stephenrollnick

I've come across a few crazy misunderstandings about MI.

Just this week I came across a potential winner. It went like this, and I quote:

"Can you do half day training for pct's (Primary Care Trusts) on how to handle angry calls from parents who get a letter from the dh (Department of Health) informing them that their child is obese? Rolling with resistance skills, over the phone?"

This is absurd.  Its origins, I imagine, are fascinating.  An organisation decides that "something must be done via a letter about a "public health problem" - childhood obesity.  I cant quite believe it, but it seems like this is the UK Department of Health? So they locate obese children, and then decide that the parents should be sent a letter?  Anyone with any common sense, or anyone who works in primary care, knows this is a sensitive subject for parents, but no, its assumed that a letter could be part of "health promotion"?   Then when the staff at the local primary care office get angry calls, someone decides that these staff need skill training in handling angry parents?

I am tempted to go in and offer to do the training just to experience quite how any organisation can get health promotion so badly wrong.

Steve

I did some digging about this, and a kind colleague explained what had happened.  It was as I suspected. Some parents, not all, got angry at the letter and called to complain.  Among their concerns were what to say to their obese children?  There was an obvious concern about the child being labelled, and so on.

I still dont think that these people who receive the calls should receive training.  The problem must be with an approach to health promotion that completely bypasses the need for engagement of parents and their kids (see posting on new framework for MI), one that also assumes that all people need is fearful information and they will change the behaviour of their children.  I appreciate that there are challenges in dealing with obesity, and that focusing on individuals has some value.  However, I just dont think that an impersonal technological fix (a letter) does health promotion any good.

Steve

Steve, I wonder what the primary aim of the letter was? I can't imagine with so much knowledge in health promotion theory and practice the DOH was targeting parents with children who suffer obesity problems to effect positive change!

I fear such a letter is more about a propensity toward poorly designed strategies to guard against child protection litigation - crudely reflecting the growing adoption of 'fault finding' to compensate people who feel their human rights have not been protected by the state!

This is probably not the forum for discussing the political contributory factors to health system design but when I read your post I shuddered as I have listened to a number of debates on the pro's and con's of strategies intended to make parents more accountable when it comes to their child's health. The moralistic, 'back covering' voices are getting louder in the current landscape of financial recession and conservative administration sadly!!

Pragmatically, in my own struggle to ward off becoming pessimistic and jaded, I think training to try and counter this assault on collaborative working is even more important to protect a threatened culture of using every encounter to be more helpful/constructive/guiding in nature.....not MI but with the qualities of MI!

Maybe this is misguided energy as it masks the core problem (sending the letter in the first place) but the analogy that I use is the situation of a person with an alcohol problem being 'sent' to an addiction service and being angry they have been judged to have a 'problem'.................how I respond to this is critical if I am not to alienate this person even more!

'Interesting times' to use a much over used euphemism................from a frozen Northern Irish friend gazing out at the freezing fog wondering what challenges are on their way!

Kathy