Agenda Mapping

MiPCT

2015

Session Overview

• Rationale

• Motivational Interviewing underpinnings

• Examples and Tips

• Mr. Jones

• Practice

• Applications to your work

What did you hope to learn in this session?

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Why are agendas valuable?

• If you don’t know where you are going, any road will get you there.

– Lewi Carroll

Focusing

• An ongoing process of seeking and maintaining a direction

Why might an agenda be helpful in the work you do?

Tip 1: Engage BEFORE Agenda Mapping

Engagement

• Listen

• State importance of partnership

• Let the story unfold whenever possible

• Emphasize options and autonomy

• Don’t move too far or too fast

• Check in frequently

Based on an idea from Steve Rollnick

Directing Guiding Following

draw out encourage motivate

teach assess prescribe lead persuade

listen understand

go along with

A Range Of STYLES

Agenda Mapping

Directing

Agenda Mapping

Following

Tip 2: Guide the Agenda

• Spirit of MI is intentional

• Content

• Timing

• Priorities

• Contingencies

Agenda Mapping

Clinician/Helper Patient/Client

Hi, I’m Dr. Kathy Reims. It is nice to meet you Mr. Smith. What brings you here today?

I have had a pain in my knee.

OK. Anything else? I need my diabetes medication filled.

OK. Would it be OK with you if we discussed your blood glucose control?

Of course!

OK, we will discuss your knee pain, your diabetes control and make sure you get refills today. Anything else that is really important to cover today?

No, I think they are the most important.

<Could start with knee pain or discuss priorities>

The Agenda

• Mutual content contributions

• Prioritize together

• Be realistic – plan for follow-up OK

• Check in to ensure you agree

Clinician/Helper Patient/Client

Hi Mr. Jones. This is Ellie Marlboro, your nurse care manager from the clinic. Is this a good time to talk?

Oh hi, Ellie. Sure!

I understand you were in the hospital and had a heart attack.

Yes, it was really scary!

I am sure! We can definitely spend some time talking about your heart attack and how you are feeling about it. Anything else?

Well they changed some of my medicine in the hospital. Am I supposed to take what I was taking before and the new ones too?

Great, let’s talk about all your medications and make sure that is clear. Anything else?

Well I want to get back to driving and I am not clear how long before I can do that and other things I used to do.

OK. Talking about your heart attack, how you are feeling about that, your medications and how to restore your activity level sounds like a great way to use our time today. Is there anything more important than these issues?

I have so many questions! But I think these are the most important right now.

Mr. Jones

• CM initial visit

• Social Work initial visit

• CM second visit

Tip 3: Avoid (or Climb Out of…) Pitfalls

• Lots of assessment questions

• Raising a challenging topic

• Going in circles or getting off track

Trios Practice

• One care manager

• One patient

• One observer

Task: Create an agenda with the patient for this encounter

Care Manager Referral: New Diagnosis

• Debbie is 45, obese with new onset diabetes and a 3 year history of high blood pressure. She is worried about her diet and does not exercise. She is tearful because her mother recently died due to complications of diabetes. Her HbA1c is 13.8%.

Care Manager Referral: High Utilizer

• Laura is a 36 year old with migraine headaches. She has been seen in the emergency room for headache pain eight times in the last 2 month. She has been unable to keep her follow up appointments with her PCP. Laura is talkative and seems distracted.

Case Manager Referral: Complex Patient, Recent Discharge

• Sam is a 72 year old male who has been hospitalized 3 times in the last 4 months with worsening CHF. His wife does not like to cook and they mostly eat processed foods. He continues to smoke – “it’s the only fun thing I have left!” His medications were changed in the hospital and he can’t find his discharge papers.

Aligning Agendas with your Work

Visit 1

Short term goals

Long term goals

Visit 2

Short term goals

Long term goals

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Et al.

Recap

• Agendas may add some structure to your complex work

• Mutually created, agendas model the Spirit of MI

• Engagement is essential to make progress toward care goals

• Our ability to focus and guide our interactions help our patients reach their care goals