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    Catalyst for change

    Motivational interviewing can help parents to help their kids

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    Key iconKey Points

    • People are more likely to change a behavior if they view the alternative behavior as being positive.
    • Motivational interviewing can facilitate positive behavioral changes.
    • Plant "seeds of change" by raising the patient's level of awareness and assess readiness for change.
    • The clinician can explore how the patient views his or her current behavior.

    Assess readiness for change

    The clinician can then ask the patient about how ready she is to take the next step. For example, the clinician can ask, "How ready are you to . . . ?" As in the precontemplation stage, a numeric rating scale can be used to gauge the patient's degree of readiness. In addition, asking the patient "How will you know when you are ready?" may assist the patient in working through his ambivalent feelings and serve to facilitate change by encouraging the patient to continue to wrestle with the behavior under discussion.

    Establish a time frame

    For the patient who expresses a desire for change, the clinician can establish a time frame for change by asking, "What is your time frame?" or "How much time do you think you need before beginning to lose weight? . . . beginning to vaccinate your child? . . . quitting cigarette smoking?"

    Conclude the discussion

    The clinician can wrap up the discussion by allowing the patient to summarize the salient pros and cons of the discussion and giving the patient an opportunity to let his thoughts percolate. If the patient indicates readiness for change, the clinician can help move the patient toward the stages of preparation and action by asking the patient if he would like to schedule a follow-up visit to work on a plan. Otherwise, the clinician can conclude with a statement such as, "It sounds like you have got a lot to think about. Take some time to consider our discussion and perhaps we can talk about this again at our next visit." Again, this is the time for the clinician to remain flexible and back off, leaving the door open for future discussion.

    Getting to yes and beyond

    Motivational interviewing techniques can often be successfully used to help patients move through the stages of healthy change. Clinicians can plant seeds of change for patients in the "no" precontemplation stage and process ambivalence with patients in the "maybe" contemplation stage. Part 2 will examine how to help patients who are in the "yes" preparation stage to move toward the action stage.

    REFERENCES

    1. Hassink S. Pediatric Obesity: Prevention, Intervention and Treatment Strategies for Primary Care. Elk Grove Village, IL: American Academy of Pediatrics; 2007.

    2. Diekema D; Committee on Bioethics. Responding to parental refusals of immunizations of children. Pediatrics. 2005;115(5):1428.

    3. Rollnick S, Miller W, Butler C. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press; 2008.

    4. Thaler R, Sunstein C. Nudge: Improving Decisions About Health, Wealth, and Happiness. New Haven, CT: Yale University Press; 2008.

    5. Christakis N, Fowler J. Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives. New York: Little Brown; 2009.

    6. Miller W, Rollnick S. Motivational Interviewing: Preparing People for Change. New York: Guilford Press; 2002.

    7. Prochaska J, Norcross J, Diclemente C. Changing For Good: A Revolutionary Six Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. New York: HarperCollins; 1994.

    8. King M, Novik L, Citrenbaum C. Irresistible Communication: Creative Skills for the Health Professional. Philadelphia: WB Saunders; 1983.

    9. Andreasen A. Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment. San Francisco: Jossey-Bass; 1995.

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