Health Behavior Change: A Guide for Practitioners (HBC) by Stephen Rollnick, Pip Mason, and Chris Butler
• Motivational Interviewing adapted for medical settings
• Presents a framework for very brief treatment encounters
• Strategies are presented in terms of principles, examples, and counterexamples with an emphasis on practicality. Read my detailed review See more information at Amazon.com
Or, if you just want the bare essentials:
Lifestyle Change by Chris Dunn and Stephen Rollnick
• Pocket-size "how-to" guide
• Super-streamlined 3-step model
• Focus on simple, structured techniques to help engage patients in a constructive conversation about change Read my detailed review See more information at Amazon.com
And if you really love this stuff, and want an expanded approach with all the theory:
Motivational Interviewing, Second Edition: Preparing People for Change (MI2) by William R. Miller and Stephen Rollnick
• Theoretical underpinnings, empirical evidence
• Some detailed examples of strategies and techniques with an emphasis on general principles
• Specialty settings, populations, topics featured in extensive edited section Read my detailed review See more information at Amazon.com
MI may be conceptualized as a particular form of the "guiding" style of communication with patients - see Steve Rollnick and colleagues' recent British Journal of Medicine article for more about incorporating MI into daily practice without over-reliance on structured interventions.
"Teaching Patient" Roleplay Guidelines -
When in the role of the teaching patient, your job is to help each other learn MI.
The teaching patient is NOT the patient from Hell!
The teaching patient should also NOT be based solely on a single real patient.
Develop a role that is familiar from your work and that you can role-play convincingly.
Consider: demographics (age, gender, race, marital status, household composition); socioeconomic background; the clinician's and client's perspective on what is the presenting problem (these may disagree); the patient's goals and values; the pros and cons of the problem behavior from the patient's perspective; the pros and cons of the desired behavior from the patient's perspective.
Keep roleplays short and focused on one specific skill at a time. Allow the person in the clinician role to set - and change! - the level of readiness or resistance displayed by the teaching patient. Audiotape the roleplays for review.
Session 2
Recommended Activities:
1. HBC Chapter 3
2. OARS Roleplay - 5-10 minutes per "turn" - repeat so everyone has a chance to play all 3 roles
Suggested topics:
What have you read lately that you would recommend?
Who in your family are you most like?
Tell me about a memorable trip you took. What made it memorable?
What is your dream job?
What do you like about yourself?
What is the best advice you ever received?
Tell me about a challenge you overcame successfully.
INTERVIEWER: Use OARS style to learn about a topic chosen by the TALKER.
TALKER: Respond naturally to the INTERVIEWER's prompts.
COACH: Use OARS coding sheet to keep track of whether the INTERVIEWER is using OARS. After 5-10 minutes, stop the interview. The COACH then gives feedback -
Did the Interviewer use mostly open questions? Were there any closed questions that could have been rephrased as an open question?
Did the Interviewer remember to affirm the Talker? Can you think of any more affirmations for the Talker?
Did the Interviewer use reflections to show she was listening? What was your favorite reflection?
Did the Interviewer have the opportunity to summarize? If not, have the Interviewer summarize what she heard.
If you have time, view the following DVD segment: Disc 1, Part B, Chapter 2, scenes 5 and 6 (extended example of reflective listening, plus some discussion of learning reflective listening; about 10 minutes). If you don't have time, this is a good one to come back to at any time during the course or afterwards.
A better example of how to get started with the patient from the video clip above:
Just for fun:A YouTube posting from a woman who attended an MI workshop at her church. I love how she explains/demonstrates reflective listening. She starts out talking about her hair, but bear with it for a couple of minutes and she'll get around to it.
Session 3
Video clip to view during the session: DVD Disc 2, Part E, Scene 7 (importance and confidence scales)
Recommended Activities:
1. HBC Chapter 3
2. Importance/Confidence Roleplay - 5-10 minutes per "turn"- repeat so that everyone has a chance to play all 3 roles:
INTERVIEWER: Use Importance/Confidence scales to learn about the patient's readiness to change a specific health-related lifestyle behavior. Your job is to understand how the patient feels about making a change.
TALKER: Respond to the Interviewer's prompts in the "teaching patient" role. Have your overall readiness to change be somewhere between 4 and 7; i.e., in the contemplation or preparation stages.
COACH: Help the Interviewer stay on track with the Importance/Confidence prompts. Remind her to summarize, if needed.
