Transcript Rapport_Building_Texas_Bridget_FINAL_NoPics

RAPPORT BUILDING
Bridget Swinney MS, RD
www.healthyfoodzone.com
www.babybitesbook.blogspot.com
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What Will You Learn?
 How to build rapport with your clients and how it can
improve nutrition assessment.
 Cultural, language, and other barriers to effective
communication in WIC and strategies that can help
you overcome them.
 How to use non-verbal communication techniques
which result in positive and effective communication.
 Effective interpersonal communication techniques
that promote a participant-centered approach to
nutrition assessment.
 LOVE Method of Counseling.
The VENA
Nutrition Assessment ProcessHow Does Rapport Building Fit In?
• Use limited time to collect relevant nutrition
assessment information
• Use critical thinking skills to link assessment
information to a participant’s individual needs
and concerns
• Engage the participant in dialogue and goal
setting
• Weave nutrition and diet throughout the
assessment process
• Plan a personalized nutrition intervention
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Rapport Building
Importance ̶ per USDA
–One of the VENA Essential
Competency Areas
• Rationale ̶ because it
works!
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What comes to mind when you
think “Rapport Building”?
Rapport defined:
“relationship between
people--especially one of
mutual understanding
or trust”
What does Rapport
Building Mean to You?
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How to Build Rapport?
• Smile!
• Remove as many
barriers as you can!
• Engage the Participant!
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What are the Communication
Barriers in Your Setting?
• Cultural
• Language
• Socio-Economic
– Generational/Situational Poverty
• Environmental/Physical
• Emotional
• Appearance/Dress
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Barriers to Effective
Communication
Discuss Handouts
Cross-Cultural
Nutrition Awareness
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Handout 2.1 : Effective Cross-Cultural
Communication
Handout 2.2 : Guidelines for CrossCultural Communication
What About Language Barriers?
Handout 2.8: Little or No English
Handout 2.9: Working with An Interpreter
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Talking Technical—DON’T!
• Sometimes we forget that not everyone
is familiar with nutrition and/or WIC
lingo!
– Postpartum
– HCP
– CA
– BMI
– Cert/Subcert
– Hematocrit
Other Barriers to Communication
• Cultural
• Language
• Socio-Economic
–Generational Poverty
–Situational Poverty
• Environmental/Physical
• Appearance/Dress
• Emotional
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Can We Overcome Environmental
Barriers…or Just learn to Deal
with Them?
Physical: Desks, windows, counters,
crowded areas, uncomfortable
temperatures
Noise distractions: kids, phones,
co-workers
Smells…
Overcoming Appearances
Others? Stress, number of people waiting
to see you, personal problems
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Take 5 and Think about
These 5 Must-Do’s…
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Create a positive environment
Limit your teaching objectives
Communicate clearly and simply
Use multiple ways to get message across
Verify understanding
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Nonverbal Communication
Techniques
• Have perceived meanings
• Exhibited by counselor and
participants
•Can Help or Hurt Communication
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Effective/Ineffective Counselor
Nonverbal Behavior
Handout 3.1 Nonverbal Behavior/Body
Language
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Establishing a
Participant-Centered Approach
Handout 4.1
Interpersonal Communication:
Characteristics of Effective
Nutrition Counselors
Handout 4.2
Interpersonal Communication:
Getting Permission
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LOVE CounselingTechnique
Listen & Observe
Open Ended Questions
Validate
Empower/Educate
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What’s the Scientific Basis?
Motivational Interviewing
• As defined by William Miller and Steven
Rollnick: “Client Centered, directive method for
enhancing intrinsic motivation to change by
exploring and resolving ambivalence”
• Transtheoretical Model of Change-Prochaska
& DiClemente
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Listen and Observe
• Listen to what the participant says as
well as the feelings behind her words
• You may need to ask questions to
clarify what she says
• What are the hidden factors,
feelings… the story behind the story,
the real issues?
• What does body language tell you?
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What is Reflective Listening?
• Paraphrasing the response, which:
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Shows you’re listening!
Helps clarify or correct info
Shows acceptance
Encourages a response or expanded answer
Gives you a chance to summarize her feelings and
actions
You’re wondering…
You feel worried about…
You’ve heard
You’re wanting information about…
…..do I have that right?
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Reflective Listening
Handout 4.6: Reflective Listening Technique
Exercise 4.2: Practice Reflective Listening 1
Exercise 4.3: Practice Reflective Listening 2
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What makes an
Open Ended Question?
