Strong4Life WIC Program Lisa Giles MS, RDN, LD, CDE Children’s Healthcare of Atlanta Advancing Motivational Interviewing Skills

WIC Provider Training 159 Counties in Georgia

Disclosure Children's Healthcare of Atlanta resolves to ensure that its educational mission, and particularly its continuing medical education activities, are not influenced by the special interests of any corporation or individual associated with its program. While having a financial interest or professional affiliation with a corporation does not necessarily influence a speaker's presentation, the standards of the Accreditation Council for Continuing Medical Education require that this relationships be disclosed to the audience. Any potential conflict of interest will be made known to participants at the beginning of the program. The speakers and planning committee for this program have disclosed that they have no financial relationships with commercial interests related to this presentation.

Objective Participants will increase self-confidence in at least one Strong4Life Motivational Interviewing Technique:  Asking Permission  Open-ended Questions  Reflective Listening

Strong4Life Observation Results Did the nutritionist:% YES% NO% I don’t know Use the Healthy Habits Assessment to facilitate conversation with the client? Praise the client for positive accomplishments noted on the Healthy Habits Assessment?

“Have you thought about trying a new healthy habit for your family or child?” “If you could make one healthy change what would it be?”

Strong4Life Observation Results Did the nutritionist:% YES% NO% I don’t know Allow client to lead the discussion related to setting a new healthy habit goal? Work with the client to create achievable goal using the clients ideas and language? Provide positive verbal support to the client to encourage progress toward goal?

Strong4Life Observation Results Was the goal SMART? SpecificMeasurableAttainableRealisticTime-bound 84.3%86.3%98.0%92.2%70.6%

I will serve 1% milk instead of juice. At dinner time 4 days a week Specific Measurable Attainable Realistic Timely Me, Dad, Grandmother Today

Strong4Life Observation Results Did the nutritionist:% YES% NO Ask permission to share their concerns with the client? Use open-ended questions to understand client feeling about child’s weight status?

Strong4Life Observation Results Did the nutritionist: Use reflective listening while speaking to the client about their child’s weight status? Never/RarelySometimesFrequently / Always 23.0%25.0%49.5%

Recognizing Barriers to Behavior Change

Ambivalence  Mixed or contradictory feelings/thoughts about something Yes No Maybe Check One

Resistant to Change  Argues −Challenges, counters, discounts input from nutritionist  Interrupts −Talking over; cutting off  Ignores −Non-responsive; sidetracking We could but… We tried that… I don’t have time

Denial  No acknowledgment of poor eating habits and sedentary behaviors  Minimizing child’s overweight status and/or comorbidities  Excuses or unconscious of unhealthy behaviors I think we eat healthy He’s big- boned But it’s fruit juice

Lack of Support & Resources  Lack of familial and peer support for healthy behavior change  Limited knowledge of and/or access to healthy food choices  Limited access to safe space for physical activity

Dealing With Barriers to Behavior Change

Guide to Client-Centered Counseling Ask, don’t tell Place responsibility for change with the client Ask for permission to share Listen more than you talk Don’t force change

5 A’s for Obesity Counseling Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y. Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician Jan;59(1):27-31 AskAssessAdviseAgreeAssist Guides counseling for behavior change Ideal for busy practices

Asking Permission “We measured Cheryl’s height, weight and BMI today. Is it OK if we go over this information together? Nutritionist Ask For permission to share information

Asking Permission When to ask: At the beginning of a session Before explaining information Before offering information or advice Ways to ask: Would it be OK? May I share my concerns with you? Do you mind if I share this information with you?

Open Ended Questions  Cannot be answered in “yes” or “no”  Invite people to tell a story  Avoid “fishing” for the right answer Start with: How… What…Tell me…

Open Ended Questions “Tell me about the types of fast foods you eat during the day.” “How do you think you are doing with drinking water instead of soda at meals?” “When Sue is with her grandmother, what types of snacks does she eat?”

Open Ended Questions Change the following into open-ended questions: Do you plan to breastfeed? Tell me about your plans for feeding the baby?

Open Ended Questions Does your daughter like carrots? What type of vegetables does your daughter like?

Open Ended Questions Do you think your family would drink 1% milk? What types of milk would your family drink?

Open Ended Questions Does your son get any active play time? Tell me about your son’s active play time?

Open Ended Questions Will you let his mom know about his healthy habit goal when you see her? How will you let his mom know about his healthy habit goal?

Reflective Listening Pay attention to what you hear, not what you’re going to say next. Ways to open:  So you feel…  You’re wondering if…  What I’m hearing you say is…  You’re feeling…  It sounds like you…

Reflective Listening “It sounds like you would like to eat at home more but working two jobs makes it hard for you to find the time to cook.” Nutritionist Reflect Re-state what the client has said to you

Reflective Listening Let’s Practice: I can’t get my kids to eat vegetables. “You are having a hard time getting your kids to eat vegetables?”

Reflective Listening It’s really hard to find time to be active. “Finding time to be active is a challenge isn’t it?”

Reflective Listening I can’t get my kids to eat vegetables. “It sounds like your kids don’t like vegetables?”

Reflective Listening I like to eat vegetables but my husband just likes to eat junk food? “So what you are saying is you like to eat healthy but your husband doesn’t.”

Reflective Listening What’s the problem with his weight? “You are wondering what the problem is with his weight?

Reflective Listening I’m just here because his mom is working? I don’t know what they do at home. “OK, mom is working today and you don’t know what they do when you are not at home?

Putting it All Together: Let’s Role Play

Provider Toolkit

Wendy Palmer, MS, RD, LD, CHES Child Wellness Program Manager Office: Contact Information