INTEGRATING STAGES York: Guilford Press. OF CHANGE Miller, W. R., - PDF document

APNA 30th Annual Conference Session 4016: October 22, 2016 References: Mueser, K. T., Noordsy, D. L., Drake, R. E., Fox, L (2003). I ntegrated treatment for dual disorders: A guide for effective practice . New INTEGRATING STAGES York: Guilford Press. OF CHANGE Miller, W. R., & Rolnick, S. (2002) Motivational I nterviewing (2nd ed.): Preparing People for Change . New York: Guilford Press. IN DAY TO DAY Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (1994) PRACTICE Changing for Good. New York: Avon Books. BY Judith Magnon RN-BC, BS, CAC TI PS: # 35 Enhancing Motivation for Change in SA TX APNA Conference, Hartford, CT # 42 SA TX for Persons With Co- Occurring Disorders Order FREE at Webb site: WWW.ncadi.samhsa.gov ( National Clearing house for alcohol & drug information) 1 4 IDDT/Stages of Change Conflict of interest note: BASED ON Recovery Thinking The person is a partner in the This presenter has treatment process and no conflict of interest, The provider is a guide with commercial support, knowledge and experience to share, discuss, educate, explore, or coach, advise, assist, encourage, off label use to disclose. negotiate, role model, validate, etc. 2 5 Learning Learning Objectiv Objectives: 10% of Programs Address The 80% Who are in: ■ Gap: Gap: Skill-How to integrate Stages of Change into mental health Precontemplation, Contemplation, and substance abuse treatment with individuals experiencing serious mental health disorders and substance abuse disorders. Preparation ■ By the end of this presentation the learner will be able to: ■ Understand Stages of Change and how to integration of Stages of Change into mental health and substance abuse treatment with STAGES OF CHANGE individuals experiencing serious mental health disorders and substance abuse disorders. ■ List the Stage of Change Process and Techniques that need to be What Process and techniques are helpful incorporated into nursing practice. in what stage? ■ Cite examples of nursing practices that can effectively incorporate Stages of Change. What is the focus of each stage? What are the Tasks of each stage? 3 6 Magnon 1

APNA 30th Annual Conference Session 4016: October 22, 2016 Precontemplation READINESS TO CHANGE GOAL: Shift the focus to THI NKI NG and I NSI GHT STAFF Individual Increasing information about self & problem Change Process: Consciousness Raising Not interested Very interested 1 2 3 4 5 in change in change Social Liberation (Action) (Precontemplation) Techniques: Observations, “confrontations”, interpretations, 7 10 Stages of Change in which particular TASKS: CHANGE PROCESSESS are most useful  Become aware of self defeating defenses— what they are and how they operate Precontemplation Contemplation Preparation Maintenance Action  Develop insight-- Increase Consciousness-Raising Social Liberation information/knowledge about the problem Emotional Arousal  Explore barriers to change Self-Reevaluation  Be willing to talk, hear feedback, feel Commitment cared for Reward  Find hope, Countering ACTION  Gain confidence Environment Control Helping Relationships 8 11 Thinking Thi Precontemplation How to help Precontemplators Stage Stage  Make therapy a safe and supportive place, encourage them Characteristics: to ask someone they trust to share with them their defenses.  I nternalize, Projection, Use education to show them how defeating defenses can be.  Unaware of Problem Rationalization  Give them permission to be human, encourage participant  Problem is external to be open about their defenses. Help them get control over  Displacement their defenses.  Resistant,  Present as Depressed,  Remind them that they are not ready for action, that  Hopeless they need to talk, get feedback, and feel cared for. They  Anxious, need to communicate with others what their goals are to  Demoralized,  Afraid to risk, change.  Defenses:  Believe they are in  Remind them that this is a process and that each step  Denial, minimize, builds toward the next and that it will not happen control overnight . 9 12 Magnon 2

APNA 30th Annual Conference Session 4016: October 22, 2016 Social liberation involves utilizing community How to help Precontemplators resources, social norms to create more alternative and choices for problem behavior. Examples include: No Smoking sections DO Fat free foods  Designated drivers Recognize that participants need Public service messages assistance to change Employee wellness programs  Provide feedback on participant defenses Reimbursement for exercise equipment Lower insurance rates for non-smokers.  Assess for shame, guilt, embarrassment Self-help groups Precontemplators can perceive these forces as DON’T positive and helpful, in which case they will – Push someone into action, Nag, Give up, progress to contemplation. – Enable They may also perceive these forces as coercive, believing that their rights are being infringed upon by society. 13 16 DATA COLLECTION: (Nursing process) Providing Feedback Psych/Social Evaluation: Comprehensive Eval includes biological Mental Status Legal History—SA & MH  Target the person’s present situation Substance Abuse Profile: and its risks or consequences. Identify Risk Factors, Triggers, strengths, and Stage of Change • Journals Collateral Resources: • Family Input Family , Law Enforcement, Employers, • Friend’s input Healthcare Workers, Friends, Lawyers Medical Profile, LABS • Objective tests QUESTIONNAIRES: • Blood Work/Medical tests DATA to give Alcohol Expectancy Questionnaire Alcohol Effects Questionnaire • Probation Input feedback from CAGE Questionnaire Comprehensive Drinker Profile your assessment • Work Performance The Drinker Inventory of Consequences Addiction Severity Index Substance Abuse Subtle Screening Inventory 14 17 Treatment Planning --- Integrating S of C Consciousness-Raising Precontemplation The first step to fostering intentional change is to Goal: Shift in Focus become conscious of the self-defeating defenses that get in the participant’s way. Target participant’s perception Educate to develop insight Increase Hope Consciousness Raising KNOWLEDGE IS POWER so provide EDUCATION Nurse Objectives: Complete Assessments Help them Become aware of defenses Review Assessments Provide Education Help them transform defense's into coping Stress Management Coping/Wellness information Assess for Depression Assess Lifestyle ( Rationalization - explaining away problems to Logical Analysis- thoughtfully and carefully analyzing problem behaviors without Interventions: becoming overwhelmed by emotions Checking the participant’s defenses Assessment Tools Medical Evaluation Education Groups Social Alternatives Encourage use of Journaling Coping/Stress Management Skills Increased awareness and practice can help a Use of Timeline Lifestyle Awareness participant turn a maladaptive defense into a Encourage Wellness and healthy diet through education positive behavior. Encourage Exercise 15 18 Magnon 3