TRIBAL HEALTH EQUITY, how they used Motivational Interviewing for Vaccine Hesitancy

“The Tribal Vaccine Equity Project, administered by the Inter-Tribal Council of Michigan (ITCM), provides tribes, tribal health centers and other tribal serving community partners training, technical assistance and monetary awards to support local vaccination efforts and address vaccine hesitancy.

Presenter: Sevilla I. Love, LCSW Behavioral Health Integration Consultant Alaska Primary Care Association (APCA) Learning Objectives/Outcomes

At the conclusion of this activity, the healthcare team will be able to:

1. Explain and recognize vaccine hesitancy

2. Use Motivational Interviewing skills to collaboratively engage with patients/clients

3. Apply Motivational Interviewing skills to evoke a person's change talk and strengthen motivation”

MONETARY AWARDS. interesting.

Peopled are trained to push the covid vaccines on ‘equity deserving communities’. Really well trained.

The guilt clinician teaches ‘motivational interviewing’. You need to know that going into a doctor’s office involves people who know how to get a result from you.

Watch to learn what a skilled MI conversation is.

are you a hard-liner?

using names using names works a person's most powerful connection

16:32

to their self-identity is often their own name so when someone uses and remembers our

16:38

name it can really make us feel a little bit more important to them and more respected

16:45

when it might be the most important word in the world to someone it can make a

16:51

lasting impression on us it means something and when we feel respected we're actually more likely to respect what is

16:59

being said to us okay so we're improving our connection and

17:04

increasing trust good humor good humor works now

17:11

not everybody's a big jokester and that's fine you may be a very serious person but you can lighten your affect a

17:17

little bit you can come in and introduce yourself with a little

17:22

more relaxed air about you and the smiles and gentle humor that we

17:27

have can go a long way to helping people to feel comfortable with us and it actually

17:32

makes you more real and less of an authority figure to argue against so you're meeting them

17:39

at a uh a common basis level

17:44

so there is not this hierarchy although you do have a medical authority and we're going to talk about that because

17:50

medical authority does work as well um we're going to show you the respectful use of your medical authority

17:57

and why that can work how it can help because most patients will go along with

18:02

the provider recommendations when they're ambivalent okay they're hard-liners they may not but if they're

18:09

ambivalent you have the opportunity to help to sway them towards scientific

18:14

evidence and you'll do that by making clear strong recommendations in a respectful

18:19

way what else works vulnerability vulnerability works vulnerability helps

18:25

to level the playing field and foster trust which is so important to get people to listen to us so patients come

18:33

to us at their most vulnerable they're sick they're tired they're scared they're in pain

18:38

and they're often desperate for help from their suffering when we share our own vulnerable stories

18:45

it makes us less of the medical political or fear-based story that they may be resistant to and shows our

18:52

respect for them you're welcoming them into the circle of trust you've humanized the interaction

18:59

when it comes to vaccine hesitance fear of making the wrong choice for their health is often at the bottom of their

19:05

reluctance and that is where we want to reach them in that space

19:10

so our own personal stories can help put us on a playing a level playing field and create that space for trust and

19:17

authentic conversations to take place and so that education has a better chance of being received

19:24

so rene renee brown is a doctor social worker she's a very famous researcher

19:30

around vulnerability and this is what she says vulnerability is not winning or losing

19:37

it's having the courage to show up when you cannot control the outcome when you shut down vulnerability you

19:44

shut down opportunity end quote the goal of story sharing is to increase

19:51

connection with our patients so they feel more confident in you and in the vaccine

19:56

people are statistically more influenced through relationship than they are

20:02

through science alone people are listening to their friends their family their loved ones

20:07

and probably if they're on the fence or hesitant resistant they're not listening to

20:15

the medical providers or science for the most part and that's okay they get to do that but

20:20

we may be able to help them with that so the last quote from brene brown i want to share is

20:27

connection is the energy that exists between people when they feel seen heard and valued

20:33

when they can give and receive without judgment and when they derive sustenance

20:39

and strength from the relationship and this is where your medical authority and your relationship comes into play to

20:46

help people get off defensive indifference okay so is this manipulation

20:52

using all these different skills names and humor and authority and your

20:57

vulnerability um are we being manipulative when we purposely use all of that

21:04

is the story sharing that we use to invoke connection and trust manipulation i would say that we're using positive

