RAPPORT BUILDING Bridget Swinney MS, RD www.healthyfoodzone.com www.babybitesbook.blogspot.com

1. RAPPORT BUILDING Bridget Swinney MS, RD www.healthyfoodzone.com www.babybitesbook.blogspot.com 1

2. 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.

3. The VENA Nutrition Assessment Process-How 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 3

4. Rapport Building • Importance ̶ per USDA • One of the VENA Essential Competency Areas • Rationale ̶ because it works! 4

5. 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? 5

6. How to Build Rapport? • Smile! • Remove as many barriers as you can! • Engage the Participant! 6

7. What are the Communication Barriers in Your Setting? • Cultural • Language • Socio-Economic • Generational/Situational Poverty • Environmental/Physical • Emotional • Appearance/Dress 7

8. Barriers to Effective Communication Discuss Handouts Cross-Cultural Nutrition Awareness 8

9. Handout 2.1 : Effective Cross-Cultural Communication • Handout 2.2 : Guidelines for Cross-Cultural Communication • What About Language Barriers? • Handout 2.8: Little or No English • Handout 2.9: Working with An Interpreter 9

10. 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

11. Other Barriers to Communication • Cultural • Language • Socio-Economic • Generational Poverty • Situational Poverty • Environmental/Physical • Appearance/Dress • Emotional 11

12. 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 12

13. Take 5 and Think about These 5 Must-Do’s… • Create a positive environment • Limit your teaching objectives • Communicate clearly and simply • Use multiple ways to get message across • Verify understanding 13

14. Nonverbal Communication Techniques • Have perceived meanings • Exhibited by counselor and participants • Can Help or Hurt Communication 14

15. Effective/Ineffective Counselor Nonverbal Behavior Handout 3.1 Nonverbal Behavior/Body Language 15

16. Establishing a Participant-Centered Approach Handout 4.1 Interpersonal Communication: Characteristics of Effective Nutrition Counselors Handout 4.2 Interpersonal Communication: Getting Permission 16

17. LOVE CounselingTechnique Listen & Observe Open Ended Questions Validate Empower/Educate 17

18. 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 18

19. 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? 19

20. What is Reflective Listening? • Paraphrasing the response, which: • 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? 20

21. Reflective Listening Handout 4.6: Reflective Listening Technique Exercise 4.2: Practice Reflective Listening 1 Exercise 4.3: Practice Reflective Listening 2 21

22. What makes an Open Ended Question? • 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 22

23. Closed vs. Open Questions • 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… 23

24. 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? 24

25. 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? 25

26. Open Ended Questions Handout 4.4: Tried and True Open-ended Questions 26

27. 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? 27

28. 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. 28

29. 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

30. Sample Validations • 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… 30

31. 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. 31

32. 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 32

33. 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 33

34. 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. 34

35. LOVE Counseling Technique Listen and Observe Open Ended Questions Validate Empower/Educate 35

36. Rapport Building ̶ Putting it All Together! • Focus on Positive Health Outcomes • Exercise 5.2 - Case Study 36

37. 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.

38. 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!! 38

39. YOU CAN MAKE A HUGE DIFFERENCE WITH VENA. YOUR CLIENTS WILL THANKYOU FOR IT! 39