stephenrollnick

I would like to share an issue I am struggling with as a registerd dietitian. MI has been identified as an "evidenced based" practice and so the ADA (American Dietetic Association) has been recommending we use this as one means of intervention. Although they have provided some great workshops (using MINT trainers), I feel we as dietitians are not understanding that with our background/training this is not something we can just go out and learn. I DO however totally love the approach and believe we can still develop skills and over time grasp the meaning of the "spirit" of MI. I just worry that there is more work to be done as far as "training" than we realize. I also believe in evaluation of skills, and have done lots of reading as far as the instruments that exist(such as the MITI), but do not feel most of us who are not MINT trainers will be able to get to that level. I have been fortunate to have worked under the supervision of pschologists for many years and so I may have a greater appreciation for the counseling field and the fact that it takes years of education, training and practice to develop these skills. I worry that with asking open ended questions, RD's may open a can of worms and not know how to redirect the patient. There probably needs to be some type of skills evaluation that takes this into consideration. Fortunately, where I work, my supervisor supports us gaining knowledge and skills in MI, and since I am the lead on this, I have been focusing on trying to educate our group on understanding and appreciating the complexity, working toward some doable gain in skills, such as even rolling with resistance vs shaming someone (what our patients seem to expect). I have started individual supervision with a MINT trainer, which is great, but most of us here can not afford this. Any advice on what other health professionals such as RD's can do to evaluate themselves to be sure they are doing the right thing? Thanks for any feedback!  Joanne

Dear Joanne,

I see that 130+ people read your post and no-one replied.  That's awful!  I was hoping that poeple could talk with each other in this forum, but I'm a web novice so maybe I dont understand why or how people behave in a forum.

I'll get back to your interesting post very soon.  Weve just had a little baby, which is why I have been otherwise engaged!

Steve

Hi Joanne

Apologies for not replying before now.  I too am a dietitian who is embracing MI and changing my approach.  I don't know if I can offer much but I can tell you how we are developing our skills in Cardiff.

The main challenge for our profession in the UK is to train dietitians to be patient-centred and to have basic listening and communication skills.  These are skills that I was not trained in at University or on placement and like many of my colleagues struggled with supporting patients with change.  It came to a point in my practice when I felt there must be another way to practice or to give up and find another profession.

I was then trained in communication skills for behaviour change and introduced to MI.  I began reading about it, attending workshops, trying it and constantly reflecting on my consultations. Of course this is an on-going process.  The main indicator of how I was progressing was feedback from the patients.  Consultations feel completely different, with patients attending more appointments, improved outcomes and comments from patients about how helpful they find appointments.

Myself and my colleagues get together and discuss the skills, practice them and watch dvd clips. 

I don't think I can suggest anything more than you are already doing but it is great to know such an effective approach is being embraced by colleagues in your part of the world as well.

All the best

Orla

Hi Joanne

I forgot to add a little about the can of worms concern.  This is a common worry that my colleagues raise and we discuss that we do not need to solve people's problems for them.  We have found that having a good knowledge of what services are available is helpful should a person need additional support.  However I have generally found that simply listening to someone is enough for them and they often say it is a relief to get something off their chest.

Not sure if this is of any help,

Orla

Thank you so much for your responses (and congrats on the new baby!!) I think maybe there are no good answers yet. It feels like we (dietitians) are just in the beginning of even understanding what we can do with MI, how complex it is to learn let alone evaluate if we are grasping the approach.
And thank you Orla, you have been very helpful. You have described just what I have been experiencing in my work with patients, just an attitude shift, they seem to leave with a feeling of relief as well as more motivation! So I guess that is definitely one way to evaluate yourself (although I am much more aware of what I am doing, I do struggle sometimes to NOT fall into that old way, forgetting to ask first before educating, etc but I know that being aware is half the battle!).....My thought was that we need to eventually get to the point where we can do some good research over time to see what works best for us as far as gaining skills. Just not sure the best evaluation tool to use, as in our department no one is really qualified to use the MITI, etc. I have thought of sending our tapes out for evaluation but that would cost too much to do for everyone. So for now we are just looking at the basics (focusing on the first stages of MI, 1, 2, 3 and 5-since rolling with resistance is so important in our field!). As for the "can of worms" that is just what we try to do...have resources to refer people to. But even recognizing that line and how to re-focus the session, I think needs to be a required skill for those of us who are not therapists. Not always an easy task for some of us! anyway, I love that everyone is so supportive of eachother in the MI world. So thank you for that! My goal is to continue to spread the word as much as possible in my flield, I feel we desperately need to do things differently. I will be sharing some of what we have been working on at Connecticut Children's Hospital, and some of the resources available (the books, websites, etc) at the FNCE conference in San DIego in September...hope to get lots of dietitians hooked!! Thanks again,
Joanne