21:11

influence but not manipulation which has a male content associated with that

21:16

no one goes into health care with the intention to cause harm we want to heal and create health in our patients lives

21:24

that's why we're here so any kind of education tool or skill set that we can

21:29

have to help us reach that aim may be considered a noble use of our

21:35

healing intentions this is why having excellent communication and persuasive skills is a

21:41

good medical practice because by doing so you are forced to focus on them

21:49

to consider their needs their desires fears and their motivations

21:54

using these skills are tools just as valuable and important as the medical knowledge in your head

22:01

so if they're in a constant state of resistance or reluctance to change their health habits

22:07

how are you going to help them think of these communication skills is the platform you use to deliver the good

22:13

medical care that you're offering okay

22:18

so we're going to be doing some role plays today to demonstrate mi skills and what's

22:24

not mi skills and so i want to introduce stephen um i just want to welcome him

22:29

and thank him for his help and support in this training today he's going to be doing the role of our medical provider

22:37

and demonstrating mi skills from that he's our clinical informaticist at the alaska primary care association

22:47

so let's talk about what does not work all right and that is the writing

22:53

something we call the writing reflex the writing reflex also known as the persuade and convince style it's when we

23:00

need to be right versus being a skillful listener and that means looking for opportunities

23:06

to help influence and engage in a respectful manner for the good of the patient while honoring their autonomy

23:14

and so stephen and i are just going to do a brief role play here now when we do role plays i'm going to be using a sound

23:21

effect so you know when the role play begins and when it ends this is the sound of the beginning of a role play

23:29

and this is the sound of the end of the role play okay so steve and i are going to begin

23:34

this and [Music] now that i've explained the risk factors

23:41

you can see why you need to make this priority you're long overdue yeah but i just don't trust it if you

23:50

cared about your health you'd listen to the science behind the vaccine and accept that this is the best choice to

23:55

keep you safe and healthy yeah well i've heard way too many stories that scare me much worse than

24:01

getting some virus that has such a high survival rate the potential side effects are nothing

24:07

compared to what could happen if you got sick with the virus itself well besides i hate needles i never even

24:14

get the flu vaccine and i've been fine all these years without it

24:19

well you're putting yourself at risk and it's the safest choice you can make think of the people in your life you'd

24:25

be putting at risk if you don't take this let alone society at large this is really important for you to do

24:33

okay thank you stephen so you can see that this persuade and convince style is not motivationally interviewing not at

24:40

all but this is this this is the model that most of us work under when we're talking with patients when we're talking

24:47

with our friends and family this is the great thing about mi is this can also work in your personal lives as

24:52

well and having conversations with friends and family not just around the vaccine but about anything because we

24:58

often find ourselves at odds with other people and learning how to have a conversation with them so we all come

25:05

out winning in the end at least maintaining the relationship is really important for all of us on a

25:10

personal level as well so this writing reflex we're going to learn how to

25:16

not do this because it's a fallback for most of us and i'm guilty of it too so we all do it

25:23

um so let's talk about the confidence ruler and how that works okay so the

25:29

confidence ruler um in some research that was done by martin hope uh christopher and tongan uh

25:36

printed in the journal of consulting and clinical psychology in 2019

25:41

um described it as this they said that discovering the confidence workers uh ruler excuse me it helps uh people to

25:48

discover their own interest in considering or making a change in their life for like diet exercise or managing

25:55

physical symptoms mental illness drugs vaccine hesitancy that helps people to

26:01

express in their own words their desire for change which is what we call change talk okay so we're examining their

26:07

ambivalence about the change we're planning for and beginning the process of change it elicits and strengthens

26:15

that change talk enhances their confidence in taking action and noticing that even small

26:20

incremental changes are important and it strengthens their commitment to that change that's the huge part we can

26:26

talk about change but having a commitment to the change is different okay so this slide of the readiness rule is

26:33

designed to help people express their own intention commitment readiness and that willingness to change so it might

26:40

also help people talk about the small steps that they're already taking so some examples would be

26:46

a commitment might sound like i will do xyz an activation might sound

26:52

like i'm ready to do xyz taking steps so i've tried to or i am doing and then

27:00

it's evidence-based so the research is showing that people who express the change talk are more likely to change so

27:06

we would use this ruler on a scale of one to ten how do you feel about this how hesitant are you how ready are you

27:12

and we can use the questions in different ways but the scale helps people to investigate how they really

