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

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)

MI “Spirit”

(Gold & Kokotailo, 2007)

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)

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)

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 empathy2. Develop discrepancy 3. Roll with resistance 4. Support self-efficacy

(Miller & Rollnick, 2002; Resnicow et al., 2002; Gold & Kokotailo, 2007)

1. Expressing Empathy

• Create safe setting

• Develop rapport

• OARES1.Open-ended questions2. Affirmations3. Reflections4. Elicit change talk5. Summarizing

(Schwartz, 2010)

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 consc) Listen for / highlight

discrepancies

2. Developing Discrepancies

1. “Shifting focusing”

2. Emphasize autonomy

3. “Reframing”

4. “Agreement with a twist”

5. “Coming alongside”

3. Rolling with Resistance

(Gold & Kokotailo, 2007)

1. Highlight effort / past success

2. Ask permission

3. “Elicit – Provide – Elicit”

4. Gauging Importance – Confidence – Readiness with a scale

4. Support Self-Efficacy

Video

YouTube - Motivational Interviewing: Evoking Commitment to Change