1. Motivational Interviewing (MI) Presentation Objectives Understand theory & spirit of MI Brief review of evidence using MI with teens Learn some MI techniques & skills Recognize strategies for motivating behavior change in health care settings

2. MI Theory Strength-based approach Based on stage of change TTM theory Collaborative counselor-youth partnership Counselor is guide; Youth is expert Goals = identify self motivation for change; work through mixed feelings about change; initiate / sustain change through learned self-motivational techniques (Gold & Kokotailo, 2007; Resnicow et al., 2002; Prochaska & DiClemente, 1992)

3. MI “Spirit” (Gold & Kokotailo, 2007) Collaboration AutonomyEvocation

4. MI Evidence Reduces adolescent substance use: cigarette smoking; alcohol; marijuana Positive impact on health risk behaviors: Diabetes management; dietary adherence; contraceptive use; HIV/Aids prevention; helmet/seatbelt use; risky driving Brief, adapted versions (15-20 minutes) in primary care: help patients adopt healthy behaviors; address teen resistance and ambivalence (Duncan et al., 2007; Ruback et al., 2005; Moyers et al., 2008; Shwarz, 2010 ; Erickson et al., 2005; Sindelar et al., 2004)

5. Matching MI to Stage of Change Mismatching counseling is like giving the wrong medication – Pre-Contemplation: increase awareness of need to change and encourage thinking about need to change – Contemplation: motivate and increase confidence in ability to change – Preparation: elicit plans for change and problem solve barriers to change (Gold, 2007)

6. Four Key MI Principles “Whereas the essence of MI resides in its spirit, there are specific techniques and strategies that, when used effectively, help ensure that such spirit is evoked.” 1.Express empathy 2.Develop discrepancy 3.Roll with resistance 4.Support self-efficacy (Miller & Rollnick, 2002; Resnicow et al., 2002; Gold & Kokotailo, 2007)

7. 1. Expressing Empathy Create safe setting Develop rapport OARES 1.Open-ended questions 2.Affirmations 3.Reflections 4.Elicit change talk 5.Summarizing (Schwartz, 2010)

8. Decisional balance: Discussion about the Pros and Cons of changing and/or maintaining a behavior a)Acknowledge positive aspects first b)Follow with discussion of cons c)Listen for / highlight discrepancies 2. Developing Discrepancies

9. 1.“Shifting focusing” 2.Emphasize autonomy 3.“Reframing” 4.“Agreement with a twist” 5.“Coming alongside” 3. Rolling with Resistance (Gold & Kokotailo, 2007)

10. 1.Highlight effort / past success 2.Ask permission 3.“Elicit – Provide – Elicit” 4.Gauging Importance – Confidence – Readiness with a scale 4. Support Self-Efficacy

11. Video YouTube - Motivational Interviewing: Evoking Commitment to Change