Session 4
Video clip to view during the session: DVD disc 1, Part B, scene 4 (exploring pros and cons)
Recommended Activities:
1. HBC Chapter 4
2. Good/Not-So-Good Roleplay - 5-10 minutes per "turn"- do 3 times to illustrate examples of 3 levels of readiness
INTERVIEWER: Ask the client about the good and not-so-good things about the health-related behavior they have agreed to discuss. Your job is to understand their decisional balance, not necessarily to try to change it. Try to reflect, ask for elaboration, affirm, or summarize when you hear change talk.
CLIENT: "Teaching client" role as developed previously. On the first "turn," the client's overall readiness should be around a 3. On the second "turn," start over again from the beginning. This time, the client's overall readiness should be around a 5-6. On the third "turn," start over again from the beginning, but this time the client's overall readiness should be around a 7-8.
COACH: Help keep the interviewer on track.
AS A GROUP - notice any differences between how the interview unfolds with a client at low, medium, and high level of readiness.
3. View DVD Disc 1, Part B, Chapter 6 (eliciting self-motivational statements). You can skip scene 4, because you will have viewed that during the call. If you skip scene 4, it will run about 15 minutes.
4. Be prepared for the next session with some examples of the difficult things clients say!
Additional Resources:
If you like theory and research, check out a recent series of literature reviews regarding "change talk" - several articles from back issues of the MINT Bulletin. Look for "what the research says" articles by Grant Corbett in October 2004, May 2005, September 2005 issues.
Session 5
Video clips to view during the session: DVD disc 1, part C, chapter 2, scenes 1-6 (reflective responses to resistance) Note - I may substitute an audio exercise instead, but please be prepared with the video "just in case"
Recommended Activities:
1. HBC Chapter 5
2. Discuss as a group:
Identify most likely sources of resistance in your clinical population.
Brainstorm: How can you help patients feel in control and understood?
When is it hardest to avoid an unproductive back-and-forth with patients/clients?
Brainstorm: Reflective/strategic solutions
3. View DVD disc 1, part C, scenes 7-16 (strategic responses to resistance; about 15 minutes)
4. Be prepared to discuss when providing information leads to resistance. Also, be prepared to present a couple of simple examples of the kinds of information you most often provide.
Session 6
Video clips to view during the session:
DVD Disc 2, Part D, Chapter 4 – Case example: Elicit/provide/elicit
DVD Disc 2, Part D, Chapter 5 - Case example: Cardiac care patient
Recommended Activities:
1. HBC Chapter 5
2. Elicit-Provide-Elicit Roleplay - 5 minutes per "turn." Repeat until everyone has a chance to play all 3 roles:
INTERVIEWER:
Ask permission to provide information
Elicit patient's ideas before providing information
Provide information in small chunks
Elicit patient's reactions to information
Reflect patient's reaction
CLIENT: Respond naturally in "teaching client" role
COACH: Give feedback to interviewer: did she follow the steps?
3. View DVD Disc 2, Part D, Chapter 2 (case example of giving feedback) - first 5 minutes or so, then forward to scene 19 and watch another 5 minutes or so
Session 7
Video clip to view during the session: DVD Disc 2, Part F, Chapter 5 (and maybe also chapter 6)
Recommended Activities:
1. HBC Chapter 4
2. Building Confidence Roleplay (one or two times through - there is an interviewer tag team instead of a coach for this one):
Don't start all over again at the beginning! This exercise focuses on what to do once the client has expressed reasonably high importance of change, and you are now ready to move on to confidence. So, decide among yourselves what the target behavior change will be, and how the client feels about it, and jump right in and start in the middle! The client should be at a pretty high level of readiness for this exercise.
INTERVIEWER 1: Begin with a brief summary of the client's decisional balance (taken from a prior roleplay, or made up on the basis of your pre-roleplay discussion). Then ask a key question, such as "where does that leave you?" or "what do you want to do?"
CLIENT: Respond in "teaching client" role. You should have a high level of readiness to change - you are convinced of the importance of change, but still need to work on the practical matters.
INTERVIEWER 1: Engage the patient in exploring past change efforts. Remember to reflect and summarize.
INTERVIEWER 2: Engage the patient in brainstorming solutions. Remember to reflect and summarize. Encourage the patient to choose a solution she is willing to try out as an experiment.
3. Be prepared to discuss:
What are the areas of obvious good fit between the behavior change counseling model and your protocol?
Where will it take some work to figure out how to apply the behavior change counseling model within your protocol?