FNH 345/HUNU: Week 4/5 Motivational Interviewing Basics Part 2 2025 PDF

FNH 345/HUNU: Week 4/5 – Motivational Interviewing Basics Part 2 Feb 5th, 2025 Sinéad Feeney, MSc, RD Overview of Today Guest Speaker Jessie Newman to join us Friday Feb 7th Outline for Today Part 2: Motivational Interviewing Basics Midterm Review Motivational Interview Part 2 The Four...

FNH 345/HUNU: Week 4/5 – Motivational Interviewing Basics Part 2 Feb 5th, 2025 Sinéad Feeney, MSc, RD Overview of Today Guest Speaker Jessie Newman to join us Friday Feb 7th Outline for Today Part 2: Motivational Interviewing Basics Midterm Review Motivational Interview Part 2 The Four Processes of MI The Four Processes of MI Engaging – Building Rapport, establish time available to meet, overview of what to expect, determine reason for visit Focusing – Invite client to select topic to discuss, suggest topic ideas if client is unsure, find out reason behind topic selection Evoking – Identify and respond to ambivalence, evoke change talk, Assess readiness to change, Transition to planning process Planning- Ask Permission before giving information, offer information using elicit provide elicit or ask tell ask, invite client to set goals, assess barriers to change How can this help us in an interview session? A great check in is to think about whether goals of the client, dietitian and health team all align The Four Processes in Practice How to use this approach in your counselling sessions: Counselling assignment Part 1 Engaging – Building Rapport, establish time available to meet, overview of what to expect, determine reason for visit Focusing – Invite client to select topic to discuss, suggest topic ideas if client is unsure, find out reason behind topic selection Gathering further information for your assessment Evoking – Started in this part by Identifying and respond to ambivalence, evoke change talk The Four Processes in Practice Counselling assignment Part 2 Evoking – Continued in the next session by Identifying and respond to ambivalence, evoke change talk, Assess readiness to change, Transition to planning process Planning- Ask Permission before giving information, offer information using elicit provide elicit or ask tell ask, invite client to set goals, assess barriers to change  How does this relate to NCP? NCP MI Process Examples Assessment Preappointment - Reading the chart Engage - Conducts assessment Focus - Asks client to complete questionnaire prior - Asking client reason for visit in interview - Asking what hoping to get out of session Diagnosis Focus - Asking client what changes if any they are interested in discussing further - Sharing possible topics to discuss based on assessment - Sharing the reason for consult if unknown to client Intervention Evoking - Inviting client to voice motivations for change Planning - Inviting the client to determine a successful route toward change - Guiding client to devise solutions for barriers to change - Determining specific goals Monitor and Evaluation Planning - Inviting client to determine appropriate monitoring Postappointment/ methods related to behaviour change Follow up - Discussing plans for follow up - Reviewing and new information eg lab values etc to assist follow up OARS - How to connect with your clients in a Session OARS: Open-ended Questions Open ended questions to start your session Designed to help people reflect on their feelings and share/elaborate on their experiences Example: You are seeing a patient in the outpatients clinic in the Diabetes centre - The patient is a 45 year old woman newly diagnosed with type 2 diabetes - She has no other comorbidities - She walks into your office and you greet her warmly and welcome her to have a seat with you to start your conversation. - What might be an open ended question you might first say? Open Ended Questions & DARN CAT Thinking about last class – we can use this acronym (DARN CAT) to think about how to: further help you and the client to figure out what changes they may want to make what motivates them How they may want to make those changes How to start This can ensure that you are focused on what the client is able and wanting to do Keeps the discussion person centered Applying DARN CAT to your sessions Applying DARN CAT Open Ended Questions Desire “How would you like things to change?” “How would you like things to be different a year from now?” Ability “If you decide to change __ how could you go about it” “What ideas do you have about how you could___” Reasons “What would be some advantages of __” “Are there reasons you want to change ___” Need “How Important is it for you __” “What needs to happen__” Commitment “What do you intend to do?” Activation “What are you ready to do?” Taking Steps “What have you started doing?” OARS: Affirmations