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Engaging the Participants: Evidence-Based Strategies and Interventions
Mabruk Quabili, BS, MPHHealth Informatics Specialist
Health Services Advisory Group (HSAG)
2
Trans-Theoretical Model: Stages of Change
Source: Prochaska, J. O. & Di Clemente, C. C., (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19(3), 276-288. Figure 2, p. 283.
Precontemplation
Relapse can occur at any time.
Contemplation
PreparationAction
Maintenance
Termination is the goal.
No recognition of need for or interest in change
Thinking about change
Planning for changeAdopting new habits
Ongoing practice of new, healthier behavior
3
Motivational Interviewing: Primary Skills
• Express empathy• Develop discrepancy• Avoid argumentation• Roll with resistance• Support self-efficacy
4
Motivational Interviewing: Other Skills
• Open-ended questions• Assess readiness• Reflective listening• Case Western
Reserve University– Am I Doing This Right?
• http://www.centerforebp.case.edu/client-files/pdf/miremindercard.pdf
– Readiness/Importance Ruler • http://
www.centerforebp.case.edu/client-files/pdf/readinessruler.pdf
5
Motivational Interviewing: Frames
• Feedback: Personalized information• Responsibility: Freedom of choice• Advice: Need for change• Menu: Strategies for change• Empathy: Supportive, reflective style• Self-efficacy: Participant belief
6
Centers for Medicare & Medicaid Services (CMS) Definitions
• Effective for services on or after January 1, 2008:– Smoking and tobacco-use cessation counseling
visit; intermediate, greater than three minutes and up to ten minutes
OR– Smoking and tobacco-use cessation counseling
visit; intensive, greater than ten minutes
Source: CMS MLN Matters; http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5878.pdf
7
Brief Provider Motivation Tips:The Five R’s of Enhancing Motivation
• Relevance to them personally• Risk of their use• Rewards gained from smoking cessation• Roadblocks or barriers• Repetition during each visit
RRR RR
8
Brief Provider Cessation Tips:The Five A’s of Tobacco Cessation
• Ask about tobacco use• Advise patient to quit• Assess readiness to quit• Assist patient with their quit attempt– Set a target date, Tell family and friends,
Anticipate challenges, Remove tobacco products (STAR)
• Arrange follow-up encounters
AAA
AA
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Ohio, under contract with the Centers for Medicare &
Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication
No. OH-11SOW-B.1 06092015-02
CMS Disclaimer