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HBC Test 2 > Motivational Interviewing > Flashcards

Motivational Interviewing Flashcards

1
Q

Motivational Interviewing Definition

A

A collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.

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2
Q

The “Spirit of MI”

A

Collaboration, Acceptance, Evocation, Compassion

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3
Q

Collaboration (“Spirit of MI”)

A

Clinician and patient are partners; Patient as expert (know their own preferences); Ask for permission (to share expertise); Avoid premature focus (don’t assume); Focuses on mutual understanding versus the care manager being right

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4
Q

Acceptance (“Spirit of MI”)

A

Clinician as guide (patient must make their own decision to change); Respect patient autonomy (Can decide whether to act); Normalize ambivalence (Give context for failure, “it happens”); Nonjudgement (Give choices but don’t get invested in their decision)

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5
Q

Evocation (“Spirit of MI”)

A

Ask, not tell (Evokes the patients own motivation and resources); Tap into patient’s own motivation (What do they want to do and why?); Avoid expert trap (Don’t sound like you have all of the answers)

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6
Q

Compassion (“Spirit of MI”)

A

Unconditional positive regard (Doing their best); Understand and validate (Show you get it); Genuine care and concern (Quality interactions without investing emotions)

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7
Q

Key Principles of MI

A

Express Empathy; Develop Discrepancy; Roll with Resistance; Support Self-Efficacy

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8
Q

Express Empathy (Key Principles of MI)

A

Understand where a patient is and then convey that to them. Guide people to understand and listen to themselves

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9
Q

Develop Discrepancy (Key Principles of MI)

A

Change is motivated by a perceived discrepancy between present behavior and important goals and values. Developing discrepancy should be done in a non-judgmental way

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10
Q

Roll with Resistance (Key Principles of MI)

A

“People don’t resist change, they resist being changed” -Peter Senge; The resistance or disconnect a person offers can be turned or reframed slightly to crear a new momentum towards change. The object that is in motion here is a perception (Go with it, no need to oppose)

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11
Q

Support Self-Efficacy (Key Principles of MI)

A

A person’s belief in his/her ability to succeed. Confidence is a strong predictor of change. The hope that the patient holds that there is a possibility for change

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12
Q

Processes Definition (MI)

A

Change is a process, not an event. There are different stages along the change continuum. Where a patient is on the continuum determines what process and what interventions make the most sense. (Oftentimes the processes overlap, so use what works with a patient at given time)

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13
Q

Processes (MI)

A

Engage, Focus, Evoke, Plan

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14
Q

Engage (Processes of MI)

A

Empathetic listening; Relational foundation- establish a helpful connection and working relationship.

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15
Q

Focus (Processes of MI)

A

Targeting change; Develop and maintain a specific direction in the conversation about change

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16
Q

Evoke (Processes of MI)

A

Clients idea; Eliciting the patient’s own motivation for change.

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17
Q

Plan (Processes of MI)

A

Bridge to change; Developing commitment to change and formulating a concrete plan for change.

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18
Q

Engage Definition (MI)

A

Relational foundation – establish a helpful connection and working relationship, establish rapport, and build trust

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19
Q

OARS (Engage, MI)

A

[O]pen-ended Questions; [A]ffirmations; [R]eflective listening; [S]ummaries

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20
Q

[O]pen-ended Questions (Engage MI)

A

Enable patients to open up and explore their stories; (Explain… Tell me about… Say more about… Clarify… How… What…)

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21
Q

[A]ffirmations (Engage MI)

A

Recognizes and reinforces success; (Offer perspective in face of difficulties; Express optimism; Any progress is progress)

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22
Q

[R]eflective (Engage MI)

A

Enable patients to hear what they are saying from the vantage point of another person (Mirrors what the patient is saying; States what the person is meaning; Shows collaboration and equity; Try to offer TWO reflections for every ONE question you ask)

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23
Q

Simple Reflection (Engage MI)

A

Repeating what the patient said; “Parroting”; Use patient’s words/language so they can hear themselves

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24
Q

Amplified Reflection (Engage MI)

A

Exaggerated reflection; Can be expressed through words and/or tone; No judgement, no sarcasm

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25
Q

Double-Sided Reflection (Engage MI)

A

Reflect ‘both sides’ of the story you hear; On the one hand….on the other hand…..

26
Q

Shifted Focus Reflection (Engage MI)

A

Use when patient is deeply stuck on a topic; Helps reduce resistance

27
Q

Empathy Reflection (Engage MI)

A

Shows you hear the facts AND the feelings of the patient; Acknowledge the need that is/is not being met and the feeling associated with that.

28
Q

[S]ummaries (Engage MI)

A

Pulls together and links relevant information (Lets patient know you’re listening and understanding; Allows patients to hear their own motivations and ambivalence; Helps to bridge and transition between topics; Focuses on priority content and feelings)

29
Q

Focus (MI)

A

Agenda mapping; Top 3; Informing and advice giving (use caution)

30
Q

Agenda Mapping (Focus MI)

A

Fill in circles with patient concerns

31
Q

Top 3 (Focus MI)

A

Ask about Top 3 Health Goals
-Once identified ask, “Are you concerned about?, If so do you want to do anything about it and when?, If not now when and how will you know?, Bc ppl sometimes change their mind is it okay if I ask you about this next time?”

