motivational interviewing. david smith, assistant managergary moore, cancer prevention navigator
TRANSCRIPT
Motivational Interviewing
David Smith, Assistant Manager Gary Moore, Cancer Prevention Navigator
What We Plan to Cover* Share the Background and History of our Involvement with
Motivational Interviewing
* Introduce some of the key elements of Motivational Interviewing
* The challenges of training and quality assurance.
How did the 2-1-1 Texas / United Way Helpline Get Involved?
Why Stay Involved?* Opportunity for New Business
* Better Outcomes
* Better I&R Specialists
Smoker Math* 16 million callers to 2-1-1 per year
* 4 million who smoke
* 600,000 to 1 million referrals to quitline
* 50,000 to 100,000 non-smokers per year
Less than half of the callers in the outcomes follow-up survey received help.
Better I&R specialists
ELEMENTS OF MOTIVATIONAL INTERVIEWING
Defining Motivational Interviewing
Motivational interviewing is a person-centered,
directive method of communication for enhancing intrinsic motivation to change
by exploring and resolving ambivalence.
MI is a Style of Communicating
* Empathetic
* Warm & Friendly
* Non-judgmental
* Collaborative
* Accepting
* Respectful
* Optimistic
* Eliciting & Listening
* Honors Autonomy & Choice
Spirit of MI* Evocation (versus education)
– Elicit solutions from the client* Autonomy (versus authority)
– Honors client choice– Clients are responsible for change
* Collaboration (versus confrontation)
– Partnership with client
MI Obstacles* Learn to identify in the caller
– Ambivalence– Resistance : Arguing, interrupting, negating,
or ignoring.* Learn to identify in self
– The Righting Reflex : the natural tendency to “make it right” for others.
Key Principles* Express Empathy
* Develop Discrepancy
* Roll with Resistance
* Support Self-Efficacy
Express Empathy* Understand the caller’s reality
* Ambivalence is normal
* Main tool is reflective listening. This shows that you “get it” and helps clarify things.
* Acceptance leads to change.
Develop Discrepancy* The caller, rather than the navigator, should present the
arguments/reasons for change.
* Change is motivated by the perceived discrepancy between present behavior and important personal goals or values. The difference between where some one is and where they want to be.
Roll with Resistance* Avoid arguing for change.
* Don’t directly oppose resistance. Dance, don’t wrestle.
* New perspectives are invited but not imposed.
* The caller may be a primary resource in finding answers and solutions.
* Resistance is a signal to respond differently.
Support Self-Efficacy* The caller’s belief in the possibility of change is an important
motivator.
* The caller, not the navigator, is responsible for choosing and carrying out change.
* The navigator’s own belief in the caller’s ability to change becomes a self-fulfilling prophecy.
OARS* Open-Ended questions
* Affirmations/Affirming
* Reflective Listening
* Summarize
Open-Ended QuestionsAsk for more details, such as an example
– What concerns you most?– How has that caused trouble for you?– What do you think about that?– How does that strike you?– If you wanted to change, how would you go about it?– What do you want to do about that?– What else?
AffirmComment positively on the statement
*I think that will really work for you.
*That’s a great idea.
*Thanks for taking care of that.
*I appreciate you talking with me.
ReflectRestate, paraphrase in different language, capture the emotion
*You’re …….
*It feels like ……
*It’s frustrating/difficult/hard/ …….
*And when that happens you ……..
SummarizeFeed back the overall statement
*Let me see if I can summarize this …
*When we talk again in a week, you’ll …
*You’ve decided to …
*So what we’ve decided is that ……
Challenges* Training
– Start-up = 8 to 16 hours, plus another 8 hours of refresher per quarter.
– Need to find a provider.• Suggestions : Ask patient health navigators,
substance abuse counselors, professors in social work at closest college who provides their training.
Challenges* Quality Assurance
– Boundaries• Have to decide where do draw the lines between
information and referral, navigation, and case management.
– Quality Monitoring and Review• Have to develop processes to monitor the quality
of navigation that mirrors I&R calls.
