As a Certified Community Health Worker as well as Health Coach, I know the importance of MI (Motivational Interviewing. Some may not know what MI means.
Motivational Interviewing is a form of client-centered counseling that is widely used throughout the world to support clients and patients to change behaviors and enhance their lives and health. There are many levels of MI and many people who provide the services especially in health care who utilize and use MI as one of the most important resources in our daily work with our clients, patients, families and groups as well as our communities.
MI is a style of counseling to promote change by helping clients to explore and resolve their uncertainty.
Just think about a time when you had to make a change for improvement in any area of your life. You can recall that time you identified that needed to change and it was a little frightening, or for some like myself it was very frightening. However, once I took the baby steps toward that change it did become just a tab bit easier. Behavioral change means to give up something that we have become used to and that provided pleasure, comfort, or a sense of meaning or identity it is natural to be uncertainty and filled with mixed emotions about changing familiar patterns of behaviors. A few listed here will give you an idea of why some clients/ patients would be reluctant to change:
Eating- healthy eating for those who have not been taught the importance of veggies and food for a healthy life would be very reluctant. They would have to create recipes, be introduced to food labels and the importance of eliminating some foods due to chronic health conditions. This one was a challenge for me as well. When you did not grow up in a household that taught you how to eat healthy which has been the case in low-income households and communities.
Exercising- for years stats show that obesity is on the rise and although they have the quick weight loss drugs to shoot in your stomach and thighs and are only affordable to those who can afford it. Trust me it would have cost me $1100.00 out of pock for this drug, with many side affects. I could not afford to pay that, my great and premium insurance only paid a small portion. However, how is that a drug needed for my health but not affordable due to my color (there are studies that actually show this) not only in healthcare , but loans as well. I digress. We had to work for a living, and go to school. In my household and many others in my communities did not exercise. Our examples, uncles, aunties, mothers and fathers worked. I never saw my mom run, maybe when she was being a victim of DV. But not for her health that run was for her life. Today, I am an advocate, not only for DV but for my own health, I exercise daily but this did not happen overnight. It is still a challenge for me to remain consistent.
Having sex-parenting, STDs, STIs and Warts are on the rise. We teach, have family planning in our schools systems, but teen pregnancy is still on the rise? Which means that the system that I grew up with does not work. Or, is it that I did not desire to get help especially getting pregnant at 15, kicked out of school had to go to night school with the other pregnant teens. What a mess that was for each of us.
Expressing anger- this is an issue for many, no training for conflict resolution. We can see that with the increased crime rates in all areas of the US. I thought hate was love in my household. I saw and experienced so much trauma as a young child, teen and adult that are still triggers today. Our communities, loss of jobs, bullying in schools and homes are contribute to this expressing of anger, it does not help it hingers every area of our lives.
Alcohol and drugs- this subject has effected us all, we all know people in our lives and families that have been affected by drugs and alcohol. The drug epidemic remains a challenge, and yes all of the lack of each one of these points affect our mental health. We go from crack epidemic (not many died from smoking crack, may have died from being robbed of their crack), opioids which started with the ones who had health insurance and was able to get their pain killers to mask their mental health issues, yes it masked it all alright, those we see living on our streets and on most channels on social media proves who they were/are (privileged) unfortunately. Check the rehabs, where that too is a money pit for those who helped to infect our families with the mask drug. I helped many to get off drugs, my mother, family, community helped my sister (may she RIP) to get off of drugs, crack cocaine. There are still family members out there on the streets on drugs. It breaks my heart to see so many. I use to live among them on the streets.
Tobacco- I remember smoking a cigarette but when I was 12 years old my sister and I on the way to get a pack of Pall Mall cigs for our uncle who just returned home from the war. We found one on the ground, took a puff and we were both sick, returned home and our uncle smelled the cigs on us and made us smoke a whole cigarette! We never smoked again to this day! It was the most horrible and horrific experience and today I hate the smell of smoke.
These minor details and subject are just to name a few. I am sure that there are many others. Motivational Interviewing as a CHW is a very important part of our jobs. The first part that is important is to build trust with our clients and patients once we do that then the MI can take place. In order for us to be agents of change for others we must first undergo our change in areas of our own lives. Our story helps others the good, the bad and the ugly. Nothing in this life is easy. Not for me and others I know as well.
MI consists of open-ended questions once you have established a connection with your client and they have expressed a need for change. Here are a few examples of some open-ended questions:
* What behaviors have you tried to change over the course of your life?
* What did you have to give up in order to make these changes?
* Did you ever feel reluctant or have doubts about changing these behaviors? If so, what does that look like?
MI highlights the way that a client, patient's motivation for change is shaped and influenced by the change needed, the interactions between the client/patient and a care team member.
OARS- Motivational Interviewing techniques.
O- Open- ended questions- encourages a client/patient to reflect and talk in a detailed way.
A- Affirmations- are statements that encourage direct and immediate positive feedback for your clients and patients efforts and accomplishments and encourage them to continue along their stages of change.
R- Reflective Listening- a skill of reflecting back to our client/patient what information they have shared about their experiences, beliefs, feelings and intentions. Repeating back as precisely as possible using words that they have said.
S- Summarizing- entails reflecting back the main concerns, their feelings or decisions that the client/patients have shared with us. This helps us to demonstrate that we have been actively listening.
We hope that you learn more about how to increase your skills in the area of MI. If you need help or a refresher course we offer this under our "services" page.
It is our duty and passion that you are an agent of change for yourself first as a CHW. Stay connected for more information that can help you with your day to day activities.
Contact us, we look forward to your feedback.