ROCKIN IT WITH MOTIVATIONAL INTERVIEWING
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- Roberta Gregory
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1 ROCKIN IT WITH MOTIVATIONAL INTERVIEWING P R E S E N T E D T O G R A N D J U N C T I O N M E D I C A L S Y M P O S I U M A U G U S T 8,
2 WHY MI? For every complex problem, there is an easy answer, and it is wrong. - H.L. Mencken
3 SERIOUSLY, WHY MI? Isn t that stuff just for therapists? MI can benefit: Therapists Case Managers Physicians Nurses Medical Assistants Community Workers Front Office Staff Others???
4 DID YOU KNOW?
5 MOTIVATIONAL INTERVIEWING Definition Motivational Interviewing is a collaborative guiding method, person centered, to elicit and strengthen motivation to change (Carvajal de la Torre, Novo Rodriguez, & Campinez Navarro, 2010) Main components Examining stages of change Listening to patients (e.g. patients have answers) Understanding patients motivations Resisting the righting reflex (e.g. correcting patients) Empowering patients to make the effort for change
6 BENEFITS TO PATIENTS Patients feel listened to Opens the door to talk about sensitive topics Provides opportunity for patients to take responsibility for their care Allows patients to track changes Use of scales Use of patient s language Promotes actual behavior change!
7 BENEFITS TO PROVIDERS Occurs within the workflow of office visits Opens the door to discuss other health topics Evaluates lifestyle choices Incorporates wellness & prevention Uses scripts Promotes effective primary care patient management
8 MI IN MEDICAL SETTINGS Chronic Disease Management Diabetes Heart disease Pain management Medication compliance Lifestyle Choices Weight loss/management Tobacco cessation Medical Procedure Anxiety Inoculations MRI/CAT scan Risky-Behavior Prevention Safe Sex practices Harm Reduction
9 CONSIDER THIS
10 WHEN IT S ABOUT BEHAVIOR CHANGE Is the problem with us or them? Tug-of-War: My patients are non-compliant! My doctor doesn t understand me!
11 WHAT TRIGGERS CHANGE? Willingness Readiness Ability Importance
12 WE CHANGE THROUGH STAGES Change takes place over a period of time Stages are predictable & well-defined People get stuck when changing Knowing what stage someone is in helps provide information about what to do Timing is important
13 STAGES OF CHANGE
14 OR, PICTURE IT LIKE THIS
15 ARE YOU LISTENING? It is impossible for me now I don t eat so much I want to: lose weight/quit smoking/ exercise more I hate me when I I really wish but I can t I wish things were easier
16 CHANGE TALK IS FOCUSED ON Needs I can t breathe. My child s health is at risk. Reasons If I reduce my weight I will have less pain in my knees. Desires I wish I could control my appetite. I want to be a better role model for my children. Abilities I did it before. I believe I can do it.
17 2 BRAIN APPROACH In the room, hold both your and your patients agendas in your head
18 TOOLS OF THE TRADE READINESS RULER Mark where you are on the line that measures your change in Not ready to change Thinking about changing Already changing
19 ANOTHER TOOL DECISIONAL BALANCE WORKSHEET Taking my meds Pros - No fighting with mom - Stay out of hospital - Feel good Cons - Tastes yucky! Not taking my meds - Don t have bad taste - Fight with mom - Get sick - Go to hospital& hate it & needles - Stomach hurts a lot
20 STORIES OF MI SUCCESS I took my hands off of the steering wheel of the bus. I asked my patient how important her little toe was. It s better to take my medication so I don t fight with my mom.
21 NEXT STEPS Commit to changing the way you/your practice interacts with patients Behavioral health experts can assist with behavior change to achieve improved physical health outcomes Consider a practice-wide training in MI Contact information: Amy Gallagher, Psy.D agallagh@cwrmhc.org
22 HELPFUL RESOURCES Bessesen, D. (2005). Motivational interviewing: putting Prochaska s theory of change to work-use with diabetes and weight management. 2 nd Annual Western Colorado Nutrition Conference. Power point slides. Carvajal de la Torre, A., Novo Rodriguez, J., & Campinez Navarro, M. (2010). Motivational interviewing in primary care: quick start guide. 16 th WONCA Europe Conference. Power point slides. Erickson, S. J., Gerstle, M., & Feldstein, S. W. (2005). Brief Interventions and motivational interviewing with children, adolescents, and their parents in pediatric health care settings. A review. ARCH PEDIATR ADOLESC MED, 159. Downloaded from on January 17, Knight, K. M., McGowen, L., Dickens, C., & Bundy, C. (2006). A systematic review of motivational interviewing in physical health care settings. British Journal of Health Psychology, 11, Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care: Helping patients change behaviors. The Guilford Press: New York. Schwartz, R. P., Hanre, R., Dietz, W. H., Wasserman, R. C., Slora, E. J., Myers, E. F., Sullivan, S., Rockett, H., Thoma, K. A., Dumitru, G. D., & Resnicov, K. A. (2007). Office-based motivational interviewing to prevent childhood obesity: A feasibility study. ARCH PEDIATR ADOLESC MED,161. Downloaded from on February 11, UCLA Center for Human Nutrition website:
Motivational Interviewing: Steps to Success! Create effective dialogue with your client
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