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Asks one question
Can’t be answered with a yes or no
Is broad based
Incorporates clients own words/language
Does not introduce bias or assumptions
– “what did you cook for breakfast today?”
• Explores feelings and facts
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Closed vs. Open Questions
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Do You…?
Will you…?
Can You…?
What is your…?
• To what extent…
• How often do you
feel…
• Why…
• Tell me about…
• Help me understand
• What, if any…
• What else…
• How do you feel
about…
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Practice Using
Open Ended Questions
How much do you weigh?
Does your child drink juice?
Can you switch from whole milk to 2%
How much weight did you gain during your
last pregnancy?
Do you take any drugs?
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Now ask the same questions,
a different way…
• How do you feel about your current weight?
• Does your child drink anything besides milk
and water?
• How easy would it be to switch from whole
milk to 2%
• How did you feel about your weight gain
when you were pregnant with Joshua?
• Pregnancy is a good time to improve habits.
Do you have any habits that you want to
stop but can’t?
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Open Ended Questions
Handout 4.4: Tried and True Open-ended
Questions
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Conversation Starters
• What is the greatest concern you have about your
child’s health today?
• Regarding your child’s health, what are you most
interested in learning about today?
• How do you feel about your child’s overall eating?
What are your biggest concerns and challenges in
feeding your child?
• What are some traditional practices that affect your
mealtime planning and mealtime setting?
• What do you do when you have little time to prepare
meals?
• Tell me what activities your child likes? How much
time does he/she spend doing the activities each
day? What kind of activity do you do as a family?
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Validate/Affirm
Validate: “Your feelings are OK and have been
expressed by others”
Affirm: Validating feelings or actions with a
positive spin. “Your feelings/actions are more
than OK—they will help you meet your
goals.”
Validating acknowledges that you hear and
support her concerns and that what she’s
feeling is acceptable.
Affirming helps supports changes.
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Validating and Affirming also:
• Establishes rapport, builds trust and will
help the participant “engage” in
conversation
• Uses simple phrases to acknowledge
participant’s knowledge and strengths
• Builds client confidence and avoids a
defensive reaction
Sample Validations
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I hear you!
That can feel scary…
Many moms feel the same way when…
Some of our other clients have said the same
thing.
I can see how that would concern you
Your feelings are completely normal
(…expected, typical, OK)
I know how that feels…
I know it’s hard to…
That’s a tough situation…
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Sample Validations/Affirmations
• I know it’s sometimes hard for you
to get here so I really appreciate
you being on time today.
• Congratulations on switching your
family to skim milk!
• I can see that you are working
hard to help your daughter give
up her bottle.
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More Affirmation
• That’s a good point
• I think that could work
• Your Mom has some great ideas
about feeding babies and I know you
want to respect that….
• You must be so happy that your
daughter’s BMI has gone down!
• You’ve really got it together when it
comes to cooking healthy
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Empower/Educate
Remember, VENA counseling is
Client Centered!
• Instead of telling clients what they’re doing
wrong…find something they’re doing right!
• Guide the conversation to address client’s
concerns first
• Provide information so that she can set a goal or
make an informed decision
• Help her find her own solutions by giving options
• Build client confidence so she feels she can do it
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Let’s Practice!
• Pretend you are a WIC client. Choose an
issue common to WIC and tell your
counselor about it.
Hint: I’m not making enough milk, fruits
and vegetables are so expensive, my son
cries when I don’t give him the bottle…
• Counselor will practice the LOVE method of
counseling until the client feels the counselor
understands her concerns and has given her
adequate options for to set a goal and steps
to reach it.
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LOVE Counseling Technique
Listen and Observe
Open Ended
Questions
Validate
Empower/Educate
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Rapport Building ̶
Putting it All Together!
Focus on Positive Health Outcomes
Exercise 5.2 - Case Study
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Did I Do a Good Job?
 How to build rapport with your clients and how it
can improve nutrition assessment.
 Cultural, language, and other barriers to effective
communication in WIC and strategies that can
help you overcome them.
 How to use non-verbal communication
techniques which result in positive and effective
communication.
 Effective interpersonal communication
techniques that promote a participant-centered
approach to nutrition assessment.
 LOVE Method of Counseling.
Concerns/Questions?
• Remember, Change DOESN’T
happen overnight!
• You’ll need to practice these
new assessment/counseling
habits!
• It’s normal to slip back into
old ways, but keep trying!
• VENA Works!!
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YOU
CAN MAKE A
HUGE
DIFFERENCE
WITH
VENA.
YOUR CLIENTS WILL
THANK YOU FOR IT!
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