Motivational Interviewing Across the HIV Care Continuum Skills - PDF document

9/9/20 Motivational Interviewing Across the HIV Care Continuum Skills Building for Care Teams Committed to Ending the Epidemic Debbie Cestaro-Seifer, MS, RN, NC-BC, CTP University of Florida, Division of Internal Medicine North Florida AIDS Education and Training Center 1 1 Disclosures § The activity planners and speaker do not have any financial relationships with commercial entities to disclose. § The speaker will not discuss any off-label use or investigational product during the program. This slide set has been peer-reviewed to ensure that there are no conflicts of interest represented in the presentation. 2 2 1

9/9/20 Motivational Interviewing to Support Linkage and Engagement in HIV Care At the conclusion of Session 2 participants will be able to: § Recall the four components of the “spirit of motivational interviewing” and describe how healthcare professionals operationalize each component. § Discuss the term ambivalence and give examples of statements that indicate a person is ambivalent. § Identify and demonstrate MI strategies and corresponding communication skills that are used when a patient is ambivalent about starting antiretroviral (ARV) treatment. § Discuss and demonstrate strategies to identify, accept and discuss a patient’s current stage of change and motivation to consider a new health behavior. § Describe and demonstrate core MI communication techniques that health professionals can use to improve HIV/HCV testing and PrEP acceptance rates in their clinical settings. § Give examples of how MI serves as a “bridge” to patient empowerment, engagement, activation and self-management. 3 3 Welcome Learning Collaborative § Welcome § HIV Care Continuum Journey using MI § Learning styles § Active Participation § MI is a powerful counseling technique 4 4 2

9/9/20 Polling Question Word Cloud Identify an MI principle or skill you consciously tried to use since our first session together 2 weeks ago. 5 5 MI: Am I Doing This Right? www.centerfor ebp.case.edu 6 3

9/9/20 7 Motivational Interviewing (MI) § 1. Overall Spirit of MI § 2. OARS: Client-Centered Communication Skills § 3. Recognizing Sustained Talk and Change § 4. Eliciting and Strengthening Change Talk § 5. Rolling with Sustained Talk and Resistance § 6. Developing a Change Action Plan § 7. Consolidating Commitment § 8. Transition and Blending with Other Coaching Approaches 8 4

9/9/20 Module 2 Quiz 9 9 Motivational Interviewing 10 5

9/9/20 Welcome! How Can We Care for You Today? 11 11 The Spirit of Motivational Interviewing Nonjudgmental Collaborative • Acceptance • Partnership Evocative Honoring Patient • Resources and Autonomy motivation for change reside • Affirms client’s right within client and capacity for self-direction 12 6

9/9/20 The MI Spirit § C ompassion § A cceptance § P artnership § E vocation 13 What’s the Difference? Apathy Sympathy Empathy Compassion 14 Image accessed on 9/6/2020 at https://brianpagan.net/2014/hierarchy-of-spiritual-intelligence/ 14 7

9/9/20 Apathy, Sympathy, Empathy and Compassion Apathy: I don’t care. (Lack of interest, enthusiasm or concern) Sympathy: I see you and feel sorry for you. (Acknowledgement. Show concern) Empathy: I feel with you. I feel your pain and I understand it. Compassion: I feel with you and act skillfully to work with you to relieve your suffering 15 15 Empathy IS ABOUT FEELINGS INVOLVES LISTENING NO JUDGEMENT FUELS CONNECTION BETWEEN PEOPLE 16 Image accessed on 9.6.2020 at https://www.bhavanalearninggroup.com/distinguishing-compassion-from- sympathy-and-empathy/ 16 8

9/9/20 Empathy Supports the Spirit of MI 17 17 Compassion is Empathy Plus Collaboration 18 18 9

9/9/20 Compassion RECOGNIZING THE I FEEL YOUR PAIN. HOW DO YOU NEED ME IN YOU ME TO HELP? 19 19 Hearing the Difference Apathy : “So what’s the big deal?” Sympathy : “Oh you poor thing. Bless your heart.” Empathy : “I understand your feelings of distress. This must be unbelievably hard for you right now.” Compassion : “I want to listen and help.” 20 20 10

9/9/20 Listening Actively Builds Empathy and Compassion Greater Listening Active Fuels Listening Connections Fuels Better Understanding 21 Talk in Groups of Four for 10 Minutes 1. Describe your self-inventory observations. 2. What are some ways for a “following style” to improve? 3. What are some ways for a “directing style” to improve? 22 22 11

