1 MIHP NEW PROVIDER ORIENTATION DAY TWO 2

1 MIHP NEW PROVIDER ORIENTATION DAY TWO

2 Introduction to Motivational Interviewing

3 MI Attends to the Language of Change Motivational interviewing (MI) is a collaborative, goal-oriented style of communication with particular attention to the language of change Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

MI is an Effective Way to Talk with People about Self Change 4 Evidence-based Over 1200 publications in journals People don’t always change their behavior, even if they know it’s the right thing to do

MI Strengthens Motivation for Self. Change Through Acceptance 5 Motivational Interviewing is designed to strengthen personal motivation for – and commitment to – a specific goal, by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

6 The Decision to Change is Difficult Lack of change is not due to “opposition” “Refused” “Lazy” “In denial” Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

7 The Decision to Change is Difficult Goals may be incompatible Some people don't change because they don't want to change; they don't believe they have any reason to change The idea of change may produce anxiety—which may lead to procrastination Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

8 Motivational Interviewing is an Art

9 Start with Stages of Change Prochaska, J. O. , Norcross, J. C. , & Di. Clemente, C. C. (1995). Changing for good. New York: Avon Books.

Spirit of Motivational Interviewing 10 ü Engaging ü Focusing ü Evoking ü Planning Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

11 Engaging is the foundation Planning Evoking Focusing Engaging Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

Engaging in a Trusting Relationship 12 A mutually trusting and respectful relationship in which the client feels supported Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

13 Engaging in a Trusting Relationship Disengaging behavior Assessing Telling how to fix (righting reflex) “The authority” Labeling Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press

14 Discovering/Evoking Client’s Own Take on Self Values Goals Resources Perceptions Strengths Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

15 Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

16 Ask Open-Ended Questions to Open the Door Be an “open door” to accept information about the person - who they are & what they are about The direction of the conversation is controlled by the questions Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press. ,

17 Ask Open-Ended Questions to Open the Door Look for an answer beyond “yes” or “no” Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press

Use Affirmations to Build Hope & Connection 18 Builds hope, strengthens connection Comes from them versus you (as praise would) Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

19 Use Affirmations to Build Hope & Connection Identifies a strength, value, goal, effort or success of the individual Use the word “you” to start the affirmation. Avoid using the word “I” Form a statement that shows recognition, support, appreciation, respect, honesty and specificity Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

20 Reflective Listening is Fundamental to MI Give words to something that they may not have been able to express Seek to understand by trying to capture the essence Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

21 Reflective Listening is Fundamental to MI Respond to the last thing said and convey that understanding to them Give yourself space to wonder about the person’s experience Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press. ,

22 Reflective Listening is Fundamental to MI Voice/intonation go down at the end of the statement (instead of a question/up) Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

23 Summarizing Reflective Listening Convey understanding, link statements together like puzzle pieces Clarify complex information and demonstrate you are listening intently Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

24 Summarizing Reflective Listening Re-gather your thoughts or change direction of the conversation Summarize the strengths, capture or emphasize change talk Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

25 Planning to Make Changes Commitment Identify and plan for barriers Expect relapse Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

26 I’m All EARS: Responding to Change Talk Elaborate Affirm Reflect Summarize Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

Offering Information and Advice (with permission) 27 Important to have engagement because they need to know you understand their experience first Pick the timing of the exchange when the person seems like they want advice, or ask for it. Look for signals of engagement, interest, concern or openness to change Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press

Offering Information and Advice (with permission) 28 Ask for permission to offer advice or information. If they say “no thank you”, honor this Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

Listen for DARN CATS - Change Talk 29 D- Desire A- Ability R- Reason N- Need C- Commitment A- Action T- Taking S- Steps Miller, W. R. , & Rollnick, S. (2013). Motivational interviewing: Helping people change (3 rd ed. ). New York, NY: Guilford Press.

MI Training Available 30

31 Takeaway Points Motivational Interviewing is a collaborative way of communicating that focuses on the client’s language of change It is evidence based and used widely across health care settings Motivational Interviewing is replacing your agenda with the client’s agenda

32 Takeaway Points MI is in keeping with stages of change Reflective listening is fundamental to MI takes ongoing practice MIHP coordinator is responsible for ensuring staff is practicing MI Home visitors are responsible for using MI

33 MIHP Operations - Foundation Medicaid Provider Manual Federal/State Policy MIHP Operations Guide Program implementation guidance MIHP Certification Tool Program requirements utilized during Certification Review MDHHS Forms and Instructions Weekly Updates Email correspondence sent from MDHHS each week with program updates Bi-Monthly MIHP Community of Practice Calls

34 SCAVENGER HUNT

32 Maternal Infant Health Program (MIHP) Beneficiary Plan of Care

Beneficiary Plan of Care: Overview Risk Identifier Plan of Care, Part 1 Plan of Care, Part 2 (POC 2) Pregnancy Health POC 2 Tobacco POC 2 Substance Exposed Infant POC 2 Plan of Care, Part 3 MIHP Safety and Action Plan 36

Beneficiary Plan of Care: Risk Identifiers All maternal beneficiaries are assessed at intake during pregnancy. The mother/primary caregiver is assessed for all infant beneficiaries. 37

38 Maternal Risk Identifier (MRI)

39 Infant Risk Identifier (IRI)

Beneficiary Plan of Care: Plan of Care, Part 1(POC 1) Required activities at Risk Identifier visit: Maternal: 12 activities Infant: 14 activities Beneficiary/caregiver education Documentation of referrals Professional (SW or RN) who completes the Risk Identifier must sign and date the POC 1 40

