Motivational Interviewing (MI) Basics for Chronic Health Conditions

1. Motivational Interviewing (MI) Basics for Chronic Health Conditions Mia Croyle, M.A. MetaStar WebinarApril 17, 2018

2. Continuing Education Disclosures Commercial Support – None Speaker or planner conflicts of interest – None For CME, CNE credit, or attendance certificate - Full session attendance and completion of one on-line evaluation. For social workers - Full session attendance, completion of one on-line evaluation, and post- test. Evaluation link – Will be displayed at the conclusion of the webinar Thank you!

3. About Me Using MI since 2007 • Primary care • Phone coaching • Groups Training & coaching MI since 2009 • Healthcare • Social services • Criminal justice Member of Motivational Interviewing Network of Trainers (MINT)

4. Objectives • After attending this webinar, participants will be better able to: • Identify the spirit of MI, and contrast it with other approaches • Begin to integrate the core MI skill of reflective listening into their current practice • Utilize one MI strategy in current practice • Design a plan for next steps in continued development towards proficiency in MI

5. Disclaimer • This webinar is not meant to prepare participants to deliver this evidence-based practice with fidelity. • Learning MI is a developmental process that requires a long-term investment of time and effort. • People learn best when they have repeated opportunities to practice learned skills and receive feedback on performance from experienced MI practitioners and to incorporate this feedback into practice.

6. Motivational Interviewing • Definition: • Motivational interviewing is a collaborative, person-centered guiding method designed to elicit and strengthen motivation for change. • A framework for structuring conversations so that the other person has ample opportunity to hear themselves making the argument for change. • Robust evidence base.

7. Chronic Conditions • Typically involve multiple behavior changes - • Diet, exercise, medication, specialty care • Healthcare professionals have traditionally been trained to promote change through advice giving • This style may work for patients who are unaware of recommendations • A portion of patients are aware of recommendations and still do not make changes

8. Goals of Motivational Interviewing • Identify internal motivation • Reinforce this motivation • Develop a plan to achieve change

9. Key Concepts • Reduce resistance • Competency worldview • Partnership • Autonomy • Empathy • Address ambivalence • Develop discrepancy • Evoke change talk

10. Spirit of MI

11. Partnership Tool

12. Change Talk • The other person’s own arguments for change. If I took my pills I might feel better I’m tired of feeling so sick all the time If I felt better I could watch my grandkids I wish I could lose weight I have to quit smoking before I go on oxygen I know I could find ways to be more active I suppose I could eat a salad for lunch I want to be alive to watch my kids grow up The dietician might help me get on track

13. MI Skills • Open-ended questions • Affirmations • Reflective listening • Summary

14. Reflective Listening • Mirrors back what the other person said or meant • Encourages other person to say more • You can shape direction by what you reflect

15. Reflective Listening Example I don’t think you understand. I don’t have any more sick time so I can’t be going to all these appointments. I’m feeling fine now and I have the pills so I don’t see why the doctor can’t just call me in more refills.

16. Reflective Listening Example • You’re frustrated • This is really hard • Coming in for appointments is challenging • You’re struggling to fit your appointments into your work schedule • Now that you’re feeling better this doesn’t seem as urgent • You wish there was an easier way. • It doesn’t make sense to you why the doctor wants to see you before refilling this prescription I don’t think you understand. I don’t have any more sick time so I can’t be going to all these appointments. I’m feeling fine now and I have the pills so I don’t see why the doctor can’t just call me in more refills.

17. Reflective Listening practice It’s no fun sticking to that low sodium diet! I can’t eat anything I like, especially at restaurants. So yeah, sometimes I guess I end up eating more sodium than the doctor said I should.

18. Reflective Listening practice • I can take these water pills fine on most days, but on days when I’m going to be out and about I can’t trust that I’m going to be able to find a bathroom in time, so then I just skip my pills those days.

19. Evoking Change Talk • Ask. Don’t Tell! • What are some of your concerns about (condition)? • What might be the worst thing that could happen if things continue as they are? • How might making a change be beneficial for you?

20. Sharing information in an MI way

21. Resources • Motivational Interviewing Network of Trainers - www.motivationalinterviewing.org • Guilford Press – Applications of Motivational Interviewing Series

22. Summary • MI spirit involves working in a style that conveys partnership, evocation, acceptance, and compassion. • Strategies such as explore-offer-explore and agenda sharing help establish partnership and invite patients to be active members of their health care team. • Change talk is when patients make their own arguments for change and plays an important role in motivation. • Learning MI is a developmental process that requires a long-term investment of time and effort and there are many resources to learn more about MI.

23. Questions? Mia Croyle, M.A. mcroyle@metastar.com www.lsqin.org www.metastar.com

24. This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MI-G1-18-18 041118