While most motivational interviewing (MI) health coaching case studies feature adult patients, MI can be a powerful approach for promoting health behavior change in families and children. The following is a real case study submitted by LG—a primary care clinic nurse health coach in an organization that recently committed to a comprehensive motivational interviewing workforce development project with HealthSciences Institute.
Visit One
“Patient Z is 5 years old and weighs 112 pounds. At the beginning of the session, things are tense. I have to work through defensive walls that Mom has up. Mom has lots of sustain talk (against possibility of change) and states that she can’t do anything for the child because she is hungry all the time. I realize that Mom has experienced lots of judgment from other health care practitioners about her parenting skills, so I concentrate on validating, showing empathy and, in general, engaging her. As Mom starts to relax, I ask an open question about what she feels her child’s health problems might be. She admits that it is probably her weight, but shares that she has no idea how to do anything about it. I resist the righting reflex and, instead of jumping into the advice mode, I ask another open question about her daughter’s eating habits and what she feels she could do to help. Her mother responds that her daughter eats very large portions and a lot of chips and pop. She said that it may be helpful to cut out the chips and pop and decrease the amount of food that her daughter eats each day. I reflect her change talk and affirm commitment to her daughter’s health and her plan.”
Visit Two
“Mom is the only one here this time. She eagerly shares that she has been limiting Z’s intake of chips from a daily large bag to a small bag and she has also cut out all soda pop. She also states that when Z demands food, she offers healthier smaller portions and encourages the child to play outside. Again, I reflect and evoke more change talk, provide support and encouragement, and end with a genuine affirmation for her efforts and commitment.”
Visit Three
“Mom, Dad and Z are here today and there is great news! Mom has lost 7 pounds and Z has lost 9 pounds! The whole family has been active in the dietary and weight loss program. Mom has cut down on the portion sizes of meals with more vegetables. I affirm and ask an open question about how she is doing this, to evoke more change talk. Mom shares that she has bought smaller plates to make her daughter think she is eating a full plate. In addition, Dad is very involved in the program now; he states he is encouraging sugar-free drinks instead of sugared ones. Lastly, Z’s older sister is not giving out snacks without first consulting the parents. The whole family is now more active – walking and playing outside and working together in an effort to help Z live a healthier life.”
LG commented: “Before the first session, I was worried about how to address the weight issue of the child. I wanted to fix the problem and say: ‘Look – you are hurting this child by letting her eat all she wants to!’ But I focused instead on thinking about the principles I learned in the MI workshop. By asking open questions and listening, I discovered that the mother had almost the same concerns that I had regarding her child. She did want to fix the problem, but didn’t know where to help. So with my encouragement and suggestions when she needed them, we have gone down this road as partners, not with me as the expert, judging her and telling her what to do. It was gratifying to be able to play a part as a change agent for this family. I truly feel that my MI skills were the key to first engaging Mom and then empowering her to take action.”
Working with the child, parents and family, health coaches can support changes to lifestyle that threaten health early and later in life. Better outcomes depend on the health coach building true proficiency in the complex skill-set of MI. By applying MI, and the new generation of MI approaches and tools designed specifically for health care, practitioners and organizations can achieve breakthrough results.
Blake Andersen, PhD,