Affirmations Positive statements about who we are and our potential Statements and gestures that recognize strengths and acknowledge behaviours that lead in the direction of positive change “ You have made some big changes in the past” “ I know that you are nervous to try this but you have also made great progress in this already here in hospital” “You have thought a lot about this” OARS: Reflections Simple & Complex Simple Reflections Simple reflections: repeating or rephrasing a client statement in a way that is meaningful and could spark thought It stays close to what the person was saying Example “I tried so many times before but I am really trying to make lasting changes this time around and seeing the difference in how I feel day to day” How might you respond? “ Hope is growing that this time will be different” Example: “I hear what you are saying about my drinking but I don’t think it is a big deal” How might you respond? ”So at this point you are not concerned about your drinking” Complex Reflections Complex reflections: this type of reflection can take more practice as it requires using different words to reflect the underlying meaning or feeling of a client statement It also requires waiting to hear from your client if you have identified what is on their mind correctly Requires being open to being wrong Eg. “I am snacking a lot at night because I am stressed” Consider the larger conversational context, have they noted being stressed about something eg work etc? A response could be “ You are snacking a lot at night because you are stressed about the upcoming deadline at work” Wait for a response to see if you are on the right track OARS:Summaries Summaries Summaries reinforce key statements of movement toward change. Clients hear change talk once when they make a statement, twice when the counselor reflects it, and again when the counselor summarizes the discussion. You may do this throughout or at the end to summarize the key points and ensure you are on the right track with the session Examples of how to Summarize Examples: You may say “Just to make sure I have this correct…” Or “So you are saying… have I got this correctly?” Or “Thank you for sharing all that background to why you wanted to see me today. I am hearing that you are wanting to work on…” You can also use it to Listen for change talk Gather the change talk and present it back You can end it with a question: ”What do you think you will do next” “Is there anything you would like to do about that in the next week or two” Summary examples “I want to make some lasting changes to my health but I am confused about what to do about my heart health. I read so much online and I am not sure what direction to go like can I eat eggs? Can I eat red meat? Is oil bad for me. There is just too much to incorporate and I am already so busy it seems impossible” What might be a summary? “I hear you on that, it can definitely be confusing when searching these things online. We can talk about how to simplify all this information including your questions about eggs, red meat and oils so that it feels like something you can follow.”  CASE STUDY Melissa has been having trouble sleeping. She works full time and has been exhausted, so in addition to her 2 cups of coffee in the morning, she’s added 1-2 cups after lunch. She has been skipping breakfast because she feels too busy in the morning and isn’t sleeping well so wants to stretch her sleep as long as possible. Her insomnia is getting worse, and Melissa is aware that these afternoon cups may be contributing to keeping her up at night. She is also feeling a huge dip in her energy mid afternoon and is relying on coffee to keep her energy up. Melissa has thought about cutting these cups of coffee out, but is afraid that if she does, she won’t be as productive at work in the afternoons.  CASE STUDY CONTINUED… What Stage of Change is Melissa in - how can we effectively counsel her? Is she expressing change talk , sustain talk or both? What questions could you ask her using motivational interviewing techniques? Breakout rooms – ~5 mins; come back prepared to share How to use MI in your Sessions: Ask Tell Ask Or Elicit Provide Elicit Ask – Tell – Ask #1 An Effective Way to Give Information and Advice Ask-Tell-Ask (also called Elicit-Provide-Elicit) uses the Spirit of Motivational Interviewing to increase the chances that people will be ready, willing, and able to act on information or advice. ASK #1 for 1) permission OR 2) what they know or want to know Option 1: Permission to give information and advice: □ “Is it ok if we talk about... ?” □ “Would you like to know more about... ?” □ OR Option 2: What they already know or want to know: □ “What do you know about... ?” □ “There are several things we could talk about, so where should we