Learning Objectives Understand key counseling techniques Learn and apply motivational interviewing tools to adherence counseling Outline Key Counseling Techniques Therapeutic Alliance Collaborative Health Education ID: 729466
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Slide1
Module 2:
Supporting Behavior ChangeSlide2
Learning Objectives
Understand key counseling techniques
Learn and apply motivational interviewing tools to adherence counselingSlide3
Outline
Key Counseling Techniques
Therapeutic Alliance
Collaborative Health Education
Motivational InterviewingSlide4
Therapeutic AllianceSlide5
Therapeutic Alliance
Eye Contact
Looking directly at someone is the first way to show them they are important and matter.
Do not look at the flipchart or document while the person is talking.
When counseling, attend to the what the person says and demonstrate attention with body language.
Nod when you understand someone.
Ask follow-up questions to clarify: “I want to understand better, can you tell me more?
Eye Contact
Active ListeningSlide6
Therapeutic Alliance
“Many
people struggle taking ARVs every day.”
“Thank
you for telling me so we can work together to make it easier
.”
With body language
Leaning forward when someone is upset, offering a tissue if tearful
Facial expressions: nonjudgment and kindWith words
“I hear how hard that was, I’m sorry you had to go through that.”
“You are working so hard, I can tell you are handling so much.”
Demonstrating Caring
Normalize and Be Nonjudgmental Slide7
Therapeutic Alliance
Demonstrate you want the best for them
“My goal today is to help you be in control of your health.”
I would like to think together how we can make things better for you.”
If they tell you something difficult, be kind.
Patient: “I haven’t been taking my medications.”
Provider: “Thank you for sharing that with me, it is hard to talk about but I appreciate you trusting me with this. Let’s talk about how we can work together for your health.”
Patient: “I’m just not sure I have HIV, I feel fine when I don’t take my medication.”
Provider: “I am so glad you brought this up. Let’s discuss your concerns.”
Developing TrustSlide8
Therapeutic Alliance
“What do you hope will be better for you in the future?”
“You’ve said your children are the most important thing to you, how might being healthy help your children?”
“What do you think would be better for you if you were taking medications?”
“I see that you have strength to handle so many challenges, I’m sure we can work together to help you take your medicine.”
“You are so motivated to be healthy for your children, taking your medications will help keep you strong and well.”
Individual Goals
Instill HopeSlide9
Therapeutic Alliance
If you feel someone needs more help than you can offer, find additional support and guidance.
Only offer realistic potential supports otherwise you could lose trust
Know Your LimitsSlide10
Normalize and Be Nonjudgmental
Adherence is a common problem because it is hard.
It is not the person in front of you being weak, it is the task that is hard.Slide11
Normalize
and Be Nonjudgmental
Nearly everyone misses doses. We need to help people feel comfortable talking about this extremely normal event.
Nonadherence risks patients’ health.
Providers
are not harmed by nonadherence so we should not respond with anger or irritation.Slide12
Normalize and Be Nonjudgmental
Many people struggle taking ARVs every day.
Ask questions that make it clear you expect doses have been missed because this is normal:
“Tell me about your last missed dose?”
“When was your last missed dose?”
“What gets in the way when you miss a dose?”Slide13
Normalize
and Be Nonjudgmental
Praise effort, not outcome. This will reduce over-reporting adherence so as not to disappoint you.
“That
is wonderful that you are
trying
to take your medications every day.”
“Your viral load is low, you must be
working hard to take your ARVs.”Slide14
Normalize and Be Nonjudgmental
Viral Load is high
What are some ways to give feedback?Slide15
Providing Health Education Collaboratively
You have a lot of information and you want to help people understand their health.
Providing information as a discussion rather than a lecture will:
Maintain the therapeutic relationship
Ensure the patient is receptive to the information
Assess what the patient knows
Target information that the patient needs
Improve motivation for the patient to learn the information
Help people become in charge of their own health
Questions promote discussion and will encourage the patient to also ask questions when they don’t understand.Slide16
Providing Health Education CollaborativelySlide17
Providing Health Education Collaboratively
Ask
Confirm
Ask
Inform
Ask
“A lot of people struggle taking ARVs. What do you find most difficult?”
