A discussion of motivational interviewing: what is it, how does it work, and how can we start to use it with students face forced behavior change in academics?
Josué Guadarrama MA Presentation at 2016 Science of HOPE
Motivational Interviewing (MI) is a directive, client-centered counseling and/or communication style for eliciting behavior change by helping individuals to explore and resolve ambivalence, while minimizing resistance and maximizing intrinsic motivation. Compared with nondirective counseling, MI is more focused and goal-directed. Based on the physics of behavior change, participants will learn assessment and communication skills that foster sustained behavior change by tapping into intrinsic motivation. Aside from a didactic approach, there will be video examples and skill practice. Audience participation is highly encouraged.
Motivational Interviewing has been described as “simple but not easy”. Continued practice and coaching are key to increasing practitioners’ MI proficiency, particularly in our intentional and strategic application of the spirit and skills of MI. This immersive, practice-based session builds on the two-day introductory Motivational Interviewing workshop by guiding participants through a series of structured, scaffolded activities that directly relate to your challenging client encounters in your day-to-day work. You will leave this fun and dynamic workshop with a renewed and deeper understanding of how to enhance your clients’ motivation for change by taking your MI skills to the next level!
Learning Objectives:
At the end of this day of applied practice, you will be able to:
1. Assess your areas of MI proficiency and further development
2. Practice OARS to evoke client change talk
3. Practice OARS to respond to clients’ change talk
4. Apply strategies to respond to clients’ sustain talk and enhance motivation for change.
A discussion of motivational interviewing: what is it, how does it work, and how can we start to use it with students face forced behavior change in academics?
Josué Guadarrama MA Presentation at 2016 Science of HOPE
Motivational Interviewing (MI) is a directive, client-centered counseling and/or communication style for eliciting behavior change by helping individuals to explore and resolve ambivalence, while minimizing resistance and maximizing intrinsic motivation. Compared with nondirective counseling, MI is more focused and goal-directed. Based on the physics of behavior change, participants will learn assessment and communication skills that foster sustained behavior change by tapping into intrinsic motivation. Aside from a didactic approach, there will be video examples and skill practice. Audience participation is highly encouraged.
Motivational Interviewing has been described as “simple but not easy”. Continued practice and coaching are key to increasing practitioners’ MI proficiency, particularly in our intentional and strategic application of the spirit and skills of MI. This immersive, practice-based session builds on the two-day introductory Motivational Interviewing workshop by guiding participants through a series of structured, scaffolded activities that directly relate to your challenging client encounters in your day-to-day work. You will leave this fun and dynamic workshop with a renewed and deeper understanding of how to enhance your clients’ motivation for change by taking your MI skills to the next level!
Learning Objectives:
At the end of this day of applied practice, you will be able to:
1. Assess your areas of MI proficiency and further development
2. Practice OARS to evoke client change talk
3. Practice OARS to respond to clients’ change talk
4. Apply strategies to respond to clients’ sustain talk and enhance motivation for change.
Resilience: how to build resilience in your people and your organizationDelta Partners
"It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change."
- Charles Darwin
Those people who are familiar with our work know that we write quite a lot about the pace of change in our global business environment. It is continual, it is unrelenting, and it appears to be accelerating.
We cannot slow the pace of change, so do we give up? Throw our hands up and succumb to the tidal wave of knowledge that we are adrift and rudderless? And if not, what can we do to make our people and our organizations more resilient in the face of this ongoing pressure?
"Resilience: an ability to recover from or adjust easily to misfortune or change."
- Merriam-Webster Dictionary
It turns out that there are definitely steps that a manager can take to influence the resilience of both the organization and the individual.
The goal of this presentation is to provide a starting point for leaders and managers as they seek ways to battle back against the apathy and exhaustion that builds in everyone. It is not the final word in these matters – rather it is best considered a jumping off point for those who are looking for a different way.
So enjoy it, share it, and use it. Just let everyone know where you found it!
Jim Ellermeyer and the students do some role playing. Does this sound familiar? We look at how do we deal with our internal thoughts and day to day using DEER MAN skills.
Homework: Go to a good friend or partner. Ask what attracts them to you. Write those down to become your mantra every morning to get some positivity in your life!
Want an audio version? Subscribe to our Podcast on iTunes, Spreaker, or iHeartRadio!
Follow the Educational Grand Rounds Playlist on Youtube!
Follow us on Twitter, Facebook, or Google+ to get updated with the link when do occasional talks LIVE via Google Hangout OnAir!
