Minnesota WIC Program
Participant-Centered Skills Training
2014
Agenda
 Welcome and overview
 Exploring participant-centered skills
 Building rapport: likeability, similarity and empathy
 Self disclosure
 Ambivalence and the righting reflex
 Change talk
 Evoking and encouraging change talk: OARS skills
 Open-ended questions
 Affirmations
 Reflective listening
 Getting to the heart of the matter: projective assessment
techniques
 Participant-centered information sharing
 Summarizing
 Goal setting
 Adjourn
Learning Objectives
• Attendees will practice participant-centered counseling skills
• Attendees will explore strategies to evoke and build motivation for adopting
healthy behaviors
• Attendees will apply projective techniques to the nutrition assessment
process
• Attendees will integrate participant-centered counseling techniques into a
nutrition counseling session
Helping Styles
Directing - Teaching, explaining, advising, telling what to do
Following - Listening, giving space, using open ended questions
Guiding - Exploring limits, affirming, asking about consequences
--------------------------------------------------------------------------------------Something I want to change /should change/ need to change… but haven’t
changed yet:
1.
2.
3.
--------------------------------------------------------------------------------------Activity 1: What PCS is NOT
Counselor
• Ask what their change goal is
• Ask why they haven’t done it
• Explain why the person should make this change
• Give at least three specific benefits that would result from making the
change
• Tell the person how they could make the change
• Emphasize how important it is to change
• Advise and persuade the person to do it
• If you meet resistance, repeat the above
This is not participant-centered so no reflective listening!
Activity courtesy of MINT
Activity 2: Is this Person Ready for Change?
For each participant statement below, indicate if the client is showing signs of being
ready to make a change. Explain why or why not.
1. Participant Statement:
It’s gotten ridiculous. Since the baby is born, all I can wear is sweatpants.
Does the statement signal possible readiness for change?
Reason:
No _____
Yes _____
______________________________________________________________
______________________________________________________________
2. Participant Statement:
I used formula for my two daughters. They are fine and hardly ever sick.
Does the statement signal possible readiness for change?
Reason:
No _____
Yes _____
______________________________________________________________
______________________________________________________________
3. Participant Statement:
It’s so hard. I would really have to be creative to find times for me to exercise.
Does the statement signal possible readiness for change?
Reason:
No _____
Yes _____
______________________________________________________________
______________________________________________________________
4. Participant Statement:
How do other mothers deal with this?
Does the statement signal possible readiness for change?
Reason:
No _____
Yes _____
______________________________________________________________
______________________________________________________________
5. Participant Statement:
I really think everything is fine. The doctor has not mentioned anything about her weight.
Does the statement signal possible readiness for change?
Reason:
No _____
Yes _____
______________________________________________________________
______________________________________________________________
Adapted from David Rosengren
Open-Ended Questions – Some examples
To open the conversation
• What has life been like since the baby came home from the hospital?
• Tell me about how this pregnancy has been for you so far?
To evoke change talk
•
•
•
•
If there were one food you wish your family ate more of, what would it be?
What are your goals for your eating during the pregnancy?
What healthy habits do you want for your kids when they grow up?
What is one thing, related to your health or eating, that you wish were different?
To gather more information
• Could you give me an example?
• Tell me more about the foods he typically eats.
To find out what the participant knows or wants to know about a topic
• What are some things you have heard about establishing your breastmilk supply?
• What concerns you the most about his picky eating?
• What types of things have you tried already?
To help the participant talk about the process of change
• What got your thinking about making the change?
• What are some of the best reasons, from your point of view, for doing this?
To draw out solutions from the participant
• What has worked in the past? What worked with your other children?
• What are some things that might work for you do you think?
• If you did decide to cook more vegetables, what types of vegetables would you try?
To follow-up after providing information
• What are your thoughts about this information?
• Which of these suggestions would be most useful in your life?
• How do you see yourself using this information?
To help the participant make a plan
• What are the first steps you would need to take to make that happen?
• If you did decide to make that change, what do you think would work for you?
• What could you do the next time she cries for the bottle?
To help build confidence
• What will you do when something comes up and you aren’t able to stick to your
plan?
• How will you feel when you are finally done with bottles?
• How confident are you that you can make this change?
Activity 3: Encourage change talk with questions
Counselor:
• Ask what their change goal is
• Ask some questions to build importance. Examples:
o What are some of the best reasons to make this change?
o What will it be like if you made the change?
o What are the best things that might happen if you do make
the change?
