1. Motivational Interviewing and the Care Manager Becky Zook BSN, RN, MS, CCP Nurse Care Manager Grace Eaton, LPN Panel Manager Family Care Lower Paxton

2. Motivational Interviewing (MI) MI/SMS Guiding Philosophy Patient-centered and empathic (pt sets the agenda, not the MD/CM/LPN) Motivation to change is elicited from the pt, and not imposed from without (less advice) Collaboration between healthcare team & pt (support pt’s own expertise & autonomy) Roll with resistance (resistance to change can be due to our way of working with the pt) Enhance readiness to change thru resolving ambivalence Enhance self-efficacy to become an activated patient

3. MI Video- Dr. William Miller http://www.youtube.com/watch?v=cj1BDPBE6Wk

4. MI- Stages of Change Pre-contemplation (denial, goal: create some conflict about unhealthy behavior ) Contemplation (ambivalent, goal: heighten conflict about behavior & resolve ambivalence) Preparation/determination (ready & willing to make a change, goal: help pt to become able) Action (able & doing, goal: integrate change into lifestyle) Maintenance (acting on change for at least 6 mos) Relapse (may occur at any stage)

5. MI Tools Tool 1. Assess Stage of Change (using Open- ended Questions or A Typical Day) o A Typical Day opening: ‘Can you take me through a typical day, so that I can understand in more detail what happens? oPlease explain to me where XXX fits in your day. Or How do you incorporate XXX into your day?

6. MI Tools Tool 2. Pros & Cons o What do you like about (drinking, cocaine, smoking…)? o What are some less good things about …?  Don’t say what’s ‘bad’ or ‘problems’ (maybe for them nothing is bad)  Use reflective & summarizing statements  Always end w/ the ‘Cons’ o Summarize first the pros & then the cons; end w/ ‘Anything else?’

7. MI Tools Tool 3. Ask-Tell-Ask o Ask: ‘How much do you know about…?’ o Tell: ‘Would you mind if I tell you some further info?’ Or, ‘What happens to some people is that…?’ o Ask: ‘What do you make of this…?’

8. MI Tools Tool 4. Importance & Confidence Scales o“How important is it for you to (QUIT SMOKING, LOSE WEIGHT..) ? If 0 is not important at all & 10 is extremely important, what number are you?” o “How confident do you feel that you could (QUIT SMOKING, LOSE WEIGHT…)? If 0 is that you don’t feel confident at all & 10 is that you could do this right now, what number are you?

9. MI Tools Tool 5. Agenda Setting oSummarize their concerns & ideas, focusing on change statements, allow pt to set priorities “This self management plan lists some risks of uncontrolled XXX and some lifestyle changes to prevent those risks. Let’s review them together. I will then ask you to prioritize the changes and choose those you want to work on.”

10. MI Tools Tool 6. Action Plans & Follow-up List pt’s specific goals in behavioral terms o Brainstorm: start w/ their ideas 1st; add your ideas last (‘What has worked for other pts is…’) o Write step-by-step plan: very operational & clear; limit to 1 or 2 for 1-2 wks: don’t overwhelm o Ask for obstacles/barriers: minimizes failure o Identify who can support the pt o Close the deal: summarize o Make a follow-up plan: phone calls, visits, mailed reminders

11. MI Video- Interviews through Stages of Change http://www.youtube.com/watch?v=wcu8oqHIsbc&feature=related

12. Resources Abramowitz, S., M.D. (2011). http://www.pcbehavioralhealth.com/motivational- interviewing. Downloaded 10/16/2011. http://www.pcbehavioralhealth.com/motivational- interviewing Miller, W. Ph. D. (2011). Excerpt from Psychotherapy.net. http://www.youtube.com/watch?v=cj1BDPBE6Wk. Downloaded 10/16/2011.Miller, W. Ph. D. (2011). Excerpt from Psychotherapy.net. http://www.youtube.com/watch?v=cj1BDPBE6Wk. Downloaded 10/16/2011. http://www.youtube.com/watch?v=cj1BDPBE6Wk Motivational Interviewing Role Play. (2011). http://www.youtube.com/watch?v=wcu8oqHIsbc&feature =relatedMotivational Interviewing Role Play. (2011). http://www.youtube.com/watch?v=wcu8oqHIsbc&feature =related http://www.youtube.com/watch?v=wcu8oqHIsbc&feature =related http://www.youtube.com/watch?v=wcu8oqHIsbc&feature =related

13. Additional Resources 2010 Motivational Interviewing Video Links. http://www.letsgo.org/resources/MotivationalInter viewingVideoLinks.php http://www.letsgo.org/resources/MotivationalInter viewingVideoLinks.php Primary Care Behavioral Health. http://www.pcbehavioralhealth.com/motivational- interviewing http://www.pcbehavioralhealth.com/motivational- interviewing California Academy of Family Physicians. http://www.familydocs.org/news- media/news/free-web-based-cmecpe-activity- motivational-interviewing.php