Motivational Practice: Online Learning

1. Motivational Practice: Online Learning Rick Botelho, BMedSci., B.M., B.S., MRCGP (UK)Professor of Family Medicine and Nursing University of Rochester, NY You can use blended learning methods (workshops, online programs, telephonic coaching) to enhance your motivational skills. To begin this life long process, your can use the MHH online learning program to improve your own health habits before helping their patients. This learning process is based on the book, Motivational Practice. You can use blended learning methods (workshops, online programs, telephonic coaching) to enhance your motivational skills. To begin this life long process, your can use the MHH online learning program to improve your own health habits before helping their patients. This learning process is based on the book, Motivational Practice.

2. 2 Personal Introduction Doing R&D on creating blended learning methods and complex process innovations that focus on motivating changes in organizations, practitioners and patient behaviors Adopting a post-modern pragmatic approach, using multiple theories and models that fit the needs of organizations, practitioners and patients Consults with organizations to set up MHH Leader Teams to disseminate and evaluate motivational practice that helps individuals to create personal evidence about healthy behavior change

3. Motivational Practice: Promoting Healthy Habits & Self-care of Chronic Disease Second Edition 2004

4. Vision from the 4th century BC W.H.S. Jones, Hippocrates, Harvard University Press, Cambridge, MA (1923).

5. Vision for the Future Motivational interventions that promote healthful behaviors must become more individualized than the 21st century advances in the drug treatment of diseases.

6. Goals Learn about Motivational Practice Experience a simulation of an online learning exercise Role play skills development

7. Goal 1: Learn about Motivational Practice How does the evidence-based mindset handicap our progress in developing effective behavior change programs? What is motivational practice? Why is a paradigm shift needed to transform how health care settings develop effective programs? Why do practitioners need to change their role in order to develop effective programs? How can practitioners develop their motivational skills as part of life long process?

8. How Does the Evidence-based Mindset Handicap Our Progress?

9. Limitations Giving information and advice to patients about changing their unhealthy behaviors is equivalent to the placebo impact of nineteenth-century drugs. The use of this �drug� over and over again, when it is clearly not working, should be regarded as a

10. Move Beyond Superficial Scientific Evidence Outside-in Approaches

11. to Personal Evidence What works for the individual patient. In other words, what does it mean to change.

12. Personal Evidence Means Moving Beyond Superficial Change Gaining knowledge

13. Doing emotional work to Deep Change

14. When evidence-based guidelines do not work, experience-based learning can help you and your patients move beyond the limits of: Scientific evidence and surface change to develop Personal evidence about deep change Experience-based Learning 

15. What is Motivational Practice?

16. Motivational Practice Involves using the following theories, models and concepts to help patients change Transtheoretical model Cognitive behavioral interventions Self-efficacy Motivational interviewing Relapse prevention Solution-based therapy Self-determination theory Patient-centered approach These resources are integrated into a six-step model

17. Perceptions about risks, benefits and harms Cognitive and emotional resistance Cognitive and emotional motivation Energy level and competing priorities Confidence and ability Motives and values Motivational Practice

18. Motivational Practice Involves using the following theories, models and concepts to help patients change Transtheoretical model Cognitive behavioral interventions Self-efficacy Motivational interviewing Relapse prevention Solution-based therapy Self-determination theory Patient-centered approach These resources are integrated into a six-step model

19. Micro-skills Development: A Stepped Approach

20. 20 Patients use a blend of methods to: Create meaningful learning opportunities Explore deep change Make sense of their learning experiences. This reflective process activates patients to optimize their health habits and/or self-care of chronic diseases. What is Motivational Practice?

21. �Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.� MI is an epiphenomenon to the individual�s internal change process that is predominantly implicit during the practitioner-patient interaction. Contrasting MI and Motivational Practice

22. Contrasting MI and Motivational Practice MP is an explicit, concept-driven process that provides individuals with learning exercises to generate reflective, meaningful and sense-making experiences. This learning process demystifies the role of the professional facilitator and helps individuals, families and communities learn skills for very day life. Individuals can access professional services when needed.