The following is for educational purposes only. It is not intended as a substitute for medical or psychological advice, diagnosis, or treatment. The content should not be used for self-diagnosis, or treatment of any health-related condition. As always, seek the advice of your health care provider with any questions regarding a medical or mental health condition. Opinions expressed are the personal opinions and do not represent S’eclairer Behavioral Therapy.
This was a conference presentation for teachers and students at Guangdong University of Foreign Studies.
Nowadays, in clinical practice, existential psychotherapy involves diverse groups of patients, methods and theories. It is a formulation of procedures which are loosely linked to some common themes (which I will describe to you shortly). The unifying notion for these themes is that existential psychotherapy is a philosophical method
of therapy (strictly speaking it is the content and not the method which is philosophical) that is founded on the belief that the inner conflict within a person is due to the individual person’s confrontation with the universal omnipresent predicaments of human existence.
Most people believe personality traits are fixed characteristics that are present at birth and persist throughout an individual’s lifetime. Recent research, however, indicates these “fixed” traits are simply the symptoms of a person’s belief system. These beliefs can be so strong, in fact, that they positively or negatively influence every aspect of an individual’s life: sports, business, relationships, parenting, teaching, and coaching.
According to Carol S. Dweck, one of the world’s leading researchers in the field of motivation, there are two main belief systems, or mindsets, that people can possess. These mindsets strongly influence the way individuals respond to success and failure, and in Mindset, Dweck uses research, examples of well-known business and sports leaders, and specific scenarios to demonstrate how changing one’s mindset can profoundly affect the outcome of almost every situation. Dweck also explains how understanding the basics of mindsets can help in accepting and understanding relationships and the people who comprise them
Learn how mindfulness-based stress reduction (MBSR) can help relax your body, calm your mind and spirit, and reduce overall stress. Our meditation techniques are ideal for women and men coping with chronic anxiety, illness, and pain.
Resilience: how to build resilience in your people and your organizationDelta Partners
"It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change."
- Charles Darwin
Those people who are familiar with our work know that we write quite a lot about the pace of change in our global business environment. It is continual, it is unrelenting, and it appears to be accelerating.
We cannot slow the pace of change, so do we give up? Throw our hands up and succumb to the tidal wave of knowledge that we are adrift and rudderless? And if not, what can we do to make our people and our organizations more resilient in the face of this ongoing pressure?
"Resilience: an ability to recover from or adjust easily to misfortune or change."
- Merriam-Webster Dictionary
It turns out that there are definitely steps that a manager can take to influence the resilience of both the organization and the individual.
The goal of this presentation is to provide a starting point for leaders and managers as they seek ways to battle back against the apathy and exhaustion that builds in everyone. It is not the final word in these matters – rather it is best considered a jumping off point for those who are looking for a different way.
So enjoy it, share it, and use it. Just let everyone know where you found it!
Jim Ellermeyer and the students do some role playing. Does this sound familiar? We look at how do we deal with our internal thoughts and day to day using DEER MAN skills.
Homework: Go to a good friend or partner. Ask what attracts them to you. Write those down to become your mantra every morning to get some positivity in your life!
Want an audio version? Subscribe to our Podcast on iTunes, Spreaker, or iHeartRadio!
Follow the Educational Grand Rounds Playlist on Youtube!
Follow us on Twitter, Facebook, or Google+ to get updated with the link when do occasional talks LIVE via Google Hangout OnAir!
The following is for educational purposes only. It is not intended as a substitute for medical or psychological advice, diagnosis, or treatment. The content should not be used for self-diagnosis, or treatment of any health-related condition. As always, seek the advice of your health care provider with any questions regarding a medical or mental health condition. Opinions expressed are the personal opinions and do not represent S’eclairer Behavioral Therapy.
This was a conference presentation for teachers and students at Guangdong University of Foreign Studies.
Nowadays, in clinical practice, existential psychotherapy involves diverse groups of patients, methods and theories. It is a formulation of procedures which are loosely linked to some common themes (which I will describe to you shortly). The unifying notion for these themes is that existential psychotherapy is a philosophical method
of therapy (strictly speaking it is the content and not the method which is philosophical) that is founded on the belief that the inner conflict within a person is due to the individual person’s confrontation with the universal omnipresent predicaments of human existence.
