Time / Topic / Materials / Trainer
8:00 am / Coffee, Sign in, Prep Participant Intros & Learning Expectations
Invite participants to write down 1 thing they’d like to walk away with after the training today. They will reference this note during group introductions. / Sign-in sheets & sticky notes / Both
8:30 am / Welcome, Participant Introductions + Learning Expectations & Overview of Training / MC Participant Manual
  1. Welcome group, introduce trainers
/ Trainers: Consider using a PBA
  1. What is BN?
/ Manual pg. 1
  1. Review Objectives:
  • Define and identify the key elements of the Brief Negotiation method
  • Demonstrate use of the Brief Negotiation method with patients in various stages of readiness to change
  • Assess the impact of your counseling style on motivating patients to make health behavior change
  • Create a plan for beginning to integrate the Brief Negotiation method into your clinical practice
/ Objective Handout
  1. Review Agenda
/ Agenda Handout
  1. Assess Confidence: Blue Dots on Ruler
  • How confident are you in your ability to work effectively with patients to enhance motivation for health behavior change? 0 = Not at all confident 10 = Totally confident
/ Chartpad: Create ruler & confidence question, blue dots for PPTs
8:45 am /
  1. Group Introductions
  • Name, Role & Location
  • Share 1 thing they would like to walk away with today (e.g. new tools, learn more about resistance, how to motivate my patients, etc.)
/ Sticky notes: Place on a chart pad as each person shares their learning expectation
  1. Review MC Participant Manual
  • Pocket for Tools
  • Content for MC 1 & MC 2
  • Worksheets for class and individual work
  • History, Theory and Research
Emphasize use for on-going development, invite ppts to pull out the Roadmap, DM and Exercise OTs and the Ruler / Manual
  1. Group Agreements
/ Chartpad as needed
  1. Highlight the Beginner’s Mind Quote
In the beginners mind, there are many possibilities, in the expert’s mind, there are few. ~Suzuki Roshi / Chartpad Roshi Quote

Motivating Change 1: Trainer Outline(rev 8_2016)

Time / Topic / Materials / Trainer
9:00 am / ‘Not So Good’ Demo
  • Demonstrate a typical directive counseling session with lots of education, advice and judgmental language
  • Debrief quickly by asking participants:
“How did that go?”
“What made it unsuccessful?”
“As a provider, were any of the clinicians behaviors familiar to you?”
  • Tie back to point that our work today will be to help enhance the things we already do well as providers, and to shift some of the ‘not-so-good’ characteristics of our style to more effective approaches.
/ Demo Pt Education Handouts / Provider:
Patient:
Topic:
Target Behavior:
9:15 am / MC Demo
  1. Introduce as alternative to first demo
Encourage participants to attend to details (having the Roadmap handy helps)
  1. Present the demo – Follow the Roadmap - keep it simple.
  2. Debrief, ask the following questions
  • What did you notice that was different from the previous approach?
  • Who did most of the talking?
  • Why is that important? Briefly describe the self-perception theory
Introducethe concept ofCHANGE TALK
  • Any language offered by the client/pt that supports the idea of change: “I want to quit smoking.” “I wish I could lose wt.” “It’s time I do something about my Diabetes!”
RETURN TO THIS CONCEPT FREQUENTLY
TIP: Manage groups comments carefully here. Encourage brief general discussion without getting bogged down with minutia. The details will come out in review of roadmap and practice as the day unfolds. / Demonstration materials:
  • Lab Results
  • Option Tools
  • Ruler
  • Pamphlets

