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1. Individual-centered2. Collaborative3. Respects right of not changing4. SMART5. Commitment statement6. Behavioral menu7. Measure confidence8. Follow-up9. Occurs in every interaction

9 Core Principles & the Evidence Base

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Action planning is individual-centered, i.e. what the person wants, not what he/she is told to do.

“Spirit” of Motivational Interviewing: Evocation

“Spirit” of Motivational Interviewing: Evocation

Core Principle #1

Miller W, Rollnick S. Motivational Interviewing: Preparing People for Change, Guilford Press, 2002

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• Work in pairs, not with your boss or supervisor• Speaker: Think of something you are considering,

something you are thinking about changing in your life but definitely haven’t decided. It might be something you think will be good for you or that you should do. Something you feel comfortable sharing. Tell this to your partner.

Persuasion

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Partner: your task is to try as hard as you can to convince the speaker to make the change they are considering. Do these five things:1.Explain why they should make the change2.Give at least three specific benefits that would result from making the change3.Tell the person how they should make the change4.Emphasize how important it is for them to make the change. This might include the negative consequences of not doing it.5.Tell the person to do it.

Persuasion, cont.

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DebriefWhat did the speaker feel or think while

their partner was talking to them?

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• Work with one other person

• Not with your boss or supervisor

• One will be the speaker and the other will be the listener

– If time permits, you can reverse roles.

– Subject: something you are ambivalent about

A Taste of MI

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• TOPIC: something about yourself that you

– Want to change

– Need to change

– Should or ought to change

– Have been thinking about changing

• But you haven’t changed yet

– i.e., something that you are ambivalent about

The speaker

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• Listen carefully with a goal of understanding the dilemma

• Give no advice

• Ask these four open-ended questions:

– Why would you want to make this change?

– How might you go about it, in order to succeed?

– What are the three best reasons for you to do it?

– On a scale from 0-10, how important would you say it is for you to make this change?• Why is it a ___ and not a zero?

The listener

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DebriefWhat did the speaker feel or think while

their partner was talking to them?

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Action planning is collaborative.

“Spirit” of Motivational Interviewing: Partnership

“Spirit” of Motivational Interviewing: Partnership

Core Principle #2

Miller W, Rollnick S. Motivational Interviewing: Preparing People for Change, Guilford Press, 2002;

Heisler et al, JGIM, 2002

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After the plan has been formulated, the clinician/coach elicits a final “commitment statement.”

Strength of the commitment statement predicts success on action plan.

.

Core Principle #3

Miller W, Rollnick S. Motivational Interviewing: Preparing People for Change, Guilford Press, 2002

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Action Planning is “SMART”: Specific, Measurable, Achievable, Relevant and Timed

.

Core Principle #4

Based on the work of Locke (1968) and Locke & Latham (1990,

2002); Bodenheimer, 2009

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After the plan has been formulated, the clinician/coach elicits a final “commitment statement.”

Strength of the commitment statement predicts success on action plan.

Core Principle #5

(Aharonovich, 2008; Amrhein, 2003)

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Offer a behavioral menu when needed or requested

“Spirit” of Motivational Interviewing: Autonomy

Core Principle #6

Rollnick, Miller & Butler, 2008. Motivational Interviewing in Health Care

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“Here are the things we have talked about. Which one is most important to work on right now?”

Behavioral Menu

Smoking

Avoiding

triggers

Exercise

Taking meds

(write others

here)

Adapted from Stott et al, Family Practice 1995; Rollnick et al, 1999, 2010

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There are many things people do to improve their health. Here are some things you might want to talk to your

health care team about.

Consider the items in circles and add other concerns in the blank circles.

Monitoring

your healthTaking medications

Eating habitsMood

Smoking

Activity

Avoiding

health

problems

Meaningful

Activities

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Confidence levels are evaluated and problem-solving utilized for confidence levels less than 7.

Higher self-efficacy is associated with healthier behaviors and better outcomes.

Core Principle #7

(Bandura, 1983; Lorig et al, Med Care 2001; Bodenheimer review, CHCF 2005; Bodenheimer, Pt Ed Couns

2009.)

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People’s beliefs about their capabilities to perform specific behaviors and their ability to exercise influence over events that affect their lives. Self-efficacy beliefs determine how people feel, think, motivate themselves and behave.

» Albert Bandura

Self-efficacy

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Action planning includes arranging follow-up or other accountability.

Core Principle #8

(Resnicow, 2002; multiple condition specific studies)

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Action planning is considered in all chronic, planned, or preventive visits.

Non-physician staff are 9 times more likely to engage in goal-setting than clinical staff. Technology (such as

howsyourhealth.org) is an option.

Core Principle #9

(Bodenheimer, 2009)