Most people believe personality traits are fixed characteristics that are present at birth and persist throughout an individual’s lifetime. Recent research, however, indicates these “fixed” traits are simply the symptoms of a person’s belief system. These beliefs can be so strong, in fact, that they positively or negatively influence every aspect of an individual’s life: sports, business, relationships, parenting, teaching, and coaching.
According to Carol S. Dweck, one of the world’s leading researchers in the field of motivation, there are two main belief systems, or mindsets, that people can possess. These mindsets strongly influence the way individuals respond to success and failure, and in Mindset, Dweck uses research, examples of well-known business and sports leaders, and specific scenarios to demonstrate how changing one’s mindset can profoundly affect the outcome of almost every situation. Dweck also explains how understanding the basics of mindsets can help in accepting and understanding relationships and the people who comprise them
Learn how mindfulness-based stress reduction (MBSR) can help relax your body, calm your mind and spirit, and reduce overall stress. Our meditation techniques are ideal for women and men coping with chronic anxiety, illness, and pain.
Motivational Interviewing - CHANGE TALKJohn Russell
In the latest Motivational Interviewing (MI) Club we look at what Change Talk really is and how to use it to help people to make changes. See examples of what words people might use when discussing their change - www.miinlondon.org
Powerpoint accompanying workshop session from the Homeless and Housing Coalition of Kentucky's 2013 conference. Presented by Patrick McKiernan
Motivational interviewing is a technique that uses a dialogue between a counselor and a client who needs to
change behaviors in his or her life. The purpose of this technique is to be non-confrontational, non-adversarial and
non-judgmental, and uses open-ended questions and reflective listening to forge a relationship between counselor
and client built on trust and empathy. This session will present basic information on how to help increase motivation
to change with individuals considering but uncommitted to change. The discussion will include background, theory,
and techniques related to the change process.
This presentation was part of Embody's Safe Healthy Strong 2015 conference on sexuality education (www.ppwi.org/safehealthystrong). Embody is Planned Parenthood of Wisconsin's education and training programs. Learn more: www.ppwi.org/embody
DESCRIPTION
Reproductive life planning (RLP) is a client-based assessment of personal life goals to determine if and where childbearing fits in with education, family, relationships, work, and more. This assessment then informs the development of a flexible strategy to prevent or plan future pregnancies in order to successfully meet these goals.
However, getting patients to modify their health or sexual habits isn’t always easy. The practice of motivational interviewing (MI) is an effective catalyst for behavior change. MI is a quick, effective, client-centered counseling technique that allows clients to define their own goals and make their own choices by helping them identify what is personally meaningful and valuable in their own lives, and to act in ways that will help them meet their goals. Best of all, it works.
This full-day pre-conference workshop introduced participants to the core concepts of motivational interviewing, placed within the context of reproductive life planning, a process which allows individuals to make appropriate decisions regarding their sexual and reproductive health, desire to have children, and birth spacing.
Participants learned the basic techniques of motivational interviewing and discovered how to help clients assess their own goals, make a plan that will help them meet those goals, and find ways to overcome obstacles that may occur along the way.
ABOUT THE PRESENTERS
Meghan Benson, MPH, CHES, has worked in the field of sexuality education since she was a teen peer HIV educator in high school. Throughout her education and professional experience, she remained dedicated to advocacy and education around women’s sexual health. She completed her MPH in Community Health Sciences with a focus on adolescent health and development at the University of Illinois-Chicago and will be pursuing her PhD at the UW-Milwaukee Zilber School of Public Health in Fall 2015. As the director of Embody, Meghan develops programming and coordinates educational opportunities throughout the state. Meghan is a board member for the Association of Planned Parenthood Leaders in Education, a Wisconsin Alliance for Women's Health board member, and a member of the Dane County Youth Commission.
Anne Brosowsky-Roth has been with Planned Parenthood of Wisconsin for over 20 years. During that time, she has held various positions within the patient services and community education departments. In her current role, she provides direct education for Planned Parenthood staff and other health professionals on reproductive and sexual health. Anne also provides research and support for staff as the manager of the Maurice Ritz Resource Center, the Planned Parenthood of Wisconsin community library.
A 'Taste' of Motivational Interviewing with Dr. Ellen GlovskyEllen Glovsky
This is an informative and exciting one-hour webinar, in which I will provided an overview of the "spirit" and technique of Motivational Interviewing. The webinar included 40 minutes of lecture and ample opportunity for questions and answers.