SUCCESS STORIES
Success Story : Ms. Glorer* Ms. Glorer is a 55-year-old lady who initially called 211 for electric bill
payment assistance and later became willing to participate in our cancer care survey. She has a history of cigarette smoking for years and smokes 3 packages per week.
* The navigator shared with Ms. Glorer the information about the statistics on smoking related illness and death, the adverse effects of smoking and the benefits of smoking cessation. The conversation also focused on the facts that she is a diabetic and has a young cousin living with her as a second-hand smoker. Ms. Glorer expressed her concern with the death of her friend from emphysema as a second-hand smoker. She realized it was time for her to think about quitting smoking.
* After a week of consideration, Ms. Glorer told the navigator that for the benefits of both her and her cousin she was ready to take the state paid smoking cessation program through the National Quit Line.
DeniseCancer Success Story #90
* Denise has a 12-year-old daughter who has not had the HPV Vaccine. Even though she felt that it was her daughter’s choice, Denise expressed mixed feelings about the safety of the vaccine and possible side effects in the long run and thought the vaccine could be experimental.
* After getting some more facts about the vaccine from her navigator, Denise was encouraged to speak with her daughter's pediatrician. He recommended that she get her daughter vaccinated for HPV and that the state is considering making the vaccine mandatory in the future. After talking with the doctor, Denise had a change in her views about the HPV vaccine. Denise had to delay the vaccination due to barriers with Medicaid benefit coverage and lack of transportation.
* After months of waiting, Denise’s daughter had an appointment on April 27 at Herman Hospital Clinic and was given her 1st dose of the HPV Vaccine and has appointment for 2nd dose in June. Denise said her 15-year-old son who is disabled, was also vaccinated for THE HPV Vaccine too.
“Ms. Daisy”Cancer Success Story #16
* Ms. Daisy called 2-1-1 seeking resources for her electric bill. She is a 50 year old, disabled African-American widow. At the time of call, she was still mourning the loss of her husband and had noticed she was smoking more than usual. She also mentioned that some of her family members had died of cancer: her mother died of breast cancer, her father died of lung cancer and her uncle died of colon cancer.
* I then shared some information about cancer screening recommendations with Ms. Daisy and gave her the 1(800) # for National Quitline. Ms. Daisy stated she had a doctor appointment already scheduled for some other exams; so, she would just ask doctor to include the FOBT with her next exam.
* Within a few of weeks, she was happy to report her Pap test, mammogram & FOBT all came back normal. She had also enrolled in a smoking cessation class offered by her doctor. She had started on the patch and was down to 4 cigarettes in two weeks.
• Ms. Daisy was complimentary toward 2-1-1 for offering information about cancer screening and early detection to callers. She said all the people she spoke with were caring, and professional—the information specialist and the navigator made her feel comfortable when speaking about the loss of her husband
and family members.
MariaCancer Success Story #3
* Erica Galvan, Cancer Navigator (Weslaco), shared the following story about one of the participants that she worked with.
* I had a client by the name of Maria. Maria is 45yrs old who had not gotten her screenings in about 3 yrs. Maria has 2 sons who are 22yrs old and 4yrs old. The risk assessment indicated that Maria needed a Pap test and a mammogram. Maria stated she usually goes to Mexico for these services. She stated they charge her $40.00 dollars for services.
* At the beginning of our initial conversations, Maria was very confident in obtaining these screenings. As time passed, she had obstacles come her way.
* First, she stated since Mexico has about 2 weeks’ vacation for Easter break, her doctor was out for vacation, so she was unable to keep her appointment. Secondly, a major obstacle she was going through was that she was having marital problems. Her husband had left her and had asked for a divorce.
Throughout our conversations I was able to give her referrals for counseling because she said she was depressed. Finally, after a couple of weeks of talking to her, she stated she felt a bit better. After all her obstacle, she told me that she was very thankful for all the follow up calls made to her. She realized that her health was her priority and was able to go to Mexico to get her mammogram and pap test done. She stated that everything came back normal.
