Pic 0: The screen transitions to one titled “Talk with Samantha” which contains information on the scenario and the goals of the conversation.
Scenario: The health coach is seeing Samantha and her four-month-old Zoe. Samantha has been breastfeeding exclusively, but now she wants to stop.
The health coach’s goals are to use reflections to help Samantha explore her ambivalence and amplify her positive feelings about breastfeeding. In the conversations, the health coach will use the techniques you learned:
Pic 1: The screen transitions to a slide titled “Phases of MI.”
Normally, MI has four phases. But in this conversation the client has come in with an agenda, so the conversation will skip the focus phase.
As the health coach progresses, the simulation will keep track of which phase they’re in and explain what that means.
Pic 2: The screen changes to a scene in an exam room, where a Health Coach sits across from Samantha.
Health Coach: Well, Zoe looks great. She’s just over 14 pounds, so almost double her birth weight. Right on track. Is she starting to babble?
Samantha: (slight laugh) A little bit. Still mostly shrieks, but we get a few “ba-bas.”
Health Coach: Great. And how’s the breastfeeding going?
Samantha: (hesitates) Actually, I was wondering if you could recommend a brand of formula? I’m, uh, back at work now, so.
Coach: The health coach is currently in the engage stage of conversation. His goal is to build a rapport with this mom and understand her situation, especially her reasons for wanting to stop breastfeeding.
Health Coach: So you're considering a feeding change.
Samantha: I guess it's time, right? I'm at work full time now and she's on a bottle during the day anyway. My mom keeps telling me it's time to wean.
Health Coach: Your mother thinks you should wean.
Samantha: Yeah. I mean, the pumping is killing me. I know my milk's already going down because of it.
Coach: By using simple reflections to explore this mom's thought process, the health coach showed he was really listening. Even though she's asking about formula, she's clearly ambivalent about giving up breastfeeding. The Health Coach should try some complex reflections next to help her explore and resolve that ambivalence.
Health Coach: It sounds like it's been distressing to feel like your milk supply is going down.
Samantha: Definitely.
Health Coach: It makes you feel like you need to make a switch, even though Zoe is very healthy and you may not be ready to give up breastfeeding.
Samantha: Well, I don't know. It would be nice if I could keep going. I mean, my friends think I'm nuts. Like, why do I want to tie myself down when I could just give her a bottle? But it's been really nice. I like nursing her. It's a special thing that only I can do.
Samantha’s thought: I am going to miss nursing her. I wish I could have taken more time off.
Coach: This was a good response. The Health Coach used a complex reflection to highlight her desire to breastfeed ("You may not be ready to give up breastfeeding"). This changed the direction of the conversation toward why she likes breastfeeding. This provoked more change talk, a key indicator that he’s building momentum toward change.
Health Coach: Nursing is a special time for you and Zoe.
Samantha: So much. Especially now, you know, being gone all day? It's like I never get to see her. But then I get home and once we're together on the couch, it's like she's part of me again. And she feels it, too, I know she does.
Coach: Nice job. Simply by reflecting this mom's feelings, the health coach has helped her realize how much nursing means to her, and he strengthened her motivation to continue.
Coach: The health coach is entering the evoke stage of the conversation. His goal is to evoke this mother’s reasons to change her decision to switch to formula.
Health Coach: So even though you're back at work, nursing Zoe helps you feel close.
Samantha: Yeah. (collects herself) But, you know, it's already happening. I'm running out of milk. I never feel engorged any more. (uncomfortable laugh) My mom thinks I'm starving the girl.
Coach: This was good. The Health Coach used reflections to build rapport and get this mom thinking of the benefits of breastfeeding. Now he should use open-ended questions and reflections to address her concerns, and then when she's ready, he can move toward a plan.
Health Coach: Do you mind if we talk about some of the normal changes your body goes through when breastfeeding?
Samantha: Sure.
Health Coach: Well, after a few months of breastfeeding, all women's bodies adjust to what their baby needs. So, even if you were at home, you'd still have less engorgement at this point. What do you think of that?
Samantha: So my supply might be okay? But how do I know?
Health Coach: As long as Zoe's growth charts look like they did today, she's getting plenty to eat.
Samantha: Oh, thank you. My mom got me so crazy thinking she wasn't eating enough.
Coach: This was a nice use of the elicit-provide-elicit technique. By asking permission first and soliciting her response afterward, the Health Coach provided this information in a way that respects the mom's autonomy. He may possess knowledge, but only the mom can decide what it means to her.