MI is an evidence-based approach to health behavior change counseling. The method has been successfully used in many types of interventions, including the lifestyle changes recommended for weight management, diabetes, heart disease, eating disorders, HIV and cancer, the promotion of breast feeding, and nutrition for wellness and the prevention of chronic disease.
For more on MI and how it works, please sign up for my monthly newsletter http://eepurl.com/tbf81 , The Changing Times.
Please join me on Facebook https://www.facebook.com/TrainingwithDrEllenGlovsky and please join me on Facebook at my new 'book' page http://on.fb.me/1c0Iz73
Feel free to email any questions or comments you may have to Ellen@TrainingWithDrEllen.com
Navigating Conflict in PE Using Strengths-Based ApproachesCHICommunications
Led by CHI's Patient Engagement team, this session is intended to teach users how to deal with and prepare for conflict as it arises in patient engagement.
This lecture explores clinical tools to interrupt sustain talk to support change talk. Interrupting sustain talk is one of the core factors that predicts change in motivational interviewing sessions.
Self-confidence is one of the biggest obstacles for women in taking a seat at the table. In order to close the gender gap, we need more women to aim for positions of leadership. However, a lack of confidence can hold women back from everything to voicing an opinion to applying for a higher position. Addressing how to overcome these barriers is a critical issue no matter what level you are in your career. In this interactive workshop, we will explore what gets in the way to self-confidence, how the lack of confidence impacts women's leadership and contributes to the leadership gap, and what you can do to get more if it to get to the next level in your career.
Motivational Interviewing - Dr Igor Koutsenok MD, MSjames_harvey_phd
Session 1 "Motivational Interviewing Course: Assisting Patients in Making Sustainable Positive Lifestyle Changes"
Presented by Dr Igor Koutsenok MD, MS (University of California San Diego, Department of Psychiatry) on 05/06/2020 during the first session of an ISSUP virtual training on MI.
**PLEASE NOTE that video slides have been removed to reduce file size**
Presentation content and learning outcomes:
After orientation to the underlying spirit and principles of MI, practical exercises will help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Research evidence will be reviewed for the efficacy of MI and for the importance of building a therapeutic relationship in clients’ outcomes. Integration of MI with other treatment modalities will be considered.
Learning outcomes:
Introduction: Motivation and behavioral change in addiction medicine
Review of the concepts of Ambivalence, Stages of change, the righting reflex, limits of persuasion.
Spirit of MI
Expressing empathy
Roadblocks to communication
Four Processes in MI
Full details: https://www.issup.net/about-issup/news/2020-05/motivational-interviewing-course
Wyoming Hospital Association, part 2, Strategies for Building a Culture of Ow...Joe Tye
Slides used by Values Coach CEO and Head Coach Joe Tye in presentation for the 2017 annual conference of the Wyoming Hospital Association, part 2 of 3 parts.
Lessons from the River: Social Work, Social Service Work and Social Media
“You can’t stand in the same river twice” (Heraclitus)
“You can’t stand in the same river once” (Cratylus, student of Heraclitus)
“Social workers and social service workers should ensure that they are technologically aware and competent, as their clients are likely to have embraced technology in step with the general population” (OCSWSSW, 2012).
Professional practice has undergone massive change over the last three decades with the rise and proliferation of mobile and distributed communication and networking, but what exactly might “technology competence” look like for social workers and social service workers in the context of a rapidly evolving (and continuously flowing) digital ‘riverscape’? What are the implications for our professional ethics, boundaries, clients’ privacy and client-centred care? This dynamic, interactive and richly informative session will equip you with essential knowledge and resources for developing ongoing technology competence as a social work/social service work practitioner.
Andragogy 2.0? Introducing emerging frameworks for teaching and learning: Paragogy and Heutagogy. Presentation to College Degree Operating Group annual conference, June 3 2013.
Digital Communication Power Tools: Speakers Notes versionMarilyn Herie
This Keynote presentation at the 2012 Ontario Association of Social Work annual conference outlines the "digital communication power tools" for social workers and other practitioners. Speakers' notes can be toggled on or off. This file provides the Speakers Notes that accompany the slides.
This Keynote presentation at the 2012 Ontario Association of Social Work annual conference outlines the "digital communication power tools" for social workers and other practitioners. Speakers' notes can be toggled on or off.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. marilyn.herie@utoronto.ca
@MarilynHerie
www.educateria.com
• Dr. Marilyn Herie is the Academic Chair, Community Services at
Centennial College in Toronto, Canada, and Assistant Professor (Status
Only), University of Toronto Factor-Inwentash Faculty of Social Work. She
is a member of the international Motivational Interviewing Network of
Trainers (MINT), and has published numerous books, chapters and journal
articles on addiction, professional education and evidence-based practice,
including Substance Abuse in Canada with Oxford University Press. Dr.