start?” □ “What information can I help you with?” □ “You already know a lot about... , but are there any questions you still have?” □ * For information about what to do when you have an obligation or when people ask for information, see next page Centre for Collaboration, Motivation & Innovation Ask – Tell – Ask TELL information respectfully, clearly, and in small amounts 1. Make sure the information fits the person and is focused on the present. □ “You said that... is on your mind right now.” 2.Provide the information in a neutral way. The purpose is to give information, not change their minds. □ “Sometimes people in this situation... ,... , or... ” □ “Let’s look at the (questionnaire/survey/screening) results together... “ 3.Focus on one or two key messages that the person wants to know. □ “There are two things to think about right now... ” 4.Use plain language (short sentences and familiar words). 5.Use pictures and handouts when they are helpful. 6.Emphasize choice and options by avoiding words like “can’t,” “must,” or “have to.” □ “There are three choices about where to go from here... ” □ Centre for Collaboration, Motivation & Innovation Ask – Tell – Ask #2 ASK #2 1) what they thought OR 2) use teach- back to make sure there is understanding Option 1: What they thought: □ “What do you think about that?” □ “I wonder what this all means to you?” □ “I wonder how you think we might best proceed?” OR Option 2: Use teach-back to make sure there is understanding: □ “I’d like to make sure I did a good job explaining. Could you say it back to me so I know I was clear?” □ “If someone asked you what we talked about today, what would you tell them?” □ “Can you show me how you are going to (use this equipment/complete this form/....) so I know that I explained it well?” Centre for Collaboration, Motivation & Innovation People ask me for advice, can’t I just tell them what to do? Be careful when giving advice, because you can fall into the expert trap. The expert trap is when you give people advice based solely on your ideas and it doesn’t fit for them. Here are two things to remember when asked for advice: 1. Emphasize choice. “I can’t tell you what to do, but I can tell you what others have done.” “Something you could try if you want to is...” 2. Instead of giving one piece of advice or a single idea, offer a menu of choices. This is a special kind of Ask-Tell-Ask, sometimes called a behavioral menu. 1. ASK: “Would you like to hear some ideas others have used or that 2. might fit for you?” 3. TELL: Share two or three ideas all at once. Use the last idea to 4. encourage one of their own. “Some things you could try are... or 5. maybe you’ve had an idea while I was talking.” 6. ASK if any of these ideas might work. Centre for Collaboration, Motivation & Innovation Other key aspects of MI The tone is warm, encouraging and expresses respect of the person, and may include: Statements of strength, e.g., “You have a lot of knowledge in this area.” Statements that respect autonomy, e.g., “It’s your choice.” Statements that express collaboration, e.g., “We can work together on this.” Centre for Collaboration, Motivation & Innovation Examples Ask – You have been trying to control your blood pressure by eating less salt. Tell more about what kinds of foods you have noticed are particularly high in salt? Would you like me to give you some more examples of foods typically higher in salt and how to reduce sodium in the diet? Tell – If yes… give information Ask – What are your thoughts on this information? Do you have any questions about it? Ask – You mentioned that your doctor had said your A1C (blood sugars) were a bit high and you are worried about diabetes. Would you like to know more about how to lower your blood sugars? Tell Ask - ? Ask – You talked about your concerns regarding your current weight but also spoke about your concerns about your health. Are you interested in learning more about health behaviours that might be helpful in achieving your health goals? Are you interested in learning about how health can be achieved at any size? Tell Ask - ?  Putting it all Together: Strategically Responding Using OARS & Ask Tell Ask  PRACTICE MOTIVATIONAL INTERVIEWING Can use motivational interviewing to learn more about why they want to make that change, create personalized meaningful interventions, and ultimately help to set them up for success Client: person looking to increase iron intake and does not want to take supplements Handout you could use and share with client (I will put in the chat so you both have it at the start) https://www.healthlinkbc.ca/healthy-eating- physical-activity/food-and-nutrition/nutrients/iron-foods Breakout rooms – 5 mins Practice using Ask Tell Ask Come back to debrief – 5 mins Switch partners – 5 mins QUESTIONS