MOTIVATIONAL INTERVIEWING CREATING PATIENT CENTERED HEALTH BEHAVIOR CHANGE

MOTIVATIONAL INTERVIEWING CREATING PATIENT CENTERED HEALTH BEHAVIOR CHANGE IN DIABETIC PATIENTS Chet Fox MD Elizabeth Stewart Ph. D Brian Manning MPH

What is Motivational Interviewing “MI works by activating patients own motivation for change and adherence to treatment” Rollnick S, Miller W , Butler C, Motivational Interviewing in Health Care p. 5

Key Elements Promote desire to change Promote confidence change is possible

Seven Principles 1. 2. 3. 4. Motivation to change is elicited from the client, and not imposed from without It is the patient’s task, not the clinician’s, to resolve his or her ambivalence Direct persuasion is not an effective method for resolving ambivalence. The counseling style is a quiet and eliciting one

Seven Principles (Con’t) 5. 6. 7. . The clinician is directive in helping the client to examine and resolve ambivalence Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction The therapeutic relationship is more like a partnership or companionship than expert/recipient roles. http: //www. motivationalinterview. org/clinical/whatismi. html

From Priest to Partner PRIEST Wears Collar Speaks Latin Expert: tells person what to do Has confessional Parishioner admits sins Gives penance DOCTOR Wears white coat Speaks Latin Expert: tells person what to do Has confidential exam room Patient confesses what they did not do Gives pills

How I got started AI M-HI The story of Larry

Notable Quotes “ It is less frightening to come to you, I feel more like you are my friend” “I don’t feel like I am going to the Principal’s office anymore”

Goal Setting Areas �Nutrition �Activity �Emotional Well Being �Smoking Cessation �Substance Abuse �Diabetes self management Need to be � Specific � What the patient wants to do (desire) � What the patient feels they can do (confidence) � Remember baby steps, we always want a positive result.

Remember Yoda “Try not. Do or do not, there is no try. ” -- Yoda

DEMONSTRATION

Workshop Assignment One 1. 2. 3. 4. 5. Pair up Alternate being Doctor and patient Set actual goals for yourself in the areas of nutrition, activity and emotional well being If you need help, ask one of the 3 of us, Brian, or myself Take 10 minutes each, then we will reconvene

Workshop Assignment Two Break up into 3 groups Take 30 minutes How did you feel about the process How did you feel about the interaction Do you feel you can incorporate this in your practice What could you easily do What are some of the barriers How would you apply this to your diabetic patients

Debrief (Whole Group) Each group reports what it found