Herie’s areas of interest and focus include e-learning and classroom
teaching, motivational interviewing and health behaviour change,
education research and evaluation, social media and interprofessional
education. She blogs about education and teaching-related topics at
www.educateria.com.
4. A scientist went to visit a famous Zen master.
While the master quietly served tea, the
scientist talked about Zen. The master poured
the visitor's cup to the brim, and then kept
pouring. The scientist watched the overflowing
cup until he could no longer restrain himself.
"It's overfull! No more will go in!" the scientist
blurted. "You are like this cup," the master
replied, "How can I show you Zen unless you
first empty your cup?"
http://users.rider.edu/~suler/zenstory/emptycup.html
5. Confidence Ruler
0 1 2 3 4 5 6 7 8 9 10
No Way I am
Bill Miller
http://www.williamrmiller.net/
6. Learning Objectives
At the end of this session, you will be able to:
1. Frame MI as a way of being with your client
– evocation versus installation
2. Review and practice the five key MI
strategies
3. Troubleshoot challenging practice
issues/cases
4. Identify barriers and enablers to
implementing MI skills with clients
5. Set concrete implementation objectives for
clinical practice
15. Compassion
Guide me to be a patient companion,
to listen with a heart as open as the
sky. Grant me vision to see through
his eyes, and eager ears to hear his
story…Let me honour and respect his
choosing of his own path.
Adapted from Miller, 2013, “A Meditative Preparation” (p.24)
17. Common Human Reactions to
Being Listened to
• Understood
• Want to talk more
• Liking the counselor
• Open
• Accepted
• Respected
• Engaged
• Able to change
• Safe
• Empowered
• Hopeful
• Comfortable
• Interested
• Want to come back
• Cooperative
17Slide from Bill Miller
18. 2. Why would I use it?
Motivational interviewing is a person-
centered counseling method for
addressing the common problem of
ambivalence about change
Miller & Rollnick 2013
26. “Unsolicited advice is the junk
mail of life.” (Bern Williams, in Miller &
Rollnick 2013)
27. Common Reactions to Righting Reflex
• Angry, agitated
• Oppositional
• Discounting
• Defensive
• Justifying
• Not understood
• Not heard
• Procrastinate
• Afraid
• Helpless, overwhelmed
• Ashamed
• Trapped
• Disengaged
• Not come back – avoid
• Uncomfortable
27Slide from Bill Miller
28. Common Human Reactions to
Being Listened to
• Understood
• Want to talk more
• Liking the counselor
• Open
• Accepted
• Respected
• Engaged
• Able to change
• Safe
• Empowered
• Hopeful
• Comfortable
• Interested
• Want to come back
• Cooperative
28Slide from Bill Miller
50. 3. How does it work?
Motivational interviewing is a collaborative,
goal-oriented style of communication with
particular attention to the language of
change. It 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 & Rollnick 2013
53. Sustain Talk and Resistance
• Sustain Talk is about the target behavior
• Discord is about your relationship
• Both are highly responsive to counsellor
style
• We respond to both in the same way
Miller & Rollnick 2013
54.
55. DARN CAT
• Desire
• Ability
• Reasons
• Need
• Commitment
• Activation
• Taking Steps
Miller & Rollnick 2013
56. Yet another metaphor
MI Hill
Contemplation Preparation Action(Pre-)
Slide from Bill Miller, 2010
57.
58. DARN CAT
• Desire
• Ability
• Reasons
• Need
• Commitment
• Action
• Taking Steps
Snap fingers = DARN
Clap = CAT
Silence = No change talk
Motivational Interviewing Network of Trainers (MINT)
59. Listening for Change Talk
“Things are getting totally messed
up with my courses.”
• Desire
• Ability
• Reasons
• Need
• Commitment
• Action
• Taking Steps
60. “My parents are the ones who are
worried about my grades.”
• Desire
• Ability
• Reasons
• Need
• Commitment
• Action
• Taking Steps
61. “I am not addicted to smoking pot.
I can quit anytime I want.”
• Desire
• Ability
• Reasons
• Need
• Commitment
• Action
• Taking Steps
62. “I want to get well again, but this
whole situation is totally unfair.”
