Meeting patients where they are to motivate change – Motivational interviewing
Often as part of a well-child check with a teenager we discuss risky behaviors such as unsafe sex or drug or alcohol use. It is important to discuss these topics in a way that helps the teen make healthy choices without being preachy. It’s a challenge. Recently I left a encounter with a teen who was using marijuana and I knew I had failed. I had come on as too preachy and he tuned me out completely.
It was sort of like this:
As providers we often think people’s unhealthy behaviors are simply due to a lack of information. And if we inform them of the facts (as we see them) that will be enough to invoke change. Wrong ! People often have a myriad of reasons for their behavior. They may disagree with your “facts”, they may be depressed, they may have competing challenges or interests behind their behavior. People are complex.
In my training I was briefly exposed to motivational interviewing as a tool but was never formally trained in this technique. It is a technique where you meet people where they are and use open ended questions to discuss habits that might be amenable to change. I set out recently to get more training in motivational interviewing (MI) and found several online free resources that I will share with you.
The foundation of MI comes from the book Motivational Interviewing: Preparing People to Change Addictive Behavior by William Miller and Stephanie Rollnick. A shorter book is Motivational Interviewing for Healthcare. As a good place to start I found an on-line webinar with slides by the Lunder Dineen program in cooperative with the MGH Psychiatry Academy. It is a great 33 minute introduction to MI.
Twine has some great hand-outs on MI.
MI is about working together with the patient. Respecting their views.
Throughout the conversation you resist the urge to be “Little Miss Bossy” and rather than tell the patient what to do – you listen and elicit their motivation to change. Everyone exists on a scale from unwilling to change to willing to change. Most people have some motivation to change.
Using the above strategies you talk with the patient and elicit “change-talk”.
For some interactive sim-based training options there are several online. The National Institute for Drug Abuse has a great website to learn MI. There are links to 3 programs. One is an interactive Medscape program where you work through a scenario with a adult using cocaine. There is also a scenario where you have a back and forth dialogue with a teen using marijuana. Another great resource is Change Talk by the American Academy of Pediatrics. This can be done online on downloaded as an app to a tablet or phone. It has 3 scenarios relating to pediatric use of MI.
Here is another video using MI.
All in all, after a weekend using these resources I feel much more equipped to work with patients regarding behaviors that they may wish to change.