“I bet that is really frustrating. People keep telling you to do something you don’t like, is hard to remember, and doesn’t feel important.
“Would you like more information about why taking ARVs keeps you healthy?”
Focus on immediate benefits like keeping partners healthy, fewer medical visits, keeping the body and brain healthy, and fewer medications.
“What questions do you have about that information?”
“Did any of those benefits seem important to you?”
“With this information, how does it change how you think about ARVs?”Slide18
ACTIVITY
Facilitators will demonstrate how to provide collaborative health education to discuss viral load.Slide19
Introduction to Motivational InterviewingSlide20
Motivational Interviewing:
Meeting People Where They Are
We want to work with patients, not against them.
Life events, skills, and knowledge affect readiness to change.
If the provider is working to set goals with someone who has not committed to changing, this can lead to a struggle between you and your patient.
Signs you may be working against your patient:
You find yourself working hard to convince a patient
Arguing with a patient
When experiencing these signs, it is important to stop struggling with the patient and instead meet at his/her readiness to change.Slide21
Motivational Interviewing:
Increasing Motivation to Change
The following techniques can increase motivation to change and develop collaborative situations:Slide22
Motivational Interviewing:
Increasing Motivation to Change
Open Ended Questions:
Avoid questions that are answered as Yes/No
“What makes it difficult for you to take ARVs every day?”
“What have you already done to try to take your ARVs every day?”
“What do you think is likely to happen if you keep taking your ARVs as you do now?”Slide23
Motivational Interviewing:
Increasing Motivation to Change
Affirmations:
Praise Effort to Change
“I appreciate that you are able
to be honest about the way you take ARVs.”
“You are clearly a resourceful person
to manage so many challenges.”
“You’ve worked really hard
to take your medications despite these challenges.”Slide24
Motivational Interviewing:
Increasing Motivation to Change
Reflective Listening:
Repeat back what they have told you
“You’re wondering if
it matters if you take ARVs.”
“So you said you
feel sad when you think about taking ARVs and that makes it really hard.”
“What I heard you saying is
you are so overwhelmed, your medications are the least of your problems right now.”Slide25
Motivational Interviewing:
Increasing Motivation to Change
Summary Statements
“Let me see if I understand so far.
You are struggling to take your ARVs because although you want to be well and healthy, you also have other problems in your life that make it difficult to focus on your health.”
“Here’s what I’ve heard you say, let me know if it is right.
You feel fine when you miss a dose and you are feeling really uncertain about whether ARVs are necessary to keep yourself healthy.”Slide26
ACTIVITY
Pair off with a partner and take turns role-playing patient and provider using the characters of Grace and John. Use OARS skills to discuss the character’s problems with adherence.Slide27
Grace
28 years old
F
ound out she was HIV+ 3 years ago while pregnant with her youngest daughter.
Has three children (8, 6, and 3 years old) who are all HIV-.
Took her medications every day while pregnant and breastfeeding, but now struggles to maintain adherence.Slide28
John
36 years old
First diagnosed as HIV+ 10 years ago
Works hard to maintain income for his family (wife and two children, ages 10 and 7)
Has never taken his medications regularly for longer than a few months and has not noticed any problems with his health as a resultSlide29
Discussion
:
Motivational Interviewing
What was difficult about using these skills?
What was different about your partner’s response to an open-ended question?
What did it feel like to have a statement affirmed?
What made affirmations or reflections feel genuine (or
not genuine)?
How useful did summary statements feel?Slide30
Summary
Accept
: Approach behavior change nonjudgmentally.
Collaborate
: Before providing psychoeducation, questions are key to involving someone in learning.
Motivate
: Meeting someone where they are by demonstrating understanding can stimulate and support internal motivation.
Remember to use OARS techniques!Slide31
Questions?