• Ask some questions to build confidence. Examples:
o If you did decide to make that change, what do you think
would work for you?
o What are the first steps you would need to take to make
that happen?
• Give a short summary/reflection of the speaker’s motivations for
change
• Ask: “So what do you think you’ll do?” and just listen with
interest
* Note: Give no advice
Activity 4: Finding strengths and affirmations
For each situation described below, write down the strengths or qualities you observe in the
participant and then form one or two affirmations based on those strengths. Try to use “you”
language for the affirmation.
1. A participant is telling you about her struggles to get her 3-year old son to eat vegetables. She
has tried offering the vegetables repeatedly but he just pushes them around his plate and tries to
hide them in his napkin. The only vegetable he eats without a fight is carrots so she makes carrots
often. She wishes he would start liking more vegetables. She knows they are important for his
health and growth. She tries to eat the vegetables herself but this hasn’t seemed to help.
1. Participant Strengths:
2. Affirmations:
2. A woman arrives at WIC who is pregnant for the first time. She explains that she is not sure
whether she will breastfeed or not. She has been reading about the health benefits of
breastfeeding in her baby books but is getting conflicting advice from friends, family and her
doctor. Some of her family members and friends have talked about pain and other difficulties
involved with breastfeeding. She wants to wait to make a decision until she can sort out all the
facts.
1. Participant Strengths:
2. Affirmations:
3. A participant is explaining that his 2 year old daughter still using the bottle. Dad reports that
she will take juice in the sippy cup but cries when the milk is not in the bottle. He tells you that he
knows how important milk is to the development of strong bones and teeth so he wants to make
sure she gets enough milk. He thinks eventually she will grow out of the bottle and start using the
cup more.
1. Participant Strengths:
2. Affirmations:
Activity adapted from David Rosengren
Activity 5: Reflection Practice
Read the sentence. Write down a reflection for each: try reflecting meaning,
emotion and/or ambivalence. Try to use different types of reflections.
1.
I am excited to be pregnant. I want to eat well for the baby. I like some
healthy things like my mom’s homemade soup. I love my Doritos, candy and
ice cream though.
____________________________________________________________________________
____________________________________________________________________________
2.
I always start with the idea of cooking at home. But then, when I pick the kids
up and they are crying and hungry, the drive through at McDonalds just seems
so easy.
____________________________________________________________________________
___________________________________________________________________________________
3.
He eats everything on his plate but the veggies. I try to force him, but it
makes me feel guilty. I eat my veggies to show him they are good but that
hasn’t worked either.
____________________________________________________________________________
____________________________________________________________________________
4.
I did want to breastfeed with my first baby, but it didn’t work. I didn’t make
enough milk and then they dried up. I don’t want to go through that again.
____________________________________________________________________________
____________________________________________________________________________
Activity 6: Let’s Watch a Session
What Skills does the Nutrition Counselor use?
Giving Advice or Information
Can cause resistance
Telling them what to do:
• You should…
• You need to…
• You have to…
• You’ve got to…
• You must…
More likely to elicit change
Exploring with them:
• What do you think about…
• What have you heard about…
• One mom shared with me…
• Maybe we can brainstorm
together
Being the expert:
• I think you should…
Draw on an external authority:
• WIC recommends…
• The AAP suggests…
Providing a menu of options
• Circle charts
Sharing some ideas that worked for
other WIC moms
Giving only one option
Telling them what worked for you
Explore
Explore Offer Explore
• Ask what the participant:
o Has heard
o Has already tried
o Would like to know
Offer (with permission)
•
•
•
•
Key points
Tailored to your client’s interest
Be brief - give one or two simple facts
What an authority says
o WIC recommends…
o The Academy of Pediatrics suggests…
Explore
• What the participant thinks about the information:
o What do you think about that?
o How could you see yourself using this information?
Activity 7: Goal Setting
•
Some questions that might help:
o
o
o
o
o
“If you were going to (make the change), how would you do it?”
“What might support you to do this?”
“How will you know when you are ‘eating better’?”
“So, what do you see yourself doing next?”
“What is your next step?”
Defining goals and action steps: what questions could I ask?
Below are broad goal statements that a participant might make. For each one, create 2 or 3
questions that you could ask the participant to help them create a more specific goal.
1. “I want to do everything I can to have a healthy baby.”
Possible Questions:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
2. “I want to eat better.”
Possible Questions:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
3. “I want Angel to be healthy.”
Possible Questions:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
4. “I need to lose weight.”
Possible Questions:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
My notes