interviewing in Health Care, 2008.
Individuals change voluntarily when they….
Become interested in or concerned about the need for change
Become convinced that the change is in their best interest or will
benefit them more than cost them
Organize a plan of action that they are committed to implementing
Take the actions that are necessary to make the change and sustain
the change.
Jeremy Evendon, MISSA, LISW-S, SAMHA, HRSA webinar. www.intergration.samhsa.gov
What and Why
would I want to
change?????
The Spirit of MI is captured in four terms:
•Partnership – Collaborative and cooperative partnership between the
client and clinician
•Acceptance – Worth, Empathy, and Autonomy To recognize and
honor this autonomy is also a key element in facilitating
health behavior change.
•Compassion- It’s NOT sympathy. It’s focusing on the best interest of
our clients, understanding their concerns.
•Evocation – An evocative spirit implies that the majority of the
answers are in the client, not in us. EACH PERSON HAS PERSONAL
GOALS, VALUES, ASPIRATIONS, AND DREAMS. Part of the art of
MI is connecting health behavior change with what your patients care
about, with their own values and concerns.
Are we committed to hearing the client’s voice, honoring the
clients self-direction, capacity, strength, and experience?
“Motivational Interviewing: Helping People Change,” Third Edition, The
Guilford Press:2013.
Robert Rhode, 2013
rrhode@u.arizona.edu
4 Guiding Principles of MI
R:
Resist the Righting Reflex
Arguing decreases the likelihood of change. “But….”
U:
Understand and explore the patients’ own motivations
What would be their reason for change? How would they do it?
L: Listen with empathy
They may likely give you the answer to their problem by just talking it
through. VENA goals
E: Empower the patient, encouraging hope and optimism.
Help show them that anything is possible. If it is their idea, they are more
likely to do something about it.
People believe more what they say than what they hear.
Rollnick, Miller, & Butler, Motivational Interviewing in Health Care, 2008.
Components of Change
RESISTANCE
AMBIVALENCE
MOTIVATION
RESISTANCE
6 things you can do to make your life more difficult:
1.Question/Answer
2.Argue for Change
3.Be the Expert
4.Label
5.Premature Focus
6.Blame/Shame
Jeremy Evendon, MISSA, LISW-S, SAMHA, HRSA
webinar. www.intergration.samhsa.gov
AMBIVALENCE
I need to lose some weight,
BUT
I don’t know what to eat.
I want to exercise,
BUT
I get bored.
I know she needs less juice,
BUT
I can’t get her to drink water.
I know I should always use condoms,
BUT
he doesn’t like them.
DANCR Steps:
•Desire to change – Clients might include a reference to enjoying, liking,
disliking, wanting, or not wanting to do the target behavior.
I want to…
I would like to…
I wish…
•Ability to change – Clients might describe being able, unable, capable, or
incapable of doing the target behavior; or clients might describe that
something is possible or impossible to do.
I could…
I can…
I might be able to…
•Need to change – Clients might reference their sense of obligation that they
should do the target behavior, or that it is unfair or unjust that they are
being asked to do something.
I ought to…
I really should…
I have to…
DANCR Steps:
•Commitment to change – When clients talk about what they will or won’t be
going in the future.
I will…
I am going to…
•Reasons to change – When the client statements would answer the
questions, “Why are you doing _______?” or “Why aren’t you
doing_______?” the client is describing his or her reasons.
•Steps that could lead to the health promoting behavior – It might be
easier to remember this as “starts” or “starting steps” because it is when the
client describes what he or she has already done. It is past tense. Clients
might describe what they have already done that might get them closer or
hinder them from a goal.
Robert Rhode, 2013
rrhode@u.arizona.edu
MOTIVATION
3 Communication Styles
Following
Directing
Guiding
3 Core Communication Skills
Asking
Informing
Listening
50
40
30
Informing
20
Asking
Listening
10
0
Directing
Guiding
Following
OARS:
Open Ended Questions
Affirmation
Reflect feelings and change talk
Summarize
+Inform or Advise
SKILLS:
•Open-ended questions about the client’s experience,
especially in the change direction.
•Affirmations – Comment favorably on a trait, attribute,
or strength of the client that would support doing the
health promoting behavior
•Reflecting or summarizing is a key part of empathy
which is central to facilitating change. Reflect and
Summarize the change talk in particular.
•+ Inform or advise ways to help accomplish their goals
(with their permission)
Change Talk Preparatory:
Desire
Ability
Reason
Need
Mobilizing Change Talk:
Commitment
Activation
Taking Steps
What might you enjoy about improving your nutrition?
How might you be able to arrange some physical activity for you
and your child?
Why do you think you need to improve your nutrition?
What reasons do you have for continuing with your exercises?
If you decided to eat less red meat, what might you do today or
tomorrow?
Steven P. Wells, Ph.D. (LCSW)
AFFIRMATION:
•“You’re the kind of person that puts a lot of
thought into something.”
•“You’re contributing some really important ideas
here.”
•“You’re very dedicated to feeding your baby a
healthy diet.”
REFLECT:
Simple: These stay close to the topic at hand
•Repetition – Be careful not to become the parrot.
•Rephrase
Complex: Makes a guess
•Paraphrase: “continuing the paragraph”
•Reflection of feelings
SUMMARIZE:
what he or she said about –
•Desire to change
•His or her ability to change
•Need to change
•Reason to change.
•Then ask, “What do you think you will do?”, and just
listen.
Join up, partner with……
Accept the client, empathize
Be curious, what do they know?
Be compassionate, dedicated
“Given a choice between changing and
proving that it is not necessary, most
people get busy with the proof.”
-John Galbraith
Evenden, MSSA, LISW-S “Engaging People in Discussions About Health-related
Changes” The Center for Evidence-Based Practices at Case Western Reserve
University. SAMHSA webinar, August, 2012 www.integration.samhsa.gov
Miller, W. & Rollnick, S., “Motivational Interviewing: Preparing People for Change”.
2nd Edition, Guilford Press, NY, 2002.
Miller, W. & Rollnick, S., “Motivational Interviewing: Preparing People for Change”.
3rd edition, Guilford Press, NY, 2012.
Rhode, Robert, Assistant Professor, University of Arizona. “Motivation interviewing:
Enhancing your outcomes by quitting your job, getting on the bus, and going
fishing.” May 2013, Denver, CO
Rollnick, S., Mason, P., & Butler, C., “Motivational Interviewing in Health Care:
Helping Patients Change Behavior” Guilford Press, NY, 2008.
Wells, Steven P., Ph.D. Oklahoma Leadership Education in Neurodevelopmental and
Related Disabilities (LEND), College of Medicine, University of Oklahoma Health
Science Center. “Partners in Progress—Strengthening Oklahoma Families” Oct.
2013, Norman, OK.