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Motivational Interviewing
August 24, 2016
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This project is supported by grant number R18HS023908 from the Agency for Healthcare Research & Quality
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Stories from the Field
Cyndi Greenlee, ARNP
Peninsula Community Health Services
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This project is supported by grant number R18HS023908 from the Agency for Healthcare Research & Quality
Motivational Interviewing.
Foundations for relationships &
enhancing motivation
Benjamin Balderson, PhD
Group Health Research Institute
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This project is supported by grant number R18HS023908 from the Agency for Healthcare Research & Quality
Educational Objectives
1) Brief background on empirical
evidence for Motivational
Interviewing (MI).
2) Understand basics of MI
a) Spirit
b) Principles
c) Basic strategies
“A few, carefully chosen words, delivered slowly and respectfully, are worth more
thank many mouthfuls of busy talk.” – Stephen Rollnick
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Difficult Patients
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What is MI
Directive, patient centered method that works on facilitating
and engaging intrinsic motivation within the client in order to
change behavior.
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Evidence for MI
Effectiveness has been shown for:
Substance Abuse: alcohol, tobacco, marijuana, cocaine,
amphetamines, and opiates
Medical issues: diet, physical activity, medication
adherence, cardiovascular and diabetes management,
hypertension, asthma, TBI, HIV prevention, Spinal Cord
Rehab and bulimia
Across medical settings and cultures
Kolli, 2010; Burke et al 2003, 2004
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Evidence for MI in cardiovascular health
• Multiple studies supporting the use of MI for various CV health
behaviors. (Thompson, 2011)
• A 2016 meta analysis showed positive effects for changing smoking
and depression and three measures of overall health domains.
Results were mixed for improving systolic and diastolic blood
pressure (Lee, 2016).
• A Dutch healthcare system study showed MI as an independent, key
factor in CV risk management. (Huntink, 2015).
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Benefits of Learning about MI
Improved patient satisfaction.
Improved provider satisfaction.
Greater success over time
Less frustration and burnout
Improves adherence and retention
Instill hope
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Three Components of MI Spirit
1. Collaboration
A partnership between provider and patient, grounded in
the point of view and experience of the patient.
Build rapport and facilitates trust
“You have mentioned a lot of great ideas as the challenges
of reaching your goal. I would like to work with you to…”
2. Evocation
Draw out ideas and solutions from individuals
Elicits patients motivation to change
“What would you like to see different about your current …”
3. Autonomy
Decision making left to the person
Increase intrinsic motivation and commitment
“We’ve discussed some options, what would you like to
do…”
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Principles of MI: R-U-L-E
Resist the righting reflex
The tendency of providers to try to actively fix
problems in clients’ lives and, failing to recognize
potential ambivalence. And by doing so,
increasing resistance and reducing the likelihood
of client change
Understanding your patient’s A provider should listen for and seek information
motivation.
about goals and beliefs and explore how this
relates to current circumstances.
Listen to your patient
Providers must create an atmosphere in which
patients can safely explore decisions to change.
Empower your patient
Outcomes are better when a patient is engaged
and ultimately all change comes from the client
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Foundational Skills: OARS
O – Open-ended Questions
A – Affirmations
R – Reflective Listening
S – Summaries
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Open-end Questions
Avoid asking questions that can be answered with a "yes" or "no.“
“So you’ve been having chest pain?”
“What's been going on with you since
we last met?”
“Did you take the medications I
prescribed?”
“How have the medications been
going for you?”
“Do you understand the information I “What do you think of the
provided?”
information I provided?”
“Do you think you could get more
walking in?”
“What might be some things you
could consider doing regarding
physical activity?
Some evidence it reduces visit times!
More evidence that it improves satisfaction, adherence, & outcomes.
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Affirmations
Affirmations is actively listening for a client’s strengths,
values, goals and positive qualities and reflecting this back
to clients in an affirming manner. Don’t underestimate
expressing empathy and celebrating successes.
“You're doing such a nice job at ______ (taking your medication, walking
daily). Great job!”
"It sounds like you are really trying to ______ (eat less junk food, reduce
smoking). It can be hard but it sounds like you are working hard. I'm proud
of you.”
"You seem happy with your ______ (progress, blood pressure).
I am too, you’re doing a great job with _____.”
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Reflective Listening
Reflections can vary from simply repeating to reflecting the implicit
meaning or feeling. The provider tries to understand the patient’s ideas,
perspective and feelings. This is reflected back to patients which helps
to clarify and help the patient explore and discover more about their
values and behaviors.
Patient: "I wish I didn't eat so much fast food."
Doctor: “You eat fast food fairly often."
Patient: "Pretty much every day. I know it’s not the best, but it's just easier."
Doctor: "It's easier because you don't have to plan and cook meals but on the other
hand you feel it’s not the healthiest choice."
Patient: "Right… it’s just easy but kind of gross. I guess there are some healthier
items on the menu."
Doctor: "So you don't want to give up the convenience of fast food, but you would
like to eat healthier."
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Summaries
Summaries are used regularly, strategically and collaboratively.
Summary statements can reinforce the patient, highlight realizations,
identify transitions or progression, identify themes and have directive
elements. Interim summaries can help to review what has been
discussed, change the pace, clarify or change the focus of the visit.
“Let me see if I hearing your concerns correctly, you have
mentioned _____. What others concerns do you have?
"It sounds like you are saying...___ ... did I get that right?"
“So on one hand _____ but on the other _____.”
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Advanced Skills Teaser:
Matching MI to Stages of Change
Precontemplation
Relapse
Contemplation
MI
Maintenance
Preparation
Action
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Closing Thoughts
We influence how others see themselves and their potential for
change.
Motivation is on a continuum influenced by knowledge, beliefs, and
skills.
Change is an evolving cycle that naturally transforms with time and
experience.
Tools such as MI can help people through the change process.
We are not responsible for our other people’s change but neither
are we passive outsiders with no influence.
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“MINT” Motivationalinterviewing.org
H2N Coaches!
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Questions & Comments
Thanks
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Coming Attractions
• September 28th Office Hour: Focus on EHR
• October 26th Webinar: Creating (MI
influenced) Care Plans & Providing SelfManagement Support
• And don’t forget, you can go to
http://healthyheartsnw.org/events/ to catch up
on what you have missed!
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