Pic 7: The screen changes to one titled “Talk with Maya and Her Dad,” which contains contextual information for the next conversation.
Scenario: The Health Coach is seeing four-year-old Maya and her dad, Adrian. Maya recently recovered from recurring pneumonia. Since then, her BMI has increased from the forty-fifth to the seventy-fifth percentile.
Goals: The Health Coach will use MI to address this concern. Her dad isn’t worried about her weight, so he might use a lot of sustain talk. The Health Coach should use the techniques you learned:
Pic 8: The next screen is titled “Phases of MI” and contains the following information:
In this conversation, the health coach will work through the four phases of MI.
As they progress, the simulation will keep track of which phase they’re in and explain what that means.
Pic 9: The screen transitions to a scene in an exam room, with a health coach sitting across from Maya and her Dad.
Health Coach: The last chest X-ray looks great. I think Maya finally beat the pneumonia.
Adrian: I’m so glad that last antibiotic worked. It was really scary seeing my baby in the hospital.
Health Coach: We measured Maya's height and weight today and I have a few concerns.
Adrian: (defensive) What concerns?
Health Coach: Well, Maya's BMI has gone up recently, past where it was before she got sick. BMI is a
Adrian: (cuts off) Yeah, I know what BMI is.
Pic 10: The screen changes to a close-up of Dr. Schwartz.
Dr. Schwartz: The health coach should be careful about that approach. For many of us in healthcare fields, it’s natural to want tot share information, set agendas, and correct behaviors that seem harmful. But taking this kind of directive tone can turn off families and make them less likely to listen to our advice.
Pic 11: The screen returns to the exam room with Adrian and Maya.
Adrian’s thought: Are you about to tell me my baby is fat?
Coach: The health coach saying she has concerns about Maya’s weight without asking for the dad's input feels threatening. It's no wonder he became defensive. He might be more receptive if the health coach showed she values his perspective.
Health Coach: A higher BMI is associated with significant medical problems in adolescents and adults.
Adrian: (voice tight) Yeah, I know.
Health Coach: I know you don't want to put Maya at risk for high blood pressure or diabetes.
Adrian: Of course not!
Coach: Adrian was already uncomfortable talking about BMI. The more the health coach tried to press the issue, the more defensive he became.
Health Coach: What do you know about BMI?
Adrian: Um, I know it's, like, something about the ratio between height and weight. So, 200 pounds might be, like, really overweight if you're five feet, but not if you're six-four.
Health Coach: That's right. And in children, it can help sort out whether a child's rate of weight gain is in the expected range.
Adrian: (flat) And you don't think Maya's in the expected range.
Coach: It was smart of the health coach to engage the dad in the conversation when she saw he was uncomfortable talking about BMI. She should keep shifting the focus to his agenda and away from her own. She should reflect Change Talk and use affirmations to show that she understands his feelings and concerns.
Health Coach: Adrian, in this office, we don't always get to see such great, involved dads like you. That's why I'm telling you this. I know how much you care about Maya and want to keep her healthy.
Adrian: (softens) Of course. I'll always take care of her. She's my baby.
Maya: I'm not a baby! I'm four!
Adrian: I just don't think I need to be worrying about BMI with a preschooler.
Coach: Affirming that she knows the dad loves Maya and is a good father made him more receptive to hearing about the change in BMI and how it might affect her future health.
Health Coach: Tell me a little bit about what Maya eats in a typical day.
Adrian: Well, uh, we try to eat healthy. I mean, I’ve been doing what you said and giving her a good breakfast, you know, with a hard-boiled egg and some fruit, before we leave in the morning. But, I don’t know, I cannot get her to eat dinner.
Maya: (whining) Daddy I wanna go home.
Adrian: Just a minute, sweetie. (to health coach) You know, most days, her teacher says she won’t eat anything at lunch. They end up giving her bread and butter, and juice to drink. Then by the time I pick her up in the afternoon, she’s starving.
Maya: (whining) I’m hungry! Daddy!
Adrian grabs a granola bar from his backpack and hands it to Maya, who unwraps it and begins to eat.
Adrian: Just be patient, honey, while we’re here with the health coach. (to health coach) So, yeah, I mean, you see, she can’t make it through without something to fill her up.
Adrian’s thought: We still need to go to the supermarket after this. How is she going to make in until dinner?
Health Coach: You want Maya to eat a good dinner, but you have to give her something when she's hungry after school.
Adrian: You better believe it! We have a lot to do after school. Between the girls, we have at least one activity every day of the week. Sometimes two.
Maya: Elena has soccer every day.
Adrian: We’re on the go all the time after school. Her sister Elena’s got soccer practice twice a week, games on Thursday, plus ice skating, and Maya does music on Mondays. I don’t even start cooking until six-thirty most days. Without a snack or two, she’d be a total mess.
Coach: Using a double-sided reflection here was a good choice, but notice how the health coach reflected the sustain talk last. The dad responded by giving even more sustain talk. A double-sided reflection works best when you reflect the change talk last.
Health Coach: A lot of times children will ask for food when they're bored, not actually hungry.
Adrian: (defensive) Look, you know, if she doesn't eat, she falls apart. You would not believe the tantrums she throws, it's ridiculous. Sometimes I just, (small laugh) I gotta take whatever's on hand and make sure that doesn't happen.
Maya: If I'm good, I get a cookie!