As of July 27th, there were a total of 44,267 clients enrolled into the Accountable Care Program:
(RCCO 1 – Rocky Mountain Health Plans) had approximately 7,991 clients enrolled;
(RCCO 2 – Colorado Access) had approximately 6,000 clients enrolled;
(RCCO 3- Colorado Access) had approximately 5,970 clients enrolled;
(RCCO 4 – Integrated Community Health Partners) had approximately 7,794 clients enrolled;
(RCCO 5 –Colorado Access) had 3,278 clients enrolled;
(RCCO 6 – Colorado Community Health Alliance) had approximately 3,843 clients enrolled, and
(RCCO 7 –Community Care of Central Colorado) had approximately 9,391 clients enrolled.

As of the end of June, the total opt-out rate for all regions was 2.23 percent. For more information, please contact Sarah Roberts.

New Eligibility Screen for ACC Members on the Web Portal
When you check eligibility through the Web Portal for a client who has been enrolled into the ACC, the eligibility screen will look different. The results of the inquiry will show (1) that the client is a member of the ACC program; (2) the RCCO that the client belongs to; and (3) the client’s Primary Care Medical Provider (PCMP). When you submit an eligibility inquiry for a client who is a member of the ACC, you will get a response that looks like the following: click here for more details

Providing Services and Submitting Claims for ACC Members
ACC members receive regular fee-for-service Medicaid, but the member’s PCMP should provide a referral for most specialty services. The services that do not require a referral are listed in the “Message” section of the eligibility screen.

Because ACC members receive regular fee-for-service Medicaid, claims are to be submitted the same way as other clients who receive fee-for-service Medicaid. However, if the claim you are submitting is for specialty care that is not one of the exempt specialty services listed on the eligibility response, it is strongly recommended that a referral be obtained from the client’s PCMP before claims are submitted for that service. Contact the PCMP to explain the client’s need, and if the PCMP approves the service, document the PCMP’s provider number in the Referring Provider Number box.

A referral does not take the place of a PAR for a service that requires a PAR. If a PAR is required, it is recommended that the PCMP be indicated as the referring provider on both the PAR and the claim.
For questions or additional information, please contact ACS Provider Services at 1-800-237-0757 or 1-800-237-0044.

Specialty Referrals for ACC Patients:
Attention: Providers that see ACC Patients from RCCO Regions 2, 3 and 5

Medicaid patients that have been enrolled in the Accountable Care Collaborative (ACC) program will require a referral for specialty care. This is true even if you are not yet contracted as an ACC provider.

Click here to view a letter from Colorado Access, the Regional Care Collaborative Organization (RCCO) for Regions 2, 3 and 5, that describes the correct process for making those referrals.

Regions 2, 3 and 5 include the following counties: Adams, Arapahoe, Cheyenne, Denver, Douglas, Kit Carson, Lincoln, Logan, Morgan, Phillips, Sedgwick, Washington, Weld and Yuma.

 Click Here for a table of RCCOs and key contacts statewide.

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Practice Manager’s Corner

CCHAP Practice Manager Meeting – Thursday October 27th  
Our next Practice Manager meeting will be on Thursday October 27th at noon. Please save the date. We will have a live panel presentation and discussion with representatives from all seven Regional Care Collaborative Organizations (RCCOs).  Please email your questions for the RCCOs in advance of the meeting to anita.rich@childrenscolorado and we will forward those on so that the presenters can be prepared to address your primary concerns. Also, based on your survey feedback from our August meeting, we will be trying out a new format for remote attendees in an attempt to resolve audio and video challenges.  More details to come soon via email...

Medicaid July 1, 2011 Provider Rates Approved by CMS
The Centers for Medicare and Medicaid Services (CMS) has approved the Medicaid reimbursement rate reduction effective July 1, 2011. The new rates have been loaded into the Medicaid Management Information System (MMIS) and the fee schedule with the new rates is published at the bottom of the Provider Services Home page of the HCPF Web site at colorado.gov/hcpf.

IMPORTANT: Medicaid will retroactively adjust all claims with dates of service on or after July 1, 2011 to reflect the new rate. Adjustments will be reflected on future Provider Claim Reports (PCRs). Please contact Jeanine Draut at Jeanine.Draut@state.co.us or 303-866-5942 with any questions.

New Vendor for Prior Authorization Requests (PARs)
Effective August, 31, 2011, PARs previously sent to the Colorado Foundation for Medical Care (CFMC) should be sent to the ColoradoPAR Program. The ColoradoPAR Program, administered by APS Healthcare, is Colorado Medicaid’s new Utilization Management Program.  Beginning August 31, 2011, the ColoradoPAR Program will be reviewing prior authorization requests that have previously been sent to CFMC for review.  The first phase of changing to the new vendor requires that all PARs be mailed or faxed to the ColoradoPAR Program.  The process and forms for submitting PARs that have been used in the past have not changed.

Please continue to send your ACS PARs to ACS for processing. At this time the change only applies to those PARs that have been sent to CFMC in the past.  

