2. Today’s Theme Song
SURPRISE!!!
• “Are those the people who do those HORRIBLE
gyrations???”
• - from my sweet mother, HUGE fan of Elvis
3. Goals for Today:
Motivation & The Interdisciplinary Team
Discuss the role of health care professionals in
promoting motivation and adherence
Describe how the role of the PT/PTA can differ
depending on the therapy setting
Differentiate between the role of the PTA/PT and
other health care professionals
Differentiate between various health care
professionals
Recognize the multi-disciplinary team approach to
health care
4. Research Paper Due Dates
Rough Draft of Visual Presentation
due Tuesday 11/01/11 at 2:30pm via Blackboard or in person
Printed Draft w/your edits & at least 1 peer edit
show Elaine 11/03/11 by 3:30pm
Printed Final Paper (7-10 pages)
due Tuesday 11/08/11 by 2:30pm
FINAL Visual Presentation & Handout
due Tuesday 11/08/11 by 2:30pm via Blackboard and/or
hard copy
5. Research Paper Requirements
APA Format – writing style guidelines published by
The American Psychological Association
7-10 pages (Introduction, Body, Conclusion)
PLUS: Title Page & Works Cited (Reference Page)
Double Spaced
1” margins on all sides
12 point, Times New Roman font (per APA recommendations)
At least 5 sources cited in your paper
One of the 5 sources must be a personal interview
6. Research Presentation Requirements
8-10 minutes in length
Utilize a visual aide during your presentation
Power Point
Flip Chart
Prezi
Prepare & issue a written handout for the class
AT LEAST 1 page
Be creative!
7. Test #3 is THIS Friday 11/04 at 10am
Disability – Psych Aspects book – Ch 10
Chronic Conditions – Psych Aspects book – Ch 11
Personality – MBTI + Lecture notes after MBTI
Motivation – Psych Aspects book – Ch 6
The Interdisciplinary Team
Intro book – pgs 27-38
Intro book – pgs 45-47
Jackie’s information – Abbreviations O-symbols (?)
8. Promoting Motivation and Adherence
Clients tend to be motivated to strive towards goals
That are important and relevant to them
That they believe/hope are possible
Clients tend to adhere to programs that are
Not too difficult
Not too costly
Not too time consuming
Are consistent with their health belief system
9. Concepts to Enhance
Motivation and Adherence
Education and empowerment
Client-centered care
Ask clients to identify questions and problems in their own words
Facilitate open dialogue
Educate clients about how to be active participants
Goal setting
Feedback and follow-up
Peer support groups
Functional programs
Collaboration
10. Client-Related Barriers to Collaboration
Non-adherence
Impairments and disabilities
Lack of interest in collaboration
Perception that clinician has lack of time
Uncertainty regarding success of treatment
11. Clinician-Related Barriers to Collaboration
Inadequate knowledge about how to collaborate
Unwillingness to relinquish/share power
Paternalistic perspective
Failure to consider pre-morbid lifestyle and history
12. Strategies to Enhance
Motivation and Adherence
Health Belief Model
Transtheoretical Model for Health Behavior Change
(Stages of Change)
Motivational Interviewing
The Five A’s Behavioral Intervention Protocol
There are MANY more strategies/behavioral techniques
13. Strategy 1 to Enhance Motivation/Adherence
Health Belief Model
Focuses on psychological theories of decision making
Health behaviors & choices are influenced by the value people
place on a potential outcome & their belief that a certain course of
action will result in a desired outcome
In order to change behavior, must first be ready to make a change
Believes that the value of making the change is stronger than the
consequences of not making the change
To motivate patients to make the suggested changes, patients’
beliefs must align with our view that Western medicine provides
solutions
14. Strategy 2 to Enhance Motivation/Adherence
Transtheoretical Model for Health Behavior Change
(Stages of Change)
Focuses on motivation
Change in health behavior is a process that takes time
People move through various stages of readiness to change
Pre-Contemplation (No plans to begin change)
Contemplation (Aware of need to change/plan to in next 6 mos)
Preparation (Plan to take action in near future)
Action (Implementing the change) – appears “Motivated”
Maintenance (Change is kept) – 6 mos to 5 yrs – relapse is
Termination (Change is integrated) – Goals reached! Confident they
will not return to previous unhealthy behavior
Relapse appears to be a necessary element in the process. It must be
addressed to allow the patient to begin anew
15. Strategy 3 to Enhance Motivation/Adherence
Motivational Interviewing
Based on the belief that patients are responsible for their own actions
and health AND for changing their health behaviors
Client-Centered, evidence based, directive counseling approach
Based on the transtheoretical model for health behavior change, follows
4 key counseling principles
Express empathy (Readiness to change comes from w/in patient)
Develop a discrepancy (between current unhealthy behaviors and goals/values
they might strive to achieve) – (Self-determination & commitment to change
rests within the patient)
Roll with resistance (PTA does not directly interfere w/client resistance.
Coercion, persuasion, & confrontation are counterproductive)
Support self-efficacy (PTA supports & communicates the belief that the
patient IS ABLE to effect change through a partnership rather than
paternalistic relationship)
Reflective listening, open ended ?’s, affirming, & summarizing are key
“Tell me what you already know about diabetes and how it is treated?”
PTA affirms and supports all facets of the conversation to change!
16. Strategy 4 to Enhance Motivation/Adherence
The Five A’s Behavioral Intervention Protocol
Taken from other models
This strategy has been shown to be more successful in promoting
patient motivation/adherence than information and advice alone
Address the issue (get patient’s attention, name the problem, &
present the need for intervention)
Assess the patient (determine where patient is in the stages of change
& identify potential barriers)
Advise the patient (include traditional medical role of giving info &
educating the patient to make change/explain pros & cons of change)
Assist the patient to make change (negotiate an agreeable plan of care)
Arrange for follow-up (schedule another appointment to review
progress, address barriers, and renegotiate the protocol)
17.
18. Variety of Physical Therapy Settings
Acute Care Facilities Primary Care Facilities
Subacute Care Facilities Outpatient Care Facilities
Rehabilitation Hospitals Long Term Care Facilities(ChronicCare)
Hospice Care Facilities Home Health Care
School System Private Practice Facilities
19. The Health Care Team
Intradisciplinary
Members work together within same discipline (PT/PTA)
Other disciplines are not involved
Multidisciplinary
Members work separately and independently in their different
disciplines, without collaboration
Interdisciplinary
Members work TOGETHER within ALL disciplines to set goals
ALL members collaborate but interventions may be done
separately
*** This type of team is the most efficient and successful to
patient outcomes.
20. Possible Team Members
PTA • Recreational Therapist
PT • Chiropractor
COTA
• Pet Therapist
• Therapy Aide
OTR
• Clinic Office Manager
SLP
• CNA
RN • Orthotist/Prosthetist
LVN • LSW
MD • ATC
PA • Physical Therapy Volunteers
CNP • SPTs/SPTAs
• Home Health Aides
21. Behavior Change
Small Group Activity: Background Information
Ted is a 45 year old construction worker who has
come to you for treatment of low back pain. This is
not his first time receiving treatment. You find that
he has been to PT, a nutritionist, and a back school
in the past. He admits that he had trouble following
through with the home programs. Ted continues to
be 50 pounds overweight and smokes a pack of
cigarettes per day. He is divorced and at the end of
the day, he likes to sit in front of the TV and “have a
few beers.”
22. Small Group Activity: Instructions
Divide into 3 groups of 5
Use the assigned method to attempt to change the
patient’s behavior
Consider the pros and cons of your assigned method
Problem solve in your group and prepare to present
in class