27:18

feel about it and we're going to demonstrate this as well okay so we're going to help our patients

27:23

develop discrepancy because change isn't going to happen without it

27:28

so we're going to help the client see that some behaviors that they have don't mesh with the ultimate goals that are important or

27:35

valuable to them so we can help the client see the difference between their core values and their behaviors

27:42

and help them to define their most important goals i'm going to create a gap between where

27:47

the client is and where she wants to be and we're going to allow the client to

27:54

realize that their current behavior isn't leading to their ultimate goal and

27:59

to be more open to change so let's talk about wars

28:06

and this is acronym for open-ended questions affirmative statements reflective

28:11

listening and summary statements these are this is the cornerstone of motivational interviewing

28:18

and uh really important we're going to go through each one of these these ores

28:23

in the following slides so we're going to get in depth into them learn about them and then we're going to do some

28:29

work around them and some polling so you pay close attention because you're gonna need it

28:34

okay so open-ended questions of the ors the o

28:41

this is going to require more than a yes or no answer and steve and i are going to

28:46

demonstrate this um because we're going to be able to create this space so people can share their stories with us

28:53

and generally we want them to do most of the talking i do want to say this though in a

28:58

medical setting when you're providing education sometimes the provider may be speaking more than the client because it

29:05

depends on the environment if we're in a counseling situation um then we may be

29:12

doing a lot more listening than we are talking in a medical setting where you have a short period of time and you have

29:18

a bunch of medical education you need to give to a patient you may do more

29:24

talking but when you're skillfully listening and employing your spirit of

29:30

mi then it's going to come across properly um what we need to understand is that

29:36

too many yes or no questions might feel like an interrogation to people and it could hamper their sense of safety

29:42

and we don't want to impede a client's choice to honestly discuss their need to change with us all right

29:49

so we're going to demonstrate a closed closed end question okay

29:55

so closed-end question is [Music]

30:01

stephen do you want to get the vaccine today

30:07

no okay pretty cut and dry right that's the

30:13

closed end question but now if we ask we're not getting any information from that that patient at all um but if steven as

30:20

the provider asks me an open-ended question look what happens

30:26

i see you're not vaccinated i'm curious about how you feel about it well i just don't think it's safe and

30:33

i'm hearing too many scary stories about it okay so you can see how the open-ended

30:40

question that he gave to me said i care about what you think i care about how you feel and i want to get

30:46

more information from you because once stephen gets more information from me as patient now he's going to know what to

30:52

address and what the pain points are so to speak that he needs to help me with

30:58

so let's talk about the a in orrs which is the affirmations and the rationale for that

31:04

so with affirmations we want to avoid sounding insincere we're using

31:09

affirmations sparingly and we're doing that by helping them to identify their own motivation

31:16

we're going to focus on making a statement instead of praising and we want to avoid cheerleading and we're

31:21

going to give an example of that so we're using this to recognize people's

31:27

strengths and successes and their efforts to change that's really the most important part of an affirmation

31:33

recognizing their strengths success and their efforts to change and it's going to help to increase their

31:38

confidence in their ability to change okay so let's give a demonstration of

31:44

that gosh doc is a long haul to get in here today no one in my family was supportive

31:51

of me to get this vaccine but i've got questions that i'd like answered because i want to decide for

31:57

myself well you're a woman with a mind of her own and you're looking for answers

32:03

yeah i am thank you steven so you can see that

32:08

what stephen did here was he held up my autonomy because i just told him

32:15

i just went against my family to come here i just

32:20

snuck out so i could ask my own questions and so he sees that as an opportunity to help me get off defensive

32:26

indifference and in doing so he's holding up my autonomy you are a woman with the mind of her own

32:33

and you're looking for answers that feels good to hear something like that that makes me feel stronger

32:39

and ready to make my own decision on in my own way right so he's moving me

32:46

towards change by saying something like that okay so now reflective listening

32:52

what does that do that helps us to intently listen to our

32:57

patients and what it does is expressing the understanding that we have of their

33:03

situation back to them and the results are that we're building empathy between yourself and the patient

33:11

the people are feeling heard and then we're encouraging their own statements

33:16

about change and a little bit of an example of that in the last slide but what if you get a reflective listening

33:22

wrong you're saying something back to your patient you get it wrong um if your understanding is incorrect

33:28

the client is going to tell you most often and this opens up more dialogue and

33:34

they'll tell you if they're sensing your spirit of am i they sense your spirit of am i they're