The list of PARs to be sent to the ColoradoPAR Program includes:
     •    Durable Medical Equipment (DME) – Limited to orthotics/prosthetics, communication devices, power wheelchairs and power scooters
     •    Diagnostic Imaging– limited to non-emergent Computed Tomography (CT) Scans, Magnetic Resonance Imaging (MRIs), and all Positron
           Emission Tomography (PET) Scans
     •    Medical/Surgical Services
     •    Reconstructive Surgery
     •    2nd surgical opinions
     •    Physical and Occupational Therapy
     •    Transportation- Limited to Meals and Lodging
     •    Out-of-State Non-Emergency Surgical Services
     •    Organ Transplantation
     •    EPSDT Home Health

Beginning August 31, 2011, please submit the above PARs via paper to the ColoradoPAR Program’s servicing center:

The ColoradoPAR Program
C/O APS Healthcare
4545 N. Lincoln, Ste. 103
Oklahoma City, OK 73105.
Fax:  866-492-3176

The ColoradoPAR Program will have the capability for providers to submit PARs electronically in the near future.  The ColoradoPAR Program will provide a new web portal with enhanced functionality to ease the administrative burden on providers for PAR submission.  There will be webinars and regional trainings to assist providers with navigation and use of the new web portal.  There will be additional information posted on the ColoradoPAR Web site soon regarding upcoming training schedules.  

Beginning August 31, 2011, for additional assistance, please contact the ColoradoPAR Program information line at 1-888-454-7686. If you have questions regarding this transition, please contact Erica Alikchihoo at 303-866-3385. There will be webinars and regional trainings to assist providers with navigation and use of the new web portal. Additional information regarding upcoming training schedules will be posted on the ColoradoPAR web site at www.coloradopar.com.

UPDATE from CORHIO: Colorado Medicaid EHR Incentive Program
The Colorado Department of Health Care Policy and Financing is in the process of implementing the Colorado Medicaid Electronic Health Record (EHR) Incentive Program, through which eligible healthcare professionals and hospitals can receive incentive payments for adoption and meaningful use of certified EHR technology.

Medicaid Program Status Update
HCPF anticipates the following timeline for the Medicaid EHR Incentive Program:
     •    Federal Approval of State Medicaid HIT Plan                  October 2011
     •    Colorado Registration & Attestation System live -
           Medicaid Provider Registration Begins                           May 2012
     •    First Incentive Payments Issued to Eligible
           Providers who Successfully Attest to Adopting,
           Implementing, or Upgrading Certified EHRs                   June 2012

Medicaid Program Point of Contact and Partnerships
HCPF has partnered with CORHIO (the Colorado Regional Health Information Organization) and CO-REC (Colorado Regional Extension Center) program to provide program coordination and assist with provider communications and outreach regarding the Medicaid EHR Incentive Program.  CO-REC will provide a central point of contact for eligible providers, partners, and other interested parties on requirements, processes, and questions regarding the Medicaid EHR Incentive Program. Currently more than 2,100 providers are working with CO-REC to achieve meaningful use.

Colorado Medicaid EHR Incentive Program central point of contact:
Robyn Leone, CO-REC Director
MedicaidEHR@corhio.org
720-285-3245

Affiliated Computer Services (ACS) has been contracted by HCPF to provide the CO R&A system, including the web portal through which eligible providers will register and attest to their EHR incentive payments.  ACS has already implemented this solution in many other states, including California, Alaska and Texas.

Physician Administered Drugs
Drugs administered in a physician’s office are not pharmacy benefits of the Colorado Medical Assistance Program. For office administered drugs, please refer to the appropriate service program rules, and if applicable, bill using the Colorado 1500 claim form or submit an 837 Professional (837P) transaction. Keep in mind, that drugs such as Synagis, Zometa, Depo-provera, Implanon and Remicade are not eligible for pharmacy benefit coverage unless they are administered in the client’s home or eligible long-term care facility. Please refer to the Provider Billing Manuals for additional billing details.

Medical Record Retention Guidelines
Providers must maintain records that fully disclose the nature and extent of services provided. Upon request, providers must furnish information about payments claimed for Colorado Medical Assistance Program services. Records must substantiate submitted claim information.

Records must be retained for at least six years or longer if required by regulation or a specific contract between the provider and the Colorado Medical Assistance Program.

Adults Without Dependent Children - Update from HCPF
HCPF has made some decisions about the adults without dependent children expansion in Medicaid, which will be implemented with CMS approval. Due to limited funding for this program, they have decided to offer the full Medicaid benefit to a maximum of 10,000 adults without dependent children who earn incomes up to 10% of federal poverty level. Enrollment will occur on first come, first serve basis. This means that only those between the ages of 19 and 64 and earn single incomes of less than $91 a month would qualify for this first round (10% of poverty for a family of two is $245 a month). Enrollment of the first 10,000 will begin March 1, 2012.

After the cap has been met, all those who would otherwise qualify for the program will be placed on a wait list, and this wait list will also be ordered on first come, first serve basis. When there is enough funding for additional enrollees, the Department will enroll more people from the wait list. This may occur no sooner than 6-8 months after the initial roll-out. In the meantime, CICP (Colorado Indigent