Motivational Interviewing Building a Foundation for Effective Patient Engagement Mia Croyle, MA Introductory Webinar 2017 Objectives Following this educational opportunity, participants will be better able to: Identify the four key domains of the spirit of Motivational Interviewing (MI) Employ the four skills of MI at a basic level Apply at least one specific MI strategy to your clinical population Design a plan for future development towards proficiency in MI 1
Today In this webinar we will cover: Evidence Base for MI The MI Worldview MI Spirit About Me Using MI since 2007 Primary Care Phone coaching Groups Training & Coaching MI since 2009 Healthcare Social Services Criminal Justice Member of Motivational Interviewing Network of Trainers (MINT) 2
Definition Motivational interviewing is a collaborative, person-centered, guiding method designed to elicit and strengthen motivation for change Another Definition a way of structuring conversations Goal: help other person hear themselves talking about their own arguments for making changes 3
Change Conversation Guide Directing----Guiding----Following Components of MI T e c h n i c a l Motivational Interviewing R e l a t i o n a l 4
MI-3 30 years after MI first emerged 1 st edition 1991 2 nd edition 2002 25,000 articles cite MI 200 RCT Some significant changes 5
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 Does MI work? 75% improved Source: Lundahl, 2010 6
How Does It Work? Reducing resistance Addressing ambivalence Raising discrepancy Eliciting change talk How Does It Work? 7
Deficit Approach What s the matter (with you)? Don t know Don t understand Don t know how Don t care Denial Helper role: Educate Inform Persuade Provide Competence Approach What matters to you? Strengths Values Resources Perspective Experiences Helper role: Listen Aim to understand Reflect themes Ask stimulating questions 8
The MI Worldview 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 Spirit of MI Partnership Acceptance Evocation Compassion 9
Partnership Evocation 10
Acceptance Compassion We developed MI for use by people like those in the helping professions whose primary focus is on the wellbeing of the client. It is never to be used with the intention of selling products or getting people to do something that benefits the provider, which we have explicitly described as unethical practice. A cornerstone of MI spirit is compassion whereby the patient s well-being is our prime directive and the reason for our consultations. Dr. William Mayo, one of the founders of the Mayo Clinic, said it well in 1910: The best interest of the patient is the only interest to be considered. William R. Miller, Ph.D. Stephen Rollnick, Ph.D. 11
Empathy Four Processes PLANNING EVOKING FOCUSING ENGAGING 12
About the 4 Processes Somewhat linear. Logically: 1-2-3-4 And yet recursive All interwoven Four Processes PLANNING EVOKING FOCUSING ENGAGING 13
Engaging Relational foundation Objective: establish a collaborative working relationship with the other person 20% rule Four Processes PLANNING EVOKING FOCUSING ENGAGING 14
Focusing Develop and maintain a specific agenda Discover what is important to the other person Unfolding and evolving process Four Processes PLANNING EVOKING FOCUSING ENGAGING 15
Evoking Evoking what? Change talk Change Talk Any speech that favors movement toward change The other person s OWN arguments for change 16
Four Processes PLANNING EVOKING FOCUSING ENGAGING Questions?Comments! miacroyle@gmail.com 17
This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-WI-B1-17-01 012317 18