33:40

gonna be more open to correcting or elaborating which is what you want them to do so you know what you can address

33:46

okay so let's start another brief role play to demonstrate what reflective listening

33:52

looks like so my husband's been pretty serious about

33:58

not getting this vaccine he's always going on about it and the government and stuff and so

34:04

we just haven't been vaccinated it sounds like you're not ready to get vaccinated no

34:10

actually i'm pretty sure i'd like to be vaccinated but my biggest fear is that my husband won't

34:15

support me because he's dead set against it oh i see so you're wanting the vaccine

34:21

you just don't want to upset your husband if you do it yes exactly

34:31

okay so here you can see where he's he was

34:40

he was corrected okay he was corrected and then he says oh okay so you're not wanting to

34:46

get the vaccine he i felt safe enough with him to tell him what my real reason was and to let him

34:53

know yeah okay now you've got that right so let's continue on with this

34:59

so my husband's been pretty serious about not getting this vaccine he's always going on about it and stuff

35:05

and the vaccine the government big pharma i mean i just haven't been vaccinated yet

35:12

i see your husband has strong feelings about not taking the vaccine but i'm hearing that maybe you're not so sure it's a bad

35:18

thing yeah that's right and i have some questions i'm hoping you can answer for me

35:26

okay so you can see here in the first one i was able to correct him and then here he gets it right the first

35:34

time which is great um he's recognizing how i feel about it my husband has strong feelings and that's what's

35:39

holding me back i don't want to have any disunity in my in my home um and so he's

35:46

just really leaning into that but he's also touching on this piece you're not

35:51

so sure it's a bad thing he's focusing it back on me and my autonomy to make my own choices for myself and so that opens

35:59

me up to say yeah and actually i have some questions about it so now i'm feeling safe to ask the provider those

36:04

questions i've been afraid to ask to anybody else because maybe i don't have a supportive environment at all okay

36:10

so what about summaries summaries um what are those okay

36:16

summaries actually require careful listening to what the person said and it's a great way to end the session or

36:22

to assist that talkative person on the next topic and a summary is just basically

36:29

sharing back to them what you heard and what that looks like how you understand what they said to you is

36:36

okay so we're gonna have an opportunity to demonstrate that and stephen is going to help me demonstrate that in a few slides

36:43

from now okay so what's the rule rule is another acronym is to remember

36:50

is that we're going to resist telling them what to do you want to understand their motivations

36:56

okay you can understand their motivations the other slide he was trying to understand her her motivation was she really wants

37:02

to know more she might want to get vaccinated but she's scared of what her husband might say um and then we want to listen with

37:09

empathy which he demonstrated that in the other slides and empower them so he was focusing on my autonomy in those

37:15

hoping to empower me to make my own choices okay so let's practice these skills

37:22

now remember these are brief interventions so don't worry if you don't get it perfectly this is just an

37:28

introduction okay and you have opportunity to learn more about mi and many other possibilities but let's give

37:34

this a go so we're going to do a poll now i'm going to read this i'm going to read the scenario and then you're going

37:41

to pick the best answer in the poll that's going to come up on your screen that our

37:47

host mike is going to share with you so here's the uh the

37:53

the challenge so i'm going to have four of the ones that are going to come up and then we're going to

37:58

have a series of answers to choose from and then we'll go on to the summary so

38:04

the first one for o is the open-ended questions and here's the scenario

38:10

i was so afraid when i got the news about my cousin being in the hospital from coped that i made an appointment to

38:15

talk to you about the vaccine i haven't gotten it yet i've been too afraid so which ones are the best which is the

38:21

best answer that would represent an open-ended question number one i hear

38:27

you that sounds like a hit close to home number two i bet you're ready to get vaccinated now aren't you

38:33

three tell me more about your vaccine fears or four how long was your cousin in the hospital

38:43

and go ahead and pick the best answer for that which one is

38:50

the best open-ended question

39:19

and are those results showing on the screen”

I encourage you to watch the video. Maybe you can recognize when someone is using the MI technique on you. Maybe you can use for your own purposes.

How does it make you feel that they went this in depth and that they educate providers to this extent?

How do you feel about ‘equity’ in this instance?

Would you like to put forth questions or techniques to respond in these situations.”

remember go to killbill293.com and help fund the door knocking campaign. Every 0.08 cents can get us a door knocker depending on the print size!