Stage Of Change Algorithm ( Nutrition Counseling)

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MEETING YOUR CLIENT:

T H E C O U N S E L I N G I N T E R V I E W

H N D S 4 5 0 / 5 9 0 N U T R I T I O N C O U N S E L I N G & C O M M U N I C AT I O N

P R O F E S S O R D O O L E Y F A L L 2 0 1 6

MOTIVATIONAL NUTRITION COUNSELING ALGORITHM

• Directs the flow of a nutrition counseling session – 4 phases: involving, exploration/education, resolving, & closing

• Incorporates – TTM

– MI

– Solution-focused therapy

– Self-efficacy

• Motivation is the underlying force for behavior change – 3 levels of motivation

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S TA G E 1 : I N V O LV I N G

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INVOLVING PHASE COMPONENTS

1. Greeting, Comfort, Small Talk

2. Opening

3. Identify Client’s General Goals

4. Explain the Counseling Process (first session)

5. Discuss Monitoring

6. Setting the Agenda for the Session

7. Transition to the Next Phase

10-15 minutes

INVOLVING PHASE • First stage of the session used to build the relationship 1. Greeting, comfort, small talk

2. Opening with an open-ended question – Focus is on specific counseling responses

• Relationship-building: empathizing, legitimation, respect

• Reflective listening

• Paraphrasing, summarizing, clarifying, open-ended questions. Stage Of Change Algorithm ( Nutrition Counseling)

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INVOLVING PHASE, CONTINUED 3. I.D. Client’s LT Behavior Change Objectives

– While discussing needs and expectations of the client

– Goal can be general in nature (i.e. to improve quality of diet)

4. Explain Counseling Process – Describe what will basically happen throughout the

counseling program

– Review Informed Consent Form (obtain signature)

– See p.84 for example explanation

INVOLVING PHASE, CONTINUED 5. Discuss Weight Monitoring

– Let client make decisions about weighing

– Weighing in works for some but not for others • Who performs the weigh-in? Where? When? How often?

6. Setting the Agenda – First Session: Explain the flow of the session

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INVOLVING PHASE, CONTINUED 6. Setting the Agenda

– Other Sessions: come to an agreement with the client after • Asking the client about any issues they want to address

• Explaining your intentions for the session (education, exploration, etc.)

• Sharing any additional assessment data that might bring up other issues

7. Transitioning into the Next Phase – Proper facilitation includes

voicing direction of the session • Make a statement indicating that you

both are moving on

S TA G E 2 : E X P LO R I N G & E D U C AT I N G

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EXPLORATION-EDUCATION PHASE 1. Education

2. Assessment

3. Providing Nonjudgmental Feedback

4. Client’s Thoughts on Assessment vs. Standards

5. Summarize

6. Assess Readiness to Make a Change

EXPLORATION-EDUCATION PHASE 1. Education

– Main focus: address health risks associated with your client’s eating pattern

2. Assessment – Some of the basic assessment techniques are discussed in Ch. 5

– Have client fill out assessment forms prior to session

• Have client discuss how they felt when filling them out and what they think about them

– Do not be redundant

• Client Assessment Questionnaire (LMF 5.1 on pp. 402-404)

• Food Frequency Questionnaire (LMF 5.4 on p. 408)

• Medical Release Form if necessary for weight loss (LMF 8.5 on p. 432)

– See example phrasing on p. 86

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• Use assessment and discussion to determine which topics to explore

• Assessment can also include the description of a typical day

– Refer to Exhibit 4.2 on p. 87

– A typical day of your life and mention where food fits in

EXPLORATION-EDUCATION PHASE

PRACTICE – TYPICAL DAY STRATEGY

• Partner up with someone • One person is the client and one is the counselor

– Counselor – request the typical day information

• Make note of important concepts (not every detail)

• Simple, open questions – “And then what?” “How did you feel then?”

• Avoid providing hypotheses, ideas, or intricate questions

• Listen and get an idea of what this person goes through everyday

– Client – comply and provide typical day routine

• Discuss daily routines, encounters, and mention foods as part of it

– Typically takes 10-20 minutes

• Switch roles if time permits

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TYPICAL DAY STRATEGY • Explain the overall information that you obtained as

the counselor. – Outside of diet, how did you learn about this person’s life?

Personal interactions? Routines? Stresses? Attitude? Schedule?

• Give specific examples

• Compare this assessment technique to a standard dietary recall.

– How are these two different in terms of what you learn about the client? Would you use one over the other? Why?

– How would you use this strategy in your counseling sessions?