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42 Text 4 Baby

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Enter MRI/IRI responses into MILogin 44

Risk Identifier: Scoresheet 45

Plan of Care, Part 2 (POC 2) Revision 46 Revised Maternal Risk Identifier and algorithm has been developed Revised Plans of Care, Part 2 have been developed in alignment with new algorithm but MIHP database has not yet been updated Risk Identifier Scoresheet + Professional Judgement = Appropriate POC 2 Development

Plan of Care, Part 2 (POC 2) Revision 47 Formatting and interventions align with the new Risk Identifier algorithm, program quality improvement initiatives and updated evidence-based best practices Two POC 2 formats currently in operation – Original and Revised Detailed instructions exist for both formats Revision includes merging some Risk Domains to reduce duplication of effort

Beneficiary Plan of Care: Plan of Care, Part 2 – Maternal Domains 48 Chronic Conditions Family Planning Asthma Diabetes Hypertension Pregnancy Health Nutrition Maternal Breastfeeding Tobacco Alcohol Substance Misuse Social Support Abuse/Violence Stress/Depression Food Housing Transportation Food/Nutrition

Beneficiary Plan of Care: Plan of Care, Part 2 – Infant Domains 49 Infant Health Care Infant Safety Feeding and Nutrition Infant Breastfeeding General Infant Development Family Social Support, Parenting and Child Care üPositive at Birth Substance-Exposed Infant üPrimary Caregiver Use üEnvironmental Exposure

Pregnancy Health POC 2 Original POC 2 formatting ‘Date 1 st Addressed’ no longer required 50

Tobacco POC 2 Revised POC 2 format Must utilize professional judgement to mitigate Risk Identifier algorithm misalignment 51

Substance Exposed Infant POC 2 Based on professional judgement If Substance Misuse scores for Maternal Considerations; Substance Exposed Infant POC 2 is required Billing considerations May utilize POC 2 beginning at enrollment Must utilize POC 2 for visits 18 – 36 (with physician order) Please review page 37 in the Operations Guide for detailed information about Substance Exposed Infants 52

POC 2 – Other Considerations Substance Exposed Infant and Breastfeeding domains do not score on the RI Provider must use professional judgement to determine risk Some domains require specific interventions to be addressed Nutrition Domain - High Risk = Referral to Registered Dietician Stress/Depression Domain - High Risk = Referral to Infant Mental Health Services Safety Plans Please utilize the Certification Tool, Operations Guide and Forms Instructions to ensure complete/accurate implementation of POC 2 s 53

Beneficiary Plan of Care: Plan of Care, Part 3 Signature page for accurate/complete development of the POC 2 Must be signed by RN and SW (within 10 days of each other) May be signed by RD, IMHS, IBCLC Must be updated, if a new domain is added 54

Beneficiary Plan of Care: MIHP Safety Plan Operations Guide, p. 94 -95 and Certification Tool – Indicator 46 MIHP Safety Plan is required for all beneficiaries who score high on the following domains: Stress/Depression Infant Safety Intervention #6 Abuse/Violence Intervention #13 Intervention #14 Substance Exposed Infant Intervention #9 55

Beneficiary Plan of Care: MIHP Action Plan Operations Guide, p. 94 § Every beneficiary chart must have documentation of at least one completed MIHP Action Plan § Documentation: § Professional Visit Progress Note (Maternal and Infant) • ‘MIHP action plan completed/reviewed’ checkbox on Page 2 56

Beneficiary Plan of Care: Connection 57 Risk Identifier Visit: Risk Identifier and POC 1 completion Risk Identifier Scoresheet and Professional Judgement inform the Plan of Care, Part 2 development Plan of Care, Part 3 is signed to confirm plan of care Professional Visits focus on POC 2 s Interventions addressed are documented on the PVPN (next presentation) Risk Identifier, POC 2 s and PVPN inform the Discharge Summary (Day 5 presentation)

58 USING MIHP FORMS Website resources Setting up charts Document, Document Common errors on forms • Narrative examples • Discussing family planning

Let’s take a closer look at the Assessment visit~ 75

60 ELEMENTS OF AN MIHP WELCOME PACKET HANDOUT (SAMPLE FOLDER)

text 4 baby and Education Packet 61 ØYou must provide either the education packet at program entry or assist with signing up for text 4 baby ØEducation Packet can be found on the MIHP website Øtext 4 baby information cards are available today text 4 baby

62 Handouts: Risk Assessment Visit (cont. ) • • • MIHP Case Scenario Outline Maternal Risk Identifier Worksheet Maternal Risk Identifier Instructions Welcome packet MIHP Cycle 7 Required Timelines

Setting Up Charts Develop a packaging/filing system. Specific formats help. Organization is the key!! The following items are included in a beneficiary chart: Checklist Contact Log Electronic print-out of the MRI/IRI (including score sheet) Consent to participate in the program Consent to release protected health information Plan of Care 1 63

Setting Up Charts (cont. ) Plans of Care 2 Plan of Care 3 Safety Plan (if needed, may be given to the beneficiary) Action Plan (if needed, may be given to the beneficiary) Professional Visit Progress Note (PVPN) Beneficiary Status Notification Prenatal or Infant Communication Form 64

Setting Up Charts (cont. ) Unique to Infant charts: ASQs Supplemental Forms Notification of multiple charts open (family chart vs individual charts) Transfer consent/checklist Reminder: Add the beneficiary to the monthly communication tool with the health plan 65

Questions? ? 66