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Beyond Motivational Interviewing: Successful Engagement with

Families About Feeding

Presented by Deb Weiner, LICSW; dfitchitt@yahoo.com

For Nutrition Network February 3, 2016

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MULTITASKINGScrewing Several Things Up At Once

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Our Happy, and Not So Happy, CustomersMake It Relevant: Bring to Mind One of Yours

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Goals for Today• Increase your confidence in

working with those clients you find most challenging

• Encourage your reflective observation and thinking

• Give you practical tools to use

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1. Quick Review of Motivational Interviewing2. Relationships Inform Progress, or Lack of3. Key Principles from Infant Mental Health 4. Your Questions

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REVIEW OF MOTIVATIONAL INTERVIEWING

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Principles of Motivational Interviewing

1. Express Empathy

Empathy matters If client does not feel understood, he or she cannot hear what you are saying.

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2. Develop Discrepancy3. Avoid Argumentation4. Roll with Resistance5. Support Self-Efficacy

*but sometimes it is hard to see!

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Mnemonic for MI

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Things you wanted to know…• What can I do with parents of overweight children

who are concerned their children don’t eat enough?

• What can I do with parents who will prepare whatever their child wants just so they will “eat something”?

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RELATIONSHIP IS THE CONTEXT

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How do we connect when we’re seen as the expert?

There’s more to this story… how can I help this family share it with me?

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Parallel Process

“How you are is as important as what you do

-Jeree Pawl

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Influences on Relationship

• Psychosocial History/ACES• Home/Community/Cultural Environment• Special Needs• Attachment Styles• Temperaments

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Attachment Styles Oversimplified: Secure; Ambivalent, Avoidant, Anxious

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Temperaments Matter!

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Relationship Matters*: the parent-child relationship impacts child’s:

• Growth• Brain Development• Sensory Regulation• Motivation• Self-Help Skills• Social Skills*from Julie Wood, MA, LMHC

“The Feeding Relationship”

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Relationship Matters*: the parent-child relationship affects parent’s:• Capacity to use nutrition information• Ability to implement changes• Responsiveness to child• Motivation• Emotional state (which child reads!)

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Case Scenario3 young children throwing food• Chaotic, stressful mealtimes• Yelling, spraying children with water• Mom has tried everything – overwhelmed

parents• Dietician has tried

everything too!

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Red Flags: When do I need consultation from a

mental health professional?

• Impaired/insecure attachment (parent and child are not attuned)• Temperament mismatch that parent struggles with

or does not acknowledge• You just know: “this family is just too much!”

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We all have days like this....

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We’re All Human

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PRINCIPLES FROM INFANT MENTAL HEALTH

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Simple IMH Definition• Infant mental health means healthy social and

emotional development in babies and young children, birth to 5 years.

• All professionals working with this population can build capacity for experiencing, regulating and expressing feelings; building close relationships, and exploring the environment to learn.

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Getting to “Green”*• Green is defined as a “ready to learn” state:

alert enough, calm enough, and interested enough. This needs to be our first goal!

• We can (sometimes) move clients to green by offering calm, empathetic, encouraging, confident presence.

• Sometimes we need other tools (OT, mental health, etc.)

*Concept from Connie Lillias, Ph.D, MFT, RN

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How You Can Do ItPractical Tools of IMH include*:

• Considering the caregiver’s experience, feelings, and needs

• Considering the child’s experience, feelings, and needs

• Reflecting on your own experience, feelings, and needs

• Remembering all behavior is communication

*Concepts from Promoting First Relationships curriculum

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“Everyone deserves the experience of existing in someone’s mind.”

– Jeree Pawl

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More Ideas• Notice the positive interactions and comment:

“When you paused and hugged her, her whole body relaxed! That prepares her body for eating.”

• Always wonder, never assume. “I wonder what it’s like for you when Samir won’t open his mouth.”

• Allow caregivers to pause and think

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Case Scenario27-month-old twins with

poor growth• No sleep (or other) schedule

• TV always on

• Sippy cups with water

• Parents overwhelmed; unable to follow through with adding calories or other changes

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WRAPPING UP

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The Need for Time to ReflectReflection means stepping back from the immediate, intense experience of hands-on work and taking the time to wonder what the experience really means. What does it tell us about the family? About ourselves? Through reflection, we can examine our thoughts and feelings about the experience and identify the interventions that best meet the family’s goals for self-sufficiency, growth and development. -Zero to Three

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Offering hope is more important than we realize

There likely was no graduate-level class on inspiring hope in your clients!

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Summary• Motivational Interviewing: RULE• It is relationships that inform progress or lack

of progress• IMH Principle: “Get to Green” first• It is NOT all up to YOU. Be a part of a team,

and team with your client families.

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Questions?

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Wishing you luck with all that you do to help nourish the children in your lives!

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Thank You!

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Contact Information and Resources

• Deb Weiner, LICSW, dfitchitt@yahoo.com; 425 299-0504

• Adverse Childhood Experiences Study www.acestudy.org

• Reflective Supervisionwww.zerotothree.org

• Self Care (aka Survival Care) traumastewardship.com