• Desire
• Ability
• Reasons
• Need
• Commitment
• Action
• Taking Steps
63. “I have started working out, quit
smoking and drinking, have joined
Varsity basketball and am attending all
of my classes.”
• Desire
• Ability
• Reasons
• Need
• Commitment
• Action
• Taking Steps
72. Open versus Closed Questions
• CLOSED questions invite a “yes/no”,
one- word or very limited answer
• OPEN questions encourage elaboration –
they evoke the client’s ideas, opinions,
hopes, concerns, etc.
74. Affirmations:
• Go beyond “giving a good grade”
• Are not about the practitioner’s approval
of the client
• Acknowledge the client’s experience,
struggle, expertise, efforts, etc.
83. Simple Reflection
Complex Reflection
They are really on your case
about your cannabis use.
It wasn’t your idea to come,
and you’re not sure this is
going to be at all helpful to
you.
“I’m only coming to see you because my parents and my
boyfriend are all pressuring me about smoking pot.”
84. Simple Reflection
Complex Reflection
They are really on your case
about your cannabis use.
How you see it is, they are
the ones who have a
problem with it, and that is
frustrating.
“I’m only coming to see you because my parents and my
boyfriend are all pressuring me about smoking pot.”
85. Simple Reflection
Complex Reflection
They are really on your case
about your cannabis use.
It would feel a lot better if
they respected that what
you do or not do is your
choice and decision.
“I’m only coming to see you because my parents and my
boyfriend are all pressuring me about smoking pot.”
86. Simple Reflection
Complex Reflection
They are really on your case
about your cannabis use.
Even if you did have any
concerns, all this pressure
makes it hard to want to
change.
“I’m only coming to see you because my parents and my
boyfriend are all pressuring me about smoking pot.”
88. Practicing Reflective
Listening
Individually, take a moment to write
down an example of a simple and a
complex reflection for the following
statement (coming up – next slide).
Then compare what you wrote with
others at your table. As a group,
choose the best examples to share with
the larger group.
91. Simple Reflection:
You are the only one to decide how to
live your life.
Complex (Enhanced) Reflection:
You’re being told you have to make all
these changes, and that doesn’t feel very
respectful of your choice and autonomy.
“How I live my life is my own business and
certainly not yours.”
94. Simple Reflection:
You see that I am concerned, but you are
ready to stop taking the medication.
Complex (Enhanced) Reflection:
You feel like I am pushing for you to take
this medication, and not really
appreciating where you are at.
“I know you mean well, but I don’t need this
medication any more.”
95. More Reflections
• I am not going to call a crisis line.
• I was too busy to do that homework
you gave me.
• I am a perfectionist – I don’t stop until I
get something perfect.
• How am I supposed to improve my self-
esteem?
• I don’t have time to eat.
• Anxiety motivates me.
100. Reflecting Panel Instructions
1. Client: Share a paragraph with the Reflecting
Panel about your struggle/experience
2. Panel: Take turns offering a single reflection
3. Client: After ALL Panel members are done,
talk to your coach about which reflection
resonates most for you and why
4. Client: Offer this feedback to the panel, and
continue the paragraph
Motivational Interviewing Network of Trainers (MINT)
105. Why use summary
statements?
• To check your understanding of the
person’s situation as a whole
• To reflect back key components of what
the person has discussed
• To signal a transition to another topic or
the end of the session/consultation
• To highlight change talk
106.
107. Example of OARS (including Summary Statement)
“Angry Bob”
http://www.youtube.com/user/teachproject#p/u/5/79YTuZUFRIc
108. Partner A: Something you are considering changing
Partner B:
• Start with an open question
• Follow up with two reflective statements
• Offer an affirmation
• End with a summary statement
Hands-on Practice: O A R S
113. Agenda Mapping
• A brief discussion with the client, where
he/she has the most decision-making
freedom possible
• The client chooses what area toward
better health they want to discuss
• No topic is off limits – success in one
area can lead to success in another
Miller & Rollnick 2013
114. • Start with understanding the patient’s
perspectives and preferences
• Try not to ‘trap’ the person by suggesting
a lifestyle change (or focusing too soon on
change) once the person raises a lifestyle
area
Tips for Agenda Mapping
Miller & Rollnick 2013
115. • Consider providing the patient with a finite
list of topics to choose from, and asking
them if any of the areas they want to
discuss are included in that list
• After the patient responds, feel free to
mention topics that you want to talk about
Tips for Agenda Mapping
Miller & Rollnick 2013
116. Strategies Include…
• Asking for elaboration
• Reflective listening
• Emphasizing personal choice and
control
• Asking permission before making
suggestions
• Summary statements
Miller & Rollnick 2013
123. “Readiness Ruler”
• How important is it to change this
behaviour?
