Strong4Life WIC Program

Lisa Giles MS, RDN, LD, CDEChildren’s Healthcare of Atlanta

Advancing Motivational Interviewing Skills

WIC Provider Training

159 Counties in

Georgia

Disclosure

Children's Healthcare of Atlanta resolves to ensure that its educational mission, and particularly its continuing medical education activities, are not influenced by the special interests of any corporation or individual associated with its program.

While having a financial interest or professional affiliation with a corporation does not necessarily influence a speaker's presentation, the standards of the

Accreditation Council for Continuing Medical Education require that this relationships be disclosed to the audience. Any potential conflict of interest will

be made known to participants at the beginning of the program.

The speakers and planning committee for this program have disclosed that they have no financial relationships with commercial interests related to this

presentation.

Objective Participants will increase self-confidence in at least one Strong4Life Motivational Interviewing Technique:

Asking Permission Open-ended Questions Reflective Listening

Strong4Life Observation Results

Did the nutritionist: % YES % NO % I don’t know

Use the Healthy Habits Assessment to facilitate conversation with the client? 75.0

25.00 ---

Praise the client for positive accomplishments noted on the Healthy Habits Assessment? 76.9 21.2 1.9

“Have you thought about trying a new

healthy habit for your family or child?”

“If you could make one healthy change what would it be?”

Strong4Life Observation Results

Did the nutritionist: % YES % NO % I don’t know

Allow client to lead the discussion related to setting a new healthy habit goal?

71.2 23.1 5.8

Work with the client to create achievable goal using the clients ideas and language?

90.2 5.9 3.9

Provide positive verbal support to the client to encourage progress toward goal?

92.2 5.9 2.0

Strong4Life Observation Results

Was the goal SMART?

Specific Measurable Attainable Realistic Time-bound

84.3% 86.3% 98.0% 92.2% 70.6%

I will serve 1% milk instead of juice.

At dinner time

4 days a week

Specific

Measurable

Attainable

Realistic

Timely

Me, Dad, Grandmother

Today

Strong4Life Observation Results

Did the nutritionist: % YES % NO

Ask permission to share their concerns with the client?

40.4 55.8

Use open-ended questions to understand client feeling about child’s weight status?

63.5 36.5

Strong4Life Observation Results

Did the nutritionist:

Use reflective listening while speaking to the client about their child’s weight status?

Never/Rarely Sometimes Frequently / Always

23.0% 25.0% 49.5%

Recognizing Barriers to Behavior Change

Ambivalence

Mixed or contradictory feelings/thoughts about something

Yes

No

Maybe

Check One

Resistant to Change Argues

− Challenges, counters, discounts input from nutritionist

Interrupts− Talking over; cutting off

Ignores− Non-responsive; sidetracking

We could but…

We tried that…

I don’t have time

Denial No acknowledgment of poor

eating habits and sedentary behaviors

Minimizing child’s overweight status and/or comorbidities

Excuses or unconscious of unhealthy behaviors

I think we eat healthy

He’s big-boned

But it’s fruit juice

Lack of Support & Resources Lack of familial and peer support

for healthy behavior change

Limited knowledge of and/or access to healthy food choices

Limited access to safe space for physical activity

Dealing With Barriers to Behavior Change

Guide to Client-Centered Counseling

Ask, don’t tell

Place responsibility for change with the client

Ask for permission to share

Listen more than you talk

Don’t force change

5 A’s for Obesity Counseling

Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y. Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician. 2013 Jan;59(1):27-31

Ask

Assess

AdviseAgree

AssistGuides counseling for behavior change

Ideal for busy practices

Asking Permission

“We measured Cheryl’s height, weight and BMI today. Is it OK if we go over this information

together?

Nutritionist

Ask For permission to share information

Asking Permission

When to ask:• At the beginning of a

session • Before explaining

information• Before offering

information or advice

Ways to ask:• Would it be OK?• May I share my

concerns with you?• Do you mind if I share

this information with you?

Open Ended Questions Cannot be answered in “yes” or “no” Invite people to tell a story Avoid “fishing” for the right answer

Start with: How… What…Tell me…

Open Ended Questions

“Tell me about the types of fast foods you eat during the day.”

“How do you think you are doing with drinking water instead of soda at meals?”

“When Sue is with her grandmother, what types of snacks does she eat?”

Open Ended QuestionsChange the following into open-ended questions:

Do you plan to breastfeed?

Tell me about your plans for feeding the baby?

Open Ended Questions

Does your daughter like carrots?

What type of vegetables does your daughter like?

Open Ended Questions

Do you think your family would drink 1% milk?

What types of milk would your family drink?

Open Ended Questions

Does your son get any active play time?

Tell me about your son’s active play time?

Open Ended Questions

Will you let his mom know about his healthy habit goal when you see her?

How will you let his mom know about his healthy habit goal?

Reflective ListeningPay attention to what you hear, not what

you’re going to say next.

Ways to open: So you feel… You’re wondering if… What I’m hearing you say is… You’re feeling… It sounds like you…

Reflective Listening

“It sounds like you would like to eat at home more but working two jobs makes it hard for you to

find the time to cook.”

Nutritionist

Reflect Re-state what the client has said to you

Reflective ListeningLet’s Practice:

I can’t get my kids to eat vegetables.

“You are having a hard time getting your kids to eat vegetables?”

Reflective Listening

It’s really hard to find time to be active.

“Finding time to be active is a challenge isn’t it?”

Reflective Listening

I can’t get my kids to eat vegetables.

“It sounds like your kids don’t like vegetables?”

Reflective Listening

I like to eat vegetables but my husband just likes to eat junk food?

“So what you are saying is you like to eat healthy but your husband doesn’t.”

Reflective Listening

What’s the problem with his weight?

“You are wondering what the problem is with his weight?

Reflective Listening

I’m just here because his mom is working? I don’t know what they do at home.

“OK, mom is working today and you don’t know what they do when you are not at home?

Putting it All Together:Let’s Role Play

Provider Toolkit

Wendy Palmer, MS, RD, LD, CHESChild Wellness Program Manager

Office: 404.785.7215Email: Wendy.Palmer@choa.org

www.strong4life.com

Contact Information