Coach: The health coach did a great job here! She’s gotten to the core of this dad's trouble setting limits on food. This is often an important step. Without addressing this dad's fear of being as controlling as his parents, he won't be able to overcome this barrier and learn to set limits with his daughter.
Health Coach: I'm glad we had a chance to talk about this. I think the best thing now would be to try to improve Maya's snacking, and we can check back in a month or two and see how that's going. Does that sound okay to you?
Adrian: (tightly) I don't know. Sure. We'll see what we can do.
Coach: The dad doesn't sound very committed to this plan. Without a firm desire for change, most families revert to their old habits very quickly. Let’s look at a different, more effective response.
Health Coach: I can see you're not ready to plan any changes today. How would you feel about just keeping a list of the snacks Maya eats for a few weeks?
Adrian: (uncomfortable) Like one of those, um, food diary things?
Health Coach: Or something more informal. Just try to keep track of about how many snacks she's eating a day, and, maybe, how many are fruits, compared to how many are chips or cookies or something fatty or sugary. Is that something you could do?
Adrian: Uh. I'll try.
Maya: Sugary sounds good! I want that.
Health Coach: And I'd like to see you back in a month or two, just to see how that goes.
Coach: It may seem important to end every appointment with a plan in place. But, knowing how hard it is to make lifestyle changes, it's sometimes better to give families time to think about it or to plan for something minor, like just monitoring instead of pushing a plan they might not stick with.
Health Coach: Great, you can make an appointment on the way out.
Pic 14: The screen changes to one that reads “Next Appointment: Six Weeks Later” before returning to the exam room.
Adrian: You know, I hate those food diaries, and I wasn’t going to do one. But I couldn’t help noticing what Maya really eats when we’re out at Elena’s games. It’s a lot more than I thought. Some days she’s having three or four snacks before we even get home for dinner. So, I’m not sure what we can do different, but it should probably be something.
Health Coach: The first thing to do is to cut down the snacks. One planned snack after school works much better than just eating on the go whenever Maya says she's hungry.
Adrian: Yeah. I started packing more when we head out in the morning, but she's still complaining that she's hungry halfway through Elena's games.
Coach: Even when you are clearly in the planning stage and a family has asked for your advice, it's still best to ask them their ideas and involve them in the plan for how to change.
Health Coach: Try to have every snack you give Maya have protein in it, or a fruit or vegetable. It's important to have a balanced plate, just like at meals.
Adrian: Well sure, yeah, at home. But it's tough to have that on hand every place we go.
Health Coach: If I remember, you said Maya isn't eating much in daycare, so this snack is almost a second lunch for her.
Adrian: You think she should have a whole meal at 4 o’clock?
Health Coach: If dinner isn't until seven and she missed lunch at school, then absolutely.
Coach: By suggesting the snacks herself, the health coach missed an opportunity to involve Maya and her dad in planning what she'll eat. And she prompted sustain talk, even at a time when the dad was already committed to making a change.
Health Coach: Maya, your Daddy and I are talking about how to give you good food that fills up your tummy and keeps you healthy. What kinds of fruits and vegetables do you like?
Maya: Fruit, fruit roll-ups?
Adrian: You like apples, sweetie, and blueberries.
Maya: I like how they squish!
Health Coach: (laughs) Maybe you can help Daddy or Mommy pick out some fruit to bring for a snack. What do you think?
Maya: Okay!
Coach: It's smart to involve Maya in planning her snacks. Kids (like adults) are much more likely to embrace changes if they feel like they have some control over them.
Health Coach: So, just to make sure we’re on the same page, you want to start packing a more substantial after-school snack for Maya. You’ll try to make it more of a meal, with protein or a fruit or vegetable.
Adrian: (dubious) Sure. Uh, when we can.
Health Coach: (to Maya) And you’ll learn all about what foods keep you healthy and growing.
Maya: I’m growing!
Health Coach: Yes, you are. You’re getting to be a big strong girl.
Maya: Can we go home now?
Adrian: After we get Elena from soccer.
Pic 15: The exam room fades away and the screen transitions to a close-up of Dr. Schwartz.
Dr. Schwartz: In this conversation, the dad offered significant sustain talk and was not interested in considering lifestyle changes. In your practice, how might the MI skills you have learned help you respond to sustain talk? Now let’s look at a dashboard, which will analyze the health coach’s choices and offer some suggestions for how to best use MI.
Pic 16: The screen changes to one that contains information about different aspects and ratings of the conversation. Under “Overall Performance,” there’s an image of a blue circle under the words “Change Talk” which has the text “0 points out of 100” on it. Each technique under “Feedback on Technique” contains a scale of 0 to 10.
Overall Performance:
Overall, the health coach did an adequate job of talking to the dad about Maya’s snacking habits, but they missed some opportunities to use motivational interviewing techniques.
Feedback on Technique:
Affirming His Perspective: Rated 10 out of 10
Reflecting Change Talk: Rated 6 out of 10
Reframing Sustain Talk: Rated 10 out of 10
Setting an Agenda: Rated 3 out of 10