• How confident are you that you could
make this change?
0 1 2 3 4 5 6 7 8 9 10
0 1 2 3 4 5 6 7 8 9 10
People usually have several things they would like to change in their lives – this may be only one of those
things. Answer the following two questions with respect to your goal for this week.
Miller & Rollnick 2013
126. “A Psychological Law”
I learn what I believe
as I hear myself speak.
Bill Miller (Based on D. Bem, 1967, “Self-Perception: An
alternative interpretation of cognitive dissonance
phenomena”)
127. …or put another way…
The word you keep between
your lips is your slave. The
word you speak is your
master.
- Arabic proverb
128. Motivational Interviewing Coding Sheet
• Number of closed questions: __________
• Number of open questions: __________
• Number of simple reflections: _________
• Number of complex reflections: _______
• Change statements by client: _______
• Sustain statements by client: __________
• Therapist talk time (approx.): __________ %
Targets:
Twice as many reflections as questions
At least 50% complex reflections
No more than 50% therapist talk time
MI “Spirit” (low) (high)
Partnership 1 2 3 4 5
Acceptance 1 2 3 4 5
Compassion 1 2 3 4 5
Evocation 1 2 3 4 5
Herie & Skinner 2013, adapted from Moyers et al. MITI coding guide
129. How Not to Do It
A conversation with Sal about his asthma
http://www.youtube.com/watch?v=kN7T-cmb_l0
130. Motivational Interviewing Coding Sheet
• Number of closed questions: __________
• Number of open questions: __________
• Number of simple reflections: _________
• Number of complex reflections: _______
• Change statements by client: _______
• Sustain statements by client: __________
• Therapist talk time (approx.): __________ %
Targets:
Twice as many reflections as questions
At least 50% complex reflections
No more than 50% therapist talk time
MI “Spirit” (low) (high)
Partnership 1 2 3 4 5
Acceptance 1 2 3 4 5
Compassion 1 2 3 4 5
Evocation 12 3 4 5
Herie & Skinner 2013, adapted from Moyers et al. MITI coding guide
131. A Better Way
A conversation with Sal about his asthma
http://www.youtube.com/watch?v=-RXy8Li3ZaE
132. Motivational Interviewing Coding Sheet
• Number of closed questions: __________
• Number of open questions: __________
• Number of simple reflections: _________
• Number of complex reflections: _______
• Change statements by client: _______
• Sustain statements by client: __________
• Therapist talk time (approx.): __________ %
Targets:
Twice as many reflections as questions
At least 50% complex reflections
No more than 50% therapist talk time
MI “Spirit” (low) (high)
Partnership 1 2 3 4 5
Acceptance 1 2 3 4 5
Compassion 1 2 3 4 5
Evocation 1 2 3 4 5
Herie & Skinner 2013, adapted from Moyers et al. MITI coding guide
135. Hands-on Practice
• In groups of three, take three roles:
– Person “A” describe a change you are thinking of
making in the next 6 months – 1 year
– Person “B” respond using motivational strategies
– Person “C” observe and give feedback
Each “Real Play” will take 5 minutes.
After each turn, rotate the roles so that everyone has
a chance to practice and receive feedback.
Please HOLD your feedback until everyone has
had a chance to practice – you will have an
opportunity to debrief as a small group at the end of
this exercise
136. In groups of three, take three roles:
– Person “A” describe a change you are thinking
of making in the next 6 months – 1 year
– Person “B” respond using motivational
strategies
– Person “C” observe and give feedback
A
B C
137. Motivational Interviewing Coding Sheet
• Number of closed questions: __________
• Number of open questions: __________
• Number of simple reflections: _________
• Number of complex reflections: _______
• Change statements by client: _______
• Sustain statements by client: __________
• Therapist talk time (approx.): __________ %
Targets:
Twice as many reflections as questions
At least 50% complex reflections
No more than 50% therapist talk time
MI “Spirit” (low) (high)
Partnership 1 2 3 4 5
Acceptance 1 2 3 4 5
Compassion 1 2 3 4 5
Evocation 12 3 4 5
Herie & Skinner 2013, adapted from Moyers et al. MITI coding guide
140. Re-write this challenging case:
• From the client’s perspective
• From the client's parents’ or
partner’s perspective
• From the faculty’s perspective
146. What are the MI skills that you
will commit to using?