9:30 am / Practice the Model ‘Describe, Demo, Do’
In this exercise participants will be introduced to and practice each element of the MC Roadmap through a three step process: ‘describe, demo, and do’. In describe, talk briefly about the goal of the section, next demo for the group what it would sound like (stick as closely to the verbiage on the roadmap as possible). Finally, invite the ‘clinicians’ to try it out in a role play style. Continue through the entire roadmap.
Activity Set Up:
  • Introduce: Dyads, 1 pt + 1 provider
All Participants: Grab the materials you pulled from the binder at the start of the day (1. DM and Physical Activity Option Tools, Roadmap and Ruler.)
Clinicians:
  • Follow the roadmap, step by step, (Trainer: Stop to describe each box on roadmap and demo quickly.)
  • Eliminate info exchange for now – will cover this in detail later
Patients:
  • Assist your partner to successfully navigate the roadmap
  • Keep it simple – think of a few pros and cons for your chosen option
  • Choose 4 - 5 or 6 on the ruler
  • Stay on task – avoid argumentation, tangential comments, using personal material
  1. First cycle: Coach clinicians through each step, remember to briefly describe the goal and give an example before they try it. Refer to each box on the roadmap, having them do just one box at a time.
Stages of Change is a key learning concept here. Review as it relates to the unsure patient and normal ambivalence about change.
  1. Second cycle: Repeat instructions for clinicians and patients. Run through from start to finish without interruption. Circulate to assist as needed.
  2. Conclude: Debrief & Summarize
TIP: Keep this activity moving quickly. The primary goal is to allow participants to try on the various sections of the roadmap and begin getting familiar with the roadmap flow and language. /
  • Roadmap large laminate or overhead
  • Manual:
Roadmap
  • Chartpad instructions for clinician and for pts
Optional: For Assessing Readiness: Stages of Change / Manual / Set up:
Clinician:
Patient:
Target behavior:
Open-
Agenda-
Readiness-
Tailor-
Close-
10:45 / Break – stretch, breathe.
10:55 / Introduce the Pyramid: Style, Skills, Tools
  1. Style: Elicit participant impressions of style. If you were newly diagnosed with a chronic illness, what style characteristics would you want in your health care team? Chartpad responses / add as needed
  • Emphasize that style is foundational to the MC method / cite research
  1. Introduce Ask-Listen-Summarize as a recurring theme in the model (mantra)–a vehicle to demonstrate the foundational ‘style’
  2. Briefly review distinction betweenstrategic open and closed ended questions – transition to group activity.
  3. Large group activity: Invite participants to create open-ended questions to replace commonly used closed ended questions
Sample Questions (Customize to group as needed)
  • Are you upset?
  • Is it hard for you to deal with your illness?
  • Are you taking all your medications as prescribed?
  • Will you be able to take care of yourself?
  • Are you ready to make this change?
Write the open versions on a chart pad as group says them aloud. / Large Laminated Pyramid
Chart Pad / Pens
Resource Manual – Style section
11:20 / Interview Activity: Listening For Change Talk & Strategic OEQs
In Dyads: Invite participants to decide who will be the Speaker and who will be the Journalist.
Instructions for each role:
Speaker:Think about a behavior change that you are CONSIDERING changing in the near future.
Interviewer/Journalist:Spend about 3 minutes getting the story:
  • Limit questions. Use strategic OEQs.
  • What are you thinking of changing?
  • What are some reasons you might do this?
  • If you did decide to do it, how might you go about it?
  • Listen fully; use minimal encouragers (mm, yes, go on)
  • Summarize back what the speaker said after 3-4 minutes.
Debrief and link to Change Talk & Sustain Talk. What do you when you hear change talk? Grow it. Ask for examples, affirm strengths, reflect. Contrast with a light acknowledgement of sustain talk.
  • Second round, lets add reflections! Briefly describe basics of reflection. Chartpad the following reflection stems for the group:
  • You feel…
  • From your perspective…
  • You’re really wanting…
**NEW PENNY ACTIVITY**
Pass out a small handful of pennys to each dyad. Instruct the Speaker to given the Journalist a penny each time he / she reflects their change talk.
Debrief and conclude: Listening is a practiced skill; highlight the Chinese symbol for listening in the manual. / Powerpoint slides
Resource Manual: Change Talk / Sustain Talk
Chartpad reflection stems for round 2, penny activity.
12:00 / Lunch – nourish.
12:45 / Offering Information to Support Behavior Change
Intro: When done with sensitivity and clarity, offering patients certain ‘clinical information’ can support an effective dialog about heath behavior change. The three types of info we’ll discuss today are: providing education, sharing clinical results & offering advice.
  1. Introduce Providing Education:Ask the group what type of education they provide their pts. Use heresy kiss/chemical element handout to support the ‘less is more’ concept.
  2. Introduce and demo*Offering Advice, Emphasizing Choice, Expressing Confidence *Consider asking a ppt to be the pt.
  3. Introduce ACC Activity:In dyads, create an Advice-Choice-Confidence statement based on the scenarios in the back of the manual. (Can be done in small groups, one scenario each: chart pad assignments)
  • For Advice: Assume you’re at the end of an encounter with an unsure or not ready pt. Simply give your advice, emphasize choice, and express confidence. No elaborate stories, exploring ambivalence, action planning, etc.
Manage activity: Circulate and assist as needed. Allow ~10mins for groups to create their responses. Go around the room, each group reading their scenario and sharing their Advice, Choice, Confidence.
(Note: removed clinical results activity)
Summarize, thank participants / Backside of the Roadmap
Manual Sections:
  • Providing Education
  • Offering Advice
  • Proving Clinical Results

