Motivational Interviewing. A Taste of MI
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1 Motivational Interviewing A Taste of MI
2 Objectives Acquaint attendees with basic concepts and methods of MI Establish an understanding and an interest in learning more about MI in the PCP setting Application of basic MI skills Review basics of MI and application within the PCP setting
3 Just a taste
4 MI-3 30 years after MI first emerged 1 st edition nd edition ,000 articles cite MI 200 RCT
5 Definition Motivational interviewing is a collaborative, person-centered, guiding method designed to elicit and strengthen motivation for change
6
7 What do we know? Improves retention, adherence, and outcomes across a range of behaviors Generalizes fairly well across cultures Relationship matters Change talk, sustain talk, and discord matter and they are in our control! It is learnable Proficiency is reliably measurable and predicts better outcomes
8 Does MI work? 75% improved Source: Lundahl, 2010
9 MI in Medical Settings MI showed particular promise in areas such as HIV viral load, dental outcomes, death rate, body weight, alcohol and tobacco use, sedentary behavior, self-monitoring, confidence in change, and approach to treatment. MI was robust across moderators such as delivery location and patient characteristics, and appears efficacious when delivered in brief consultations. The emerging evidence for MI in medical care settings suggests it provides a moderate advantage over comparison interventions and could be used for a wide range of behavioral issues in health care. Lundahl B, Moleni T, Burke BL, Butters R, Tollefson D, Butler C, Rollnick S. Patient Educ Couns Nov (Epub 2013 Aug 1). Motivational interviewing in medical care settings: A systematic review and meta-analysis of randomized controlled trials.
10 MI in Primary Care MI appears to be useful in clinical settings and as few as one MI session may be effective in enhancing readiness to change and action directed towards reaching health behavior-change goals. Vanbuskirk KA, Wetherell JL. J Behav Med Aug 11. Motivational interviewing with primary care populations: a systematic review and meta-analysis.
11 MI facilitates change by: Helping a person identify, consolidate, strengthen, and act upon their intrinsic motivation
12 The MI Spirit People are competent We assume that they have selfknowledge, attitudes, and capabilities that can effect change Our main focus is on being present in a way that supports change
13 Spirit of MI Partnership Acceptanc e Evocation Compassion
14 Four Processes PLANNING EVOKING FOCUSING ENGAGING
15 Engaging Relational foundation Objective: establish a collaborative working relationship with the other person
16 Focusing Develop and maintain a specific agenda Discover what is important to the other person Unfolding and evolving process
17 Evoking Differential eliciting of change talk Change talk = the other person s arguments for change
18 Planning* Ongoing process not the end Begin with the end in mind Use the other person s expertise as your PRIMARY resource *not necessary for it to be MI
19 Key MI Skills Open-Ended, Evocative Questions Affirmation Reflective Listening Summaries
20 Key MI Skills: Change Talk Recognizing Change Talk Responding to Change Talk Eliciting Change Talk
21 Continuing to Learn MI One-shot trainings don t promote competent practice (Miller & Mount, 2001; Walters et al., 2005) Initial training with follow-up coaching based on direct observation of practice is gold-standard Peer-learning groups have shown some usefulness You will learn from your patients if you know what to look for!
22 Resources for Learning MI Motivational Interviewing Network of Trainers Guilford Press Applications of Motivational Interviewing Series
23
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