• MI Spirit
• Identify and evoke change talk
• OARS
• Using Elicit/Provide/Elicit to provide
information
• Agenda-mapping
• Other?
148. Recommended Resources
Martino, S., Ball, S.A., Gallon, S.L., Hall, D., Garcia, M., Ceperich, S., Farentinos, C.,
Hamilton, J., and Hausotter, W. (2006). Motivational Interviewing Assessment:
Supervisory Tools for Enhancing Proficiency (MIA STEP). Salem, OR: Northwest
Frontier Addiction Technology Transfer Center, Oregon Health and Science
University.
http://www.motivationalinterview.org/Documents//MIA-STEP.pdf
Miller, W.R. & Rollnick, S. (2013). Motivational Interviewing: Helping People Change
(Third Edition). New York: Guilford.
Miller, W.R. & Rollnick, S. (2009). Ten things that Motivational Interviewing is not.
Behavioural and Cognitive Psychotherapy, 37, 129-140.
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=531
8416
Rollnick, S., Miller, W.R., & Butler, C.C. (2008). Motivational Interviewing in Health
Care: Helping Patients Change Behavior. New York: The Guildford Press.
First chapter and table of contents available at www.motivationalinterview.org
Rosengren, D.B. (2009). Building Motivational Interviewing Skills: A Practitioner
Workbook. New York: Guilford.
Wagner, C.C. & Ingersoll, K.S. (2013). Motivational Interviewing in Groups. New
York: Guilford
Useful Websites
Motivational Interviewing Website
http://www.motivationalinterview.net/
Motivational Interviewing Network of Trainers (MINT) Website
www.motivationalinterviewing.org
Examples of Motivational Interviewing Videos on YouTube
http://www.youtube.com/user/teachproject#p/u
149. Motivational Interviewing Glossary of Acronyms
Compiled by Marilyn Herie, PhD, RSW November, 2012
ACE (Spirit of MI from Miller and Rollnick 2002 edition)
Autonomy / Collaboration / Evocation versus
Authority / Coercion / Education
OARS (Fundamental strategies of MI)
Open questions / Affirmations / Reflections / Summary statements
EARS (Strategies for eliciting change talk)
Evocation / Affirmation / Reflective listening / Summary statements
RULE (Fundamental strategies in MI v.2)
Resist the righting reflex / Understand reasons for change (motivation) / Listen empathically / Empower
the client to use own resources
DARN CAT (Types of preparatory change talk and commitment language)
Desire / Ability / Reasons / Need / Commitment / Action / Taking steps
FRAMES (Ingredients of brief, motivational interventions)
Feedback / Responsibility / Advice / Menu (of strategies)/ Empathy / Self-efficacy
RAISE (How to give advice)
Relationship / Advice to change / “I” statements (affirmation) / Support autonomy / Empathy
READS (Principles of MI)
Roll with resistance / Express empathy / Avoid argumentation / Develop discrepancy / Support self-
efficacy
PACE (Spirit of MI from Miller and Rollnick 2013 edition)
Partnership / Acceptance / Compassion / Evocation
MIST (Coding form)
Motivational Interviewing Supervision and Training Scale
MITI (Coding form)
Motivational Interviewing Treatment Integrity Coding Form
MET (Manual-based motivational intervention)
Motivational Enhancement Therapy
MIA (Coding abbreviation, used in the MITI)
Motivational Interviewing Adherent
MINA (Coding abbreviation, used in the MITI)
Motivational Interviewing Non-Adherent
MIA-STEP (MI supervision manual and coding resource)
Motivational Interviewing Assessment – Supervisory Tools for Enhancing Proficiency
AMI
Adaptations of Motivational Interviewing
151. Confidence Ruler
0 1 2 3 4 5 6 7 8 9 10
No Way I am
Bill Miller
http://www.williamrmiller.net/
152. “When people are ready to, they change.
They never do it before then, and
sometimes they die before they get
around to it. You can't make them change
if they don't want to, just like when they do
want to, you can't stop them.”
― Andy Warhol, Andy Warhol in His Own Words
http://en.wikipedia.org/wiki/File:Warhol-Campbell Soup-1-screenprint-1968.jpg