Motivational Interviewing 30k feet

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  • Revisit to include make sure non-clinical is covered? Here’s how long I’m going to talk
  • We are all lifelong learners. What I’ve learned along the way after my Masters in Public Health IFTF Role of the consumer and technology research. Demographic and economic changes create long-term trends that effect healthcare and how consumers engage with it. Consumer demands are changing HC. Internet, mobile, health games, LifeMastersMI and activation and resultsDirect experience w translation of research into practiceAward winningLong road, staff quotes:StayWellWellness approachBackground in health coaching, personal training gave an advantage nurses didn’t have. They are trained to work with the motivation the member has, not push their ideas onto the member.
  • Value being clear to case managers and to the non-clinical staff translates into clear articulation of the value for the member.
  • For this project, we’ve devised strategies to improve member engagement. These won’t all get the same weight and time in the training because we don’t have a large amount of time with the staff, currently the clinical staff training is 8 hours. These are all strategies that can be expanded over time. This may just be the first step in your continued efforts to improve engagement .
  • As a result of this training, participants will be able to:Constraint: Stress basic MI given that normal intro to MI is a 16 hour course and we have half the time
  • Successful training, with WellPoint’s integration of techniques, will result in the following:
  • The evaluation process of the context for case management will allow us to step back and look at the big picture of what’s being asked of the CM staff. We want the end result to not be just piling more on top but rationalizing their interaction with the member to make it as efficient and productive as possible. We’ll customize the training to the WellPoint-Anthem context. Case Management is an incredible valuable service to members. We want CM staff to have pride in what they do and feel good about how WellPoint is supporting them to do their jobs well.
  • That definition is very different from how most CMs are trained as nurses. Nurses are trained to listen but then to educate and direct. MI is going to be a big change for CM staff. Care plans might change. If they’re going to be successful and from the member’s perspective, then they can’t be put upon the member by the CM. If care plans are more successful, then CM staff will be more effective and successful and feel better too, assuming that the collaboration with the member ends in an appropriate. Beware of the pendulum swinging too far in the other direction and staff losing the ability to guide the member/come along side.
  • Example of exercise
  • Example of exercise Support self-efficacy: pt has the resources they need to succeed, draw it outExpress empathy: see the world through their eyes, how would you respond?Roll with resistance: a helper wants to direct, and tell the pt why they should do x, y, z. when CM takes up the argument for change, the only side available to the pt is the argument against changeDevelop discrepancy: btwn how you want your life to be vs. how it currently is, btwn values and day-to-day behavior Most people come in to a treatment situation ambivalent about making a change. Meet a helper who is fixer. Stop go back, you should do this insteadFixer makes arguments for change. Client says no, it’s not that bad. When you take resp for good arguments, but you leave the bad arguments for the client. Client talking self out of changing.
  • Example of exercise
  • Image of overlapping studies of MI
  • This isn’t full MI. this is just putting your toe in the water.
  • I looked for a before and after picture to illustrate the size of the change. It’s reminiscent to me of learning a new language. When you start, it’s about key concepts and some vocabulary. Being immersed in it and continuing to practice it is the best way to really take it in and incorporate it into who you are and how you interact with the world. you are there when you don’t have to think about it, when it just comes to you. When you dream it.
  • So what does this all result in? Member > positive self-efficacy, lower depression, more likely to get help, more likely to experience better health
  • Motivational Interviewing 30k feet

    1. 1. ENGAGEMENT TRAINING FOR CASE MANAGEMENT: MOTIVATIONAL INTERVIEWING Mary M. Cain, MPH July 8, 2011
    2. 2. Mary I am a part of all that I have met – Tennyson  Institute for the Future > role of consumers & technology  LifeMasters > application of activation and motivational interviewing in disease management call centers decreased HC utilization by 11%  StayWell > health coaches have an advantage in engaging members
    3. 3. Improving Member Engagement From Case Management Team:  We need to improve engagement with members  Case Managers don’t like “selling” themselves  We want to improve member’s health by ensuring access to the services available  The value of case management not clear to the member or to case managers  Current results:  Short interactions  Missed opportunities  No connection made with the member
    4. 4. How to improve CM results  Revisit the value of case management from the case manager’s perspective  Introduce Motivational Interviewing  Meet the member where they are  Learn how to listen, collaborate and connect with the member
    5. 5. Objectives for training  Describe the core skills of motivational interviewing and the concept of engagement as they apply it to the case management process  Demonstrate basic motivational interviewing techniques and an understanding of how to engage members in assessment, goal setting and achieving plan of care  Practice specific techniques to increase member engagement to facilitate assessment, goal setting and achieving plan of care  Demonstrate skills to utilize effective responses designed to reduce member resistance, allowing facilitation of goal setting and continued member engagement with the plan of care
    6. 6. Process for developing and conducting training  Learn about the context for case management  How are staff trained?  What are they measured on?  What do they think works and why?  Develop customized training  Provide training  Train-the-trainer  Clinical: 3 modules trained in August  2 virtual 2-hour trainings over 2 weeks, 1 onsite 4-hour training  Non-clinical: 2 modules trained in September  2 virtual 2-hour trainings over 2 weeks  Post-training evaluation
    7. 7. Success Metrics  CM staff’s ability to articulate an understanding of the case management program  CM staff’s comfort with ability to engage members as measured by pre- and post-training assessments  Effective communication with members as measured by member surveys  Efficient process for staff that doesn’t increase perception of workload burden as measured by pre- and post-training assessments (i.e. revisiting the process, not just piling more on top)  Long-term measures of success  Fewer “one and done” cases, fewer incidences of “lost contact”  Greater member satisfaction with case management services
    8. 8. Context of Case Management  Why do people choose to be case managers?  What helps them connect with their members?  What are the barriers to connecting?
    9. 9. Motivational Interviewing  Collaborative, person-centered form of guiding to elicit and strengthen a person’s motivation for change – Bill Miller  Goal: give the staff tools to draw the member out and support the member’s own motivation for change in the context of an appropriate care plan
    10. 10. Spirit of MI  Collaborative > a partnership, not top down  Evocative > the member has the resources within herself to make a change  Honors autonomy > Case Manager can’t make choices for the member
    11. 11. Principles of MI  Support self-efficacy  Express empathy  Roll with resistance  Develop discrepancy
    12. 12. MI Techniques  OARS  Open-ended questions  Affirmative statements  Reflective statements  Summary statements  Listening for change talk  Desire: Why would you want to make this change?  Ability: How would you do it if you decided?  Reason: What are the three best reasons?  Need: How important is it? and why?  Commitment: What do you think you’ll do?
    13. 13. MI works
    14. 14. Keys to success  Training is the first step in a journey  Evidence supports ongoing coaching and management support will make or break the sustainability of the change  Supporting infrastructure is key  Performance evaluation and measurement must adjust to continue staff growth in skills
    15. 15. MI is a big change  Change is hard  Congratulations on taking this first step  This is a marathon, not a sprint
    16. 16. Value  To member: greater self-efficacy, help when they need it and ultimately better quality of life  To staff: job satisfaction, more efficient process and time well spent  To Corporation: more appropriate use of services, improvement in the health of the member population
    17. 17. Thank You  Mary M. Cain, MPH  mcain@ht3.com  415-656-6788

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