1:35 / The Not Ready Patient
  1. Intro the Not Ready Patient:
Often this feels like most challenging pt to counsel on behavior change. In this model we redefine successwith people who are not ready to consider change. The primary goal of the conversation is to build rapport, increase awareness and mine for even the slightest bits of Change Talk. Offering empathic reflections has been shown to be particularly useful to create trust and rapport with pts who are not ready to consider change.
  1. Demo the Not Ready Pt - keep it simple.
Remember: The Not Ready Pt remains not ready during the demo although can build Change Talk as the demo progresses.
  1. Activity: In DYADS, (same as the interview activity from the morning) invite the dyad to decide who will be the pt and who will be the Clinician. They will be working with a NOT READY pt.,the topic is quit tobacco.
IMPORTANT: Elicit quickly from group the why this ‘pt’ is not willing to quit smoking and why they MIGHT consider it in the future. This serves to make a more realistic practice conversation.
Next: Add the pennys! Have participants switch roles and ask the not ready pt to hold the pennys. When their Clinician reflects their change talk, they earn a penny! Encourage the participant playing the pt to offer just small amounts of Change Talk, so the clinician has to ‘hunt’ for it. This additional task builds further understanding of Change Talk and how to reflect it, especially with a not ready encounter when the righting reflex is tough to keep in check.
2:15 / The Ready Patient
  1. Introduce – Working effectively with a ‘ready’ pt seems simple, they’re ready! The key with someone who is ready to change is to strengthen their commitment to change, especially when the going gets rough. In this model, the goal for pts who are ready is to continue to elicit Change Talk and co-create an action plan the pt feels confident pursuing.
  2. Ready Practice Activity:
TIP: The coached practice has enormous impact on helping participants build skills in the MC method. As you observe, ask participants if you can offer feedback, affirm their efforts to try on the model. This activity solidifies learning and highlights areas for growth.
Trynew DYADS! Invite the group to choose someone new to work with – this increases the energy and increases adherence to the activity.
  • Participants who are in the Clinician role decide on clinical scenario and how they will work with their pt. Pts chooses a 8-10 on the readiness ruler. Encourage dyads to use their tools and to ask for help if they get lost on the roadmap.
  • Debrief quickly – switch roles and repeat process
Note: Manage time carefully and communicate with your co-trainer about your timing as the exercise progresses. /
  • Roadmap
  • Ruler
  • Options tool
  • Action plan as necessary

3:00 / Get Ready to put MC Into Practice – More Ready Pt Practice
  1. Dyads – participants identify something about the MC model they are ready to try in their practice when they return to work.
Each participant spends 5-10 minutes assisting partner to explore readiness and tailor the transition using the guidelines for working with the ready patient
  1. Personal Debrief: Handout “Putting the Model into Practice” sheet – we no longer follow up directly with the participants, but they can buddy up and connect with their partner. The worksheet is intended to help them focus their integration of the model and begin to take some steps toward using it in their practice.
/
  • MC Options Tool
  • Ruler
  • Roadmap

3:25 / Close
  1. Invite participants up to the ruler again, place green dots their level of confidence after a full day of training. Briefly discuss – handout evaluation forms while this is happening.
  2. Revisit parking lot prn
  3. Quickly go around room and have each participant verbalize one key learning from the training
  4. Distribute Pocket Cards
  5. Thank participants, make closing remarks. Remind group about next steps to continue the learning. Offer Email/Phone for follow up Q/A if comfortable, Promote MC 2, MCG, and Online Training. Further questions refer to Mindy Boccio.
(If time permits, close with Tao of Leadership – Being a Midwife)
4:00 / Adjourn
Congratulate yourself and your co-trainer on a job well done!

INTERNAL USE ONLY1

The Permanente Medical Group Supported by Regional Health Education

Motivating Change Training Trainer Outline Contact: M Boccio (8-427-4444). Updated as of 3/17