23. Contrasting MI and Motivational Practice Motivational Interviewing Psychological Context Single, sequential agenda One-to-one interaction Behavioral specialists High touch Inter-personal process 45-60 minutes Limited sessions Motivational Practice Primary Care Context Concurrent, complex agendas Blended learning methods Team/IT approach High-tech, High touch Intra-personal process 3-15 minutes Ongoing partnership

24. Contrasting MI and Motivational Practice Motivational Interviewing Reflective listening Facilitator-dependent Individualistic focus FRAMES OARS MISC Scientific evidence Motivational Practice Reflective learning Concept-driven Ecological approaches Motivational principles A Six-step Model 12 motivational variables Personal Evidence

25. An intra-personal process that uses a blend of learning methods: Reading Journaling Telephonic support Online learning Interpersonal support family members & friends, peer counseling lay health guides, health care professionals Motivational Practice

26. Putting Motivational Principles into Practice Support Autonomy Invite participation Gain consent Be nonjudgmental Offer choice

27. Putting Motivational Principles into Practice Understand patient�s perspective Develop empathic relationships Clarify roles and responsibilities Clarify patients� issues about change Work at a pace sensitive to patients� needs Understand patients� emotional resistance, perceptions & values

28. Putting Motivational Principles into Practice Adopt a Positive Perspective Focus on strengths & health rather than on weaknesses & pathology Focus on solutions rather than on problems Help patients believe that healthy outcomes are possible Encourage patients to do emotional work (address dis-ease and negative emotions)

29. Putting Motivational Principles into Practice Elicit patients� problem-solving skills Enhance patients� confidence and ability Increase supports & reduce barriers Negotiate reasonable goals for change Develop plans to prevent relapses Use �failures� as learning opportunities

30. Why is a paradigm shift needed to develop effective programs?

31. Old-New Paradigm  Old Scientist as PI Health advisors Advice= change agent Fixed process Rational, linear Teaching moments Surface change New Patients as PI Motivational Guides Dialogue = change agent Individualized process Emotional, nonlinear Learning opportunities Deep change

32. Why do practitioners need to change their professional role?

33. Metaphors and Professional Behaviors Metaphors that shape our professional behavior toward patients are hidden to varying degrees because they are embedded in the words of our everyday language. Metaphors can act as weapons against change, as well as agents for change.

34. Aristotle

35. Hammer Metaphor When we have only been trained to use hammers (give health information & advice), we tend to see every risk behavior as a nail.

36. Nut and Bolt Metaphor Hammers do not work very well with a nut (risk behavior) rusted to a bolt (patient). Hammering away at patients may make things worst, and even damage the threads of the bolt so the nut never comes off.

37. Gardener Metaphor We are most effective in helping patients change when we work as gardeners; cultivating the soil, planting seeds, and fertilizing the ground.

38. How can practitioners develop their motivational skills as part of life long process? 

39. A Model for Continuing Professional Development

40. Goal 2: Experience a simulation of an online learning exercise Clarify your issues about improving one of your health habits Rate your motivational scores Make sense of your motivational score and reflect on what they mean to you

41. Clarifying Issues About Change: Using a Decision Balance

42. Chapter 6 from "Beyond Advice: Developing Motivational Skills" by R.J. Botelho 42 Benefits Continuum

43. Chapter 6 from "Beyond Advice: Developing Motivational Skills" by R.J. Botelho 43 Risk Continuum

44. Chapter 6 from "Beyond Advice: Developing Motivational Skills" by R.J. Botelho 44 Readiness for Change

45. Lower Resistance:Using Nondirect Interventions Use simple reflection Probe priorities Use double-sided reflection Explore the future Acknowledge ambivalence Emphasize personal responsibility and choice

46. Increase Motivation:Using Direct Interventions Use benefit substitution Bring the future to the present Clarify values Identify discrepancies Use differences in motivational reasons Reframe events or issues:

47. Make Plans for Change Overcome negative self-talk Use your strengths Take a time-out Suppose a miracle happened Find exceptions

48. Make Plans for Change Build your confidence Increase your ability Understand addictions Selects goals Prevent lapses and relapses

49. 49 Summary Practitioners need to learn how to change themselves before helping others Practitioners need CPD opportunities to develop motivational skills through their careers Self-directed and web-based, distance learning training programs can greatly reduce the cost for helping practitioners develop basic skills Practitioners need mentors to develop advanced skills A resource www.MotivateHealthyHabits.com