9/9/20 Activity #1 1. Think of someone you work with who has recently been linked to care at your clinic who is very concerned about confidentiality and HIV stigma. Pt. Initials AS 2. Think about a patient you work with who has recently experienced homelessness. Pt. Initials SC 3. Think about a patient you work with who does not show for their scheduled telehealth or in-person clinic visits. Pt. Initials MJ 23 23 Self Inventory Activity Mark the box that occurred most often in past month #1 relating to this patient. Pt. AS I seem indifferent to I recognize and I struggle with the Pt. SC the patient’s wishes honor the patient’s patient’s choices Pt. MJ and choices. choices, including and/or press the not to change. patient to change. Pt. AS We meet, but not We are working in We are working Pt. SC much is happening. partnership. against each other. Pt. MJ Pt. AS I let the session go I am drawing out I am presenting the Pt. SC wherever the patient the patient’s own reasons for change. Pt. MJ takes it. views on change. Total Marks _____ Total Marks _____ Total Marks _____ 24 24 12

9/9/20 Conversation Style Continuum Following Guiding Directing 1 2 3 4 5 6 7 8 9 Talking Pt. talks Pt. talks & Pt. talks Pt. talks & I Pt. talks & I Pt. talks & I Client talks Client Client & I listen I speak & I guide guide guide & I talk equally talks less talks much very little; I speak some, minimally moderately frequently than me less than mostly but I mostly me listen listen Conversation Conversati Conversa- Conversati Conversation Conversa- Disagreement Power Pt. may feels like on seems tion seems on seems seems very tion seems may occur struggle shut down therapy very one- one-sided natural natural natural occasionally may sided happen 25 25 Polling Question: Conversation Style Continuum Use your own Self Inventory data and your group discussion to help you choose a number on the Conversation Style Continuum where you believe you are currently performing. _________________________________ 1 2 3 4 5 6 7 8 9 26 26 13

9/9/20 Techniques to Guide and Partner Follow Guide Direct _ Listen Draw out Teach Understand Encourage Instruct Go along with Motivate Lead 27 28 14

9/9/20 Empathy, Sympathy, Compassion and the Goldilocks Zone Guiding 29 29 First Step: Develop Rapport (LURE) § L isten § U nderstand (and check back) § R esist the urge to correct the patient § E mpower your patient Reference: All Motivational Interviewing All the Time: Pocket Guide for Health Coaches January 2014; Mountain Plains AETC 30 15

9/9/20 Empowerment Strengths “The empowerment of Resiliency a person or group of Knowledge people is the process of Goals giving them power and status (recognition) in a Skills particular situation.” Leadership Lessons learned 31 Source: Modified from the Collins Dictionary accessed pm 8/24/2020 31 Activity #2 MI Spirit: Talk in Groups of Four for 5 Minutes Use your CAPE notes and work as group to discuss the rating you would give the Counselor for establishing the spirit of MI into the prevention counseling session. Use the MI Spirit Meter below to give a number rating to the Counselor for each component of the Spirit of MI: Compassion, Acceptance, Partnership and Evocation. _________________________________________ 0 1 2 3 4 5 6 7 8 9 10 No Abundant MI Spirit Meter MI Spirit MI Spirit 32 32 16

9/9/20 Activity #2 Spirit of MI Video Activity Groups of Four Aspects of the MI Spirit List ways the counselor demonstrated MI Spirit Rating this aspect C ompassion A cceptance and autonomy P artnership and collaboration E vocation 33 33 Activity #2 Video Review for MI Spirit 34 34 17

9/9/20 Conversation Style Continuum Following Guiding Directing 1 2 3 4 5 6 7 8 9 Talking Pt. talks Pt. talks & Pt. talks Pt. talks & I Pt. talks & I Pt. talks & I Client talks Client Client & I listen I speak & I guide guide guide & I talk equally talks less talks much very little; I speak some, minimally moderately frequently than me less than mostly but I mostly me listen listen Conversation Conversati Conversa- Conversati Conversation Conversa- Disagreement Power Pt. may feels like on seems tion seems on seems seems very tion seems may occur struggle shut down therapy very one- one-sided natural natural natural occasionally may sided happen 35 35 Activity #2 Video Polling Question Conversation Style Continuum Choose a number rating on the Conversation Style Continuum below to identify the Counselor’s overall Conversation Style. _________________________________ 1 2 3 4 5 6 7 8 9 Conversation Style Continuum 36 36 18