PHI includes, but is not limited to:- Patient name- Date of birth- Address- Occupation- Name of patient’s friends/family- Other identifiable features, i.e. scars,

tattoos, hair/eye color

Please DO NOT disclose any Protected Health Information (PHI)

Health, Wellness and Co-OccuringMedical Disorders in FEP

Team members:

Andy Pasternak, MD (Family Medicine)Erika Ryst, MD (Psychiatry)Amy Hughes Lansing, PhD (Health Psychology)

Disclosure PolicyAs an accredited provider of continuing medical education through the Accreditation Council for Continuing Medical Education (ACCME) the University of Nevada, Reno School of Medicine must ensure balance, independence, objectivity, and scientific rigor in all its educational activities. In order to assure that information is presented in a scientific and objective manner, The University of Nevada, Reno School of Medicine requires that anyone in a position to control or influence the content of a continuing medical education activity disclose relevant financial relationships with any commercial or proprietary entity producing health care goods or services relevant to the content being planned or presented. Following are those disclosures.

The following presenter has disclosed the following relationship with a commercial interest.• Erika Ryst, Hub Team

• Grant / Research Support: SAMHSA Mental Health Block Funding through Nevada Division of Public and Behavioral Health

• Grant / Research Support: HRSA/MCH – Nevada LEND Program• Consultant: Washoe County School District

All other presenters, planners or anyone in a position to control the content of this continuing medical education activity have indicated that neither they nor their spouse/legally recognized domestic partner has any financial relationships with commercial interests related to the content of this activity.

Motivating Health Behavior Change

Amy Hughes Lansing, Ph.D.

Overview

• Context of health behavior change interventions• Where did they come from?• Who delivers them or practices them?• Why do we care about behavior change interventions in medical care?

• Strategies for increasing motivation for health behavior change• Brief Goal Setting• Motivational Interviewing• Motivational Enhancement Therapy

Health behavior change is demanding.

• Complex, unrelenting, sometimes expensive.

• Behavior is foundation of health• yet is not the only influence on health outcomes

• Patients/parents often feel out of control of health

• Different stages of readiness for change

• Arguments about adherence at home and in clinic are exhausting.

Health Psychology

1. Psychologists interested in the psychological and behavioral aspects of physical and mental health

2. Learn how biology, environment, and behavior impact health and illness?

3. Incorporate psychological theory and research to develop methods to assist patients in maintaining healthy lifestyles

4. Help patients manage chronic disease and avoid preventable diseases

SocietyforHealthPsychology.org

Behavioral Medicine• Behavior Matters:

https://www.sbm.org/UserFiles/file/BehaviorMattersAJPM2011.pdf• Career Paths:

• PhD, MD, EdD, PsyD, DrPH, DDS, DSc/ScD, JD, NP, APRN, RD, RN, CHES, LPC, NCC, DCC, MBA, MSN, MEd/EdM, MSW, MPH, MSPH, MLIR/MLIS/MLS, MHK, MS, MA, MBS, BScKin/BHK/BKin, BCB, BS and BA.

• “Research Shows that Behavioral Interventions can Affect HealthExamples include: prevent disease onset; lower blood pressure; lower serum cholesterol; reduce body fat; reverse atherosclerosis; decrease pain; reduce surgical complications; decrease complications of pregnancy; enhance immune response; increase relaxation; increase functional capacity; improve sleep; improve productivity at work and school; improve strength, endurance and mobility; and improve quality of life.”• https://www.sbm.org/about/behavioral-medicine

Behavior Matters• Cancer

• Up to 95% of cancer diagnoses might be prevented through behavioral intervention (Anand et al., 2008; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/)

• Cardiovascular Disease• Prevention of CVD and recovery from acute coronary disease (Rozanski et al., 2005)–

behavioral cardiology field• Obesity

• Primary intervention modality is lifestyle changes vis behavioral intervention• Diabetes

• ADA Standards of Care include behavioral intervention• Substance Use

• Substantial health costs in vulnerable populations; behavioral interventions and prevention

• https://www.apa.org/health/briefs/index

Strategies for Behavior Change, Decreasing Distress, and Building

Strong Relationships in Outpatient Care

Strengths-based communication

• Review what is going well in health management:• Patient and family strengths• Ratings from resilience and self-management surveys

• Goal is to shift focus and tone of clinical encounters toward reinforcing strengths.

Hilliard et al., 2018

Praise behavior, not health outcome.

¨So many influences on heath outcomes¨Punishing numbers à “Blame and shame” à not an

effective strategy to change behavior or improve mood!

¨Catch patients doing well with adherence: ¤More likely to happen again¤Create positive atmosphere¤Develop confidence & ownership

Set realistic goals.¨Major changes can be daunting

¨Small changes, one step at a time

¨Focus on behavior goals

¨Each step achieved will reinforcemanagement behaviors

¨Celebrate each success!

Build Strong Relationships

•Empathy and respect for quality of life challenges•Encourage social support building•Repairing relationships when trust is lost• Identify common ground or goal• Return to it frequently

• Make small plans towards that goal that fit expectations of both groups• Appreciate their frustrations while staying firm on non-

negotiables

Motivational Interviewing

Motivational Interviewing

• Spirit of Motivational Interviewing-- PACE• Partnership/Collaboration• Acceptance• Compassion• Evocation

Motivational Interviewing

• Partnership!• Shift from expert/authoritarian to equal partnership• Focus on behavior change that patient and family wish to make• Explore and understand their perspective• Evoke their reasons to change

• Try instead:• “May I share my perspective?”• “We can discuss treatment options based on what makes the most

sense for you.”• “Help me understand more about how you see it.”

Motivational InterviewingUse the elicit-provide-elicit framework for knowledge exchange

• Elicit prior knowledge, elicit existing emotions, query interest• Provide brief knowledge focused on personal choice and offer a menu of

options • Elicit feedback

Elicit (engage explore)Provided (emphasize personal choice)

Elicit (effects of feedback)

Chuck-check-chunk

Motivational Interviewing

Standardized Motivation Interventions• Collaborative Problem Solving:• Increasing use in inpatient psychiatric treatment units and residential

treatment facilities• Developed for children and teens; works well with young adults• http://www.thinkkids.org/learn/our-collaborative-problem-solving-

approach/

• Motivation Enhancement Therapy:• Standardized motivational interviewing for substance misuse

• Has been extended to other chronic health issues• Treatment Manual: https://casaa.unm.edu/download/MET.pdf

Questions?