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Effective Communication with Families Brief Focused Advice
Step # 1: Engage the Patient / Parent
Can we take a few minutes together to discuss your
health and weight?

What do you feel about your health and weight?

Step # 2: Share Information (optional)
Your current weight puts you at risk for developing
heart disease and diabetes.

What do you make of this?

Some ideas for staying healthy include(see poster)

What are your ideas for working toward a healthy
weight?

Step # 3: Make a Key Advice Statement
I strongly encourage you to...

Get up and play hard, 30-60 minutes a day

Limit TV and video games to 60 minutes or less a day

Eat 5 helpings of fruits or vegetables every day

Limit sodas & juice drinks to 1 cup or less a day

Use patient ideas from step # 2
Step # 4: Arrange for Follow up
Would you be interested in more information on ways to
reach a healthier weight? AND / OR

Lets set up an appointment in __weeks to discuss this
further.


Effective Communication with Families
Scott Gee, MD, Jodi Ravel, MPH, Sandra Roberts, RN, Amanda Wylie
Regional Health Education Kaiser Permanente Northern California


Communication Techniques
Lifestyle Advice Well Child or Urgent Visit


< 1 minute
Children not currently at risk for overweight
Brief Focused Advice Well Child Visit


< 3 minutes
Children who are overweight or at risk for overweight
Brief Negotiation & Cognitive Behavioral Skills - Follow
up Visit or Weight Management Intervention


10 + minutes: single or multiple sessions
Children who are overweight or at risk for overweight
Who Do You Communicate With?
2 - 5 Years Old


Communicate with Parent
Child in Room
6 - 12 Years Old


Communicate with Parent or Both
The First Encounter Consider Taking Parent to Your
Office to Discuss in Private First
Over 12Years Old


Communicate with Teen or Both
The First Encounter Consider Having Parent Leave
Exam Room First
Brief Negotiation Skills Particularly Effective for
Contemplative/Ambivalent Patients
Asking open ended questions
Listening
Summarizing
Clinician Style: empathetic, accepting, collaborative
Cognitive Behavior Skills For Patients Ready
and Willing to Make Changes
Develop awareness of eating habits, activity and
parenting behavior
Identification of problem behaviors
Problem solving and modification of problem
behaviors
Weekly goal setting for children and parents on
dietary, activity and self-esteem/parenting goals
Positive reward systems
Record keeping
Weight checks

Lifestyle Advice
To stay healthy and energized:
Get up and play hard, 30-60 minutes a day

Limit TV and video games to 60 minutes or less a day

Eat 5 helpings of fruits or vegetables every day

Limit sodas & juice drinks to 1 cup or less a day


Prochaska & Di Clemente: Transtheoretical Model of Behavior Change
Action
Preparation
Contemplation
Relapse &
Recycle
Maintenance
Pre-contemplation
Integrated
Behavior
Stages of Behavior Change
Stages of Behavior Change
Brief Negotiation
(http:// www. kphealtheducati on. org)


Open the Encounter
Ask Permission
Would you be willing to spend a few minutes discussing your weight? /

Are you interested in discussing ways to stay healthy and energized
?

Ask an Open-Ended Question - Listen - Summarize
What do you think /How do you feel about your weight? / What have
you tried so far to work toward a healthier weight?

Share BMI / Weight / Risk Factors (optional)
Your current weight puts you at risk for developing heart disease and diabetes.


Ask for the patients interpretation: What do you make of this?
Add your own interpretation or advice as needed AFTER eliciting the patients / parents response

Negotiate the Agenda
There are a number of ways to achieve a healthy weight. They include (see poster):
Get up and Play Hard

Eat 5 helpings of fruits & vegetables a day
Cut back on TV and Video Games
Cut down on soda and juice
Is there one of these youd like to discuss further today? Or perhaps you have another idea that isnt listed here.

Assess Readiness
On a scale from 0 to 10, how ready are you to consider [option chosen above]
Straight question: Why a 5?
Backward question: Why a 5 and not a 3?
Forward question: What would it take to move you from a 5 to a 7?

Explore Ambivalence
Step 1:

Ask a pair of questions to help the patient explore the pros and cons of the issue

What are the things you like about____? AND What are the things you dont like about______? OR
What are the advantages of keeping things the same? AND What are the advantages of making a change?

Step 2:
Summarize Ambivalence: Let me see if I understand what youve told me so far.....
(begin with reasons for maintaining the status quo, end with reasons for making a change)
Ask: Did I get it all? / Did I get it right?

Tailor the Invention
Stage of Readiness
Key Questions
Not Ready 0 3 Raise
Awareness Elicit Change Talk Advise
and
Encourage
Would you be interested in knowing more about reaching a healthy weight?
How can I help?
What might need to be different for you to consider a change in the future?

Unsure 4 6 Evaluate
Ambivalence Elicit Change Talk Build
Readiness
Where does that leave you now?
What do you see as your next steps?
What are you thinking / feeling at this point?
Where does ________fit into your future?

Ready 7 10 Strengthen
Commitment Elicit Change Talk Facilitate
Action
Planning
Why is this important to you now?
What are your ideas for making this work?
What might get in the way? How might you work around the barriers?
How might you reward yourself along the way?

Close the Encounter
Summarize: Our time is almost up. Lets take a look at what youve worked through today
Show Appreciation / Acknowledge willingness to discuss change: Thank you for being willing to discuss your weight.
Offer advice, emphasize choice, express confidence: I strongly encourage you to be more physically active. The choice to
increase your activity, of course, is entirely yours. I am confident that if you decide to be more active you can be successful.
Confirm next steps and arrange for follow up: Are you able to come back in 1 month so we can continue to work together?

2004 REGIONAL HEALTH EDUCATION KAISER PERMANENTE
0 1 2 3 4 5 6 7 8 9 10
Overweight Sensitivity
Overweight Sensitivity
Do no harm Obesity Ideal Weight Personal
Improvement Focus on Weight Diets or Bad
Foods Exercise Overweight Healthier Weight Family
Improvement Focus on Lifestyle Healthier Food
Choices Physical Activity