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Similar to Stephen Rollnick MI presentation for MPS Feb2013
Stephen Rollnick MI presentation for MPS Feb2013
- 1. Motivational Interviewing Stephen RollnickPhD Cochrane Institute of Primary Care & Public Health School of Medicine, Cardiff University, WALES
- 2. What is good prac.ce? Dr: and I don't see why it ends up like this, I’ve been doing this job for 20 years and now apparently its all my fault. I want this sorted just like you do, but I don’t have the Ame for all this…… You: ?
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- 5. What’s the problem? Behaviour change is hard Your approach?
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- 8. You would think that….. having been disciplinedtwice for misconduct would be enough to persuade a man to do anything possible to protect his career and livelihood?
- 9. You would think that….. having been disciplinedtwice for misconduct would be enough to persuade a man to do anything possible to protect his career and livelihood? hangovers, damaged relationships, an auto crash, and memory blackouts would be enough to convince a woman to stop drinking
- 10. You would think that….. very realthreats of blindness, amputations and the kidney failure from diabetes would be enough to motivate weight loss and glycemic control
- 11. You would think that….. very realthreats of blindness, amputations and the kidney failure from diabetes would be enough to motivate weight loss and glycemic control time spent in the dehumanizing privations of prison would dissuade people from re-offending
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- 14. Righ.ng reflex Ambivalence
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- 16. Consider yourself Imagine something inyour life that you’ve often thought about changing, but haven't. Imagine this:
- 17. Consider yourself Imagine something inyour life that you’ve often thought about changing, but haven't. Imagine this: You cant leave the room until you’ve made a decision to change!
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- 19. “After all, whenyou seek advice from someone it’s certainly not because you want them to give it. You just want them to be there while you talk to yourself”. Terry Pratchett, 1948 –
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- 21. COMMUNICATION STYLES Direct ‐ Guide ‐ Follow teach draw out listen instruct encourage understand lead mo.vate go along with Match the style to the problem
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- 23. Collaboration QUESTIONS ‐ OBSERVATIONS Compassion Acceptance Evocation
- 24. Core Skills OARS: Open questions Affirmation Reflection Summary Offering Information and Advice
- 25. Goal of MI Quietly clarify ambivalence and elicit change talk Defini.on … a person‐centered, goal oriented counseling style for addressing the common problem of ambivalence about change
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- 28. How you respond to change talk is key “... and I don't see why it ends up like this, I’ve been doing this job for 20 years and now apparently there’s a problem. I want this sorted out just like you do, but I don’t have the Ame for all this.” If you respond with reflec.on: Predicts better “Its frustra)ng yet you’d like to sort outcome this out” More change talk will follow….. “I need this off my back as soon as I can”
- 29. You: Would youmind if we talked about your smoking? Patient: Well, OK You: How do you really feel about it? Pt: I’m trying to cut back, but I cant say its easy with my job, you know its stressful driving that truck You: Its not easy for you yet you’d like to smoke less Pt: Oh if I could, definitely, I know its not good for my chest for a start You: You can feel the effect for yourself and its not pleasant Pt: That right, but its such a stress reliever its hard to let go You: Its difficult for you to imagine being without smoking Pt: yes, that’s exactly right, you got me. You: I don’t want to give you a lecture or hassle you about this, but I’m wondering what would be helpful for you? Pt: I just don’t know Doc. You: Tell me, deep down, how important is this for you right now? Pt: I feel sick and I’m tired, and this smoking wears me down….
- 30. Recent Changes inMI Motivational Interviewing: Helping People Change (3rd edition). NY: Guilford, 2012. Introduce compassion as a key element From “behaviour change” to “any change” Make it simpler & easier to apply in practice Include planning for action 4 Processes – let’s look!
- 31. New Four ProcessModel This is what happens in an effec.ve MI session
- 32. PLAN If they want to, support them to plan changes EVOKE Draw out their own good reasons to change FOCUS Find a useful direction ENGAGE Settle into a helpful conversation
- 33. PLAN If they want to, support them to plan changes EVOKE Draw out their own good reasons to change FOCUS Find a useful direction ENGAGE Settle into a helpful conversation
- 34. “Settle into ahelpful conversation” ENGAGE 1. Just be nice and friendly? 2. You can get better & better 3. A service-wide challenge The 20% rule
- 35. PLAN If they want to, support them to plan changes EVOKE Draw out their own good reasons to change FOCUS Find a useful direction ENGAGE Settle into a helpful conversation
- 36. “Find a usefuldirection” FOCUS 1. Who’s direction? 2. Usually more than one direction 3. Agenda mapping as a skill
- 37. PLAN If they want to, support them to plan changes EVOKE Draw out their own good reasons to change FOCUS Find a useful direction ENGAGE Settle into a helpful conversation
- 38. “Draw out theirown good reasons to change” EVOKE 1. Defining heart of MI 2. Ear for language: change talk
- 39. PLAN If they want to, support them to plan changes EVOKE Draw out their own good reasons to change FOCUS Find a useful direction ENGAGE Settle into a helpful conversation
- 40. “If they wantto, support them to plan changes” PLAN 1. Righting reflex & other familiar challenges 2. Usually more than one possible plan 3. Path mapping as a skill
- 41. Planning Evoking Focusing Engaging
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- 45. 1. Importance (Why?) “Why should I?” “I want to, but....” “What will I gain/lose?” 2. Confidence (How?) “Will I be able to ?” “What skills do I need” “Will I cope in situations x, y & z?”
- 46. Importance & Confidence Scaling 1. How importantis it for you to …..… (I) 2. How confident are you that you will succeed? (C) Summarize & check understanding
- 47. Importance & Confidence Scaling How important isit for you right now to quit smoking? On a scale from 0 - 10, if 0 was “not at all important” and 10 was “very important”, what number would you give yourself? 1. Why are you at x and not at 1? 2. What would need to happen, for you to get from x to (higher no.)? 3. How can I help you get from x to (higher no.)? Understanding answers increases motivation to change in active patient
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- 49. Theory 1. A linguis.c theory your MI style – change talk – beaer outcome 2. Self‐determina.on theory (SDT) 3 needs – Autonomy, Competence & Relatedness
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- 52. Biomedical Markers MI Comp. Blood Glucose (5) OR 1.12* 52% vs 48% Blood Pressure (1) OR 1.65** 57% vs 43% Cholesterol (3) OR 1.09* 51% vs 49% Heart failure (1) OR 7.78** 75% vs 25% Heart rate (1) OR 0.91 49% vs 51% Body weight (11) OR 1.15** 52% vs 48% Dental (caries) (2) OR 1.85** 58% vs 42% HIV Viral Load (2) OR 2.06* 60% vs 40% Death rate (2) OR 1.54 56% vs 44% Mental health (5) OR 1.29** 54% vs 46%
- 53. Health behaviors MI Comp. Health behavior Eating healthy (7) OR 1.08 51% vs 49% Eating disorder (6) OR 0.79 47% vs 53% Injury Prevention (1) OR 1.76* 57% vs 43% Alcohol Amount (11) OR 2.51** 62% vs 38% Dangerous Use (3) OR 1.94** 59% vs 41% Smoking Abstinence (8) OR 1.25* 51% vs 49% Marijuana Amount (5) OR 3.08** 65% vs 35% Abstinence (1) OR 1.99 60% vs 40%
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- 56. People are generallybetter persuaded by the reasons which they have themselves discovered, than by those which have come into the mind of others.” Blaise Pascal, Pensées, (1670)