3. Nonjudgmental Feedback – Assessments need to be reviewed point-by-point in a neutral

manner

– “Just the facts, ma’am!”

– Provide the standard norms for comparison

4. Client’s Thoughts about Assessment vs. Standards – Encourage exploration of the results

– Do not use “you” when clarifying the information • “People with high cholesterol levels are at higher risk for CVD.”

EXPLORATION-EDUCATION PHASE

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5. Summarize • What is the client doing well?

• What problems were identified in the assessment?

• If any, what were the self-motivational statements made by the client?

• Where there any ideas of change that the client stated?

– Does the client have anything to add or clarify?

– How would the client like to proceed?

6. Assess Readiness to Change – If your client would like to start making changes, then

• What stage of the TTM would they be found in?

EXPLORATION-EDUCATION PHASE

ASSESSING READINESS TO CHANGE • Stage of Change Algorithm

– Readiness-to-change open ended questions

• How ready to you feel to make a change in this behavior?

• Readiness-to-change scale question • On a scale from 1 (not at all) to 10 (very ready)

• Readiness-to-change graphic

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STAGE OF CHANGE ALGORITHM Can be modified to assess stages for other dietary factors Purpose: Determine TTM stage Assignment: select another lifestyle behavior and use it in algorithm • Complete with 2

people

EXAMPLE STAGE OF CHANGE ALGORITHM

1. What level of fiber would you say is in your overall diet? – Low, Very low, In the middle, High, Very High

– Go to #2 How long have you followed a diet high in fiber? • < 1 month to 5 months = ACTION

• 6 months to > 1 year = MAINTENANCE

2. In the past 6 months, have you tried to eat more fiber? – Yes How successful were you? No Go to #3

• Very and somewhat successful = PREPARATION • Not successful Go to #4

3. Are you seriously thinking about eating more fiber in the next 6 months?

• Yes Go to #5 No = PRECONTEMPLATION

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EXAMPLE CONTINUED

4. Do you plan to continue try to eat more fiber in the next 6 months? • Yes = PREPARATION No = CONTEMPLATION

5. How confident are you that you can change your diet to eat more fiber? • Very and Somewhat confident = PREPARATION

• Not very and Don’t know = CONTEMPLATION

RESOLVING PHASE • The two previous phases focused on

– Clarifying the problem & identifying the strengths within themselves

• The focus of this phase is dependent on the motivation level of the client

– Level 1: Not ready to change (precontemplative)

– Level 2: Unsure, low confidence (contemplative to preparation)

– Level 3: Motivated, confident, and ready (preparation to action)

• Refer to Table 4.2 on p. 89

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CLOSING PHASE • Review the session

– Summary of the issues

– Identification of the strengths

– Clear restatement of the goals

• Express optimism about the future

• Statement of appreciation – enhance self-efficacy – For any obstacles overcome

CHAPTER 4 CASE STUDY • Nancy was just recently diagnosed with HTN

– 26 y.o.f., overweight

– Lives with her 3 small children, husband, and mother

– Works nights

• Read this example (pp.96-98) – To prepare you for typical counseling sessions

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NUTRITION RESOURCES • Healthy Dietary Information

– www.choosemyplate.gov

• Healthy Weight Management – http://www.eatright.org/Public/landing.aspx?TaxID=6442451978

• Food and Nutrition Handouts – http://www.eatright.org/HealthProfessionals/content.aspx?id=2

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CHAPTER 14 GUIDED COUNSELING

• Preparation for Session 1 – See checklist on p. 355

• Informed consent (instead of LMF 14.1 and 14.2)

• Client Assessment Questionnaire (LMF 5.1)

• Food Frequency Questionnaire (LMF 5.4)

• Medical Release (LMF 8.5) – if client is at risk of health condition

– Contacting the client before session 1 • Email or phone call

– See example on p. 352

– Provide the above forms to be completed prior to the session

– Schedule the session date, time, and place

– Provide contact information – in case change of plans

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PRACTICING YOUR FIRST COUNSELING SESSION

• Write your 1st contact statement – See example on p. 352 and make appropriate adjustments

– Obtain the forms you need from Canvas and make adjustments as needed

• Complete the Assessment Forms for yourself as practice. Stage Of Change Algorithm ( Nutrition Counseling)

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PRACTICE – MOCK SESSION 1 • Write a mock dialog of your first session

– Follow the Interview Checklist

– Include actual statements that you and the client would make

– Following the involving, exploration, resolving, & closing phases in succession

• Explain when and how you would use attending and relationship-building skills in this session

• You may want to use a class partner to act as your client • You may want to complete the Typical Day Strategy &

Stage of Change Algorithm activities at the same time