32
Q

Informing and advice giving (Focus MI)

A

(Use caution) Ask for permission; Tie information or advice to patient’s concerns; Ask most helpful way to show and interpret data; Offer menu of options; Elicit-Provide-Elicit

33
Q

Listen for Change Talk (DARN CAT, Focus)

A

[D]esire; [A]bility; [R]eason; [N]eed; [C]ommitment; [A]ctivation; [T]aking steps:

34
Q

[D]esire (DARN CAT, Focus)

A

What do you want to do?

35
Q

[A]bility (DARN CAT, Focus)

A

What do you think you can do?

36
Q

[R]eason (DARN CAT, Focus)

A

Why might you make that change?

37
Q

[N]eed (DARN CAT, Focus)

A

Why is this important to your health?

38
Q

[C]ommitment (DARN CAT, Focus)

A

Will you do it?

39
Q

[A]ctivation (DARN CAT, Focus)

A

Are you prepared?

40
Q

[T]aking steps (DARN CAT, Focus)

A

What will you do?

41
Q

Evoke)

A

Explore patient’s motivation, goals, and ideas; Help patient come up with their own reasons; Identify resolve ambivalence; Identify barriers to change; Preparation/ Target dates, support, resources; (Pros and cons (decisional balance), Rulers, Hypotheticals)

42
Q

Rulers (Evoke)

A

On a scale from 1 – 10…(Scaling Questions; Follow-up scaling questions; What do you think you can do about that?; Set goals based on the response)

43
Q

Scaling Questions (Rulers, Evoke)

A

Importance, confidence, commitment, readiness

44
Q

Follow-up scaling questions (Rulers, Evoke)

A

Why higher or lower number?, What number would you like to be?, What would it take to go from…

45
Q

Hypotheticals (Evoke, MI)

A

Help people envision change if they are less ready (What do you want to do with this information?, What can you draw on from the past to help with this situation?, Suppose you were willing to make this change. How would you succeed?)

46
Q

Planning (Evoke, MI)

A

Clarify when someone is willing, able, and ready (Change talk, Taking steps, Questions about change); Focus less on whether and why and more about how; Collaborate on incremental goals; Develop a plan that includes adequate structure, accountability, benchmarks, and rewards.

47
Q

Smart Goals (MI)

A

[S]pecific, [M]easurable; [A]ctionable; [R]elated; [T]imebound

48
Q

Partner with Patients (MI)

A

Provide [F]eedback with permission; Emphasize patient’s choice and [R]esponsibility; Offer [A]dvice with permission; Discuss a [M]enu of options for taking action; Normalize ambivalence using [E]mpathetic style; Promote [S]elf-efficacy by identifying strengths and accomplishment

49
Q

Agenda Setting- 1st Contact (Engage, MI)

A
  • Welcome and “settle” in the patient
  • Ask about patients concerns and priorities
  • Fit the assessment into the interview (conversational vs. Q/A)
  • Be honest regarding any limitations; Clarify role as care manager
  • Review plan for next session
50
Q

Agenda Setting- Follow Up Contact (Engage, MI)

A
  • Start with small talk
  • Let patient know your goals for the visit; Ask what they want to cover
  • Follow up from last visit
  • Review plan for next time
51
Q

Elicit 1 (Focus, MI)

A

Ask permission to provide information or advice (“Would you like to take a look at your lab results?”)

52
Q

Provide (Focus, MI)

A

Give information tying yo patients concerns; Try not to overload the person but deliver info in smaller chunks (“This might explain the reasons you have had difficulty sleeping”)

53
Q

Elicit 2 (Focus, MI)

A

Elicit patients reactions and understanding particularly when giving critical and personal info and advice (For understanding: “I would like to check whether this made sense to you”) (For reaction: “What are your thoughts about what you would like to do with this information”)

54
Q

[F] (FRAMES, Focus)

A

Provide feedback with permission

55
Q

[R] (FRAMES, Focus)

A

Emphasize patients choice and responsibilitity

56
Q

[A] (FRAMES, Focus)

A

Offer advice without judging

57
Q

[M] (FRAMES, Focus)

A

Discuss Menu of options for taking action

58
Q

[E] (FRAMES, Focus)

A

Normalize ambivalence using empathic style

59
Q

[S] (FRAMES, Focus)

A

Promote self-efficacy by identifying strengths and accomplishments

60
Q

Exploring Pros and Cons (Evoke)

A

Advantages of behavior/ Advantages of changing behavior; Disadvantages of behavior/ Disadvantages of changing behavior

61
Q

Change Talk (Plan)

A

The change I want to consider is; My main goals in making this change are; These are some possible obstacles to change and how I would handle them; I plan to do these things to accomplish my goals; Other people could help me with change in these ways; I will know that my plan is working when I see these results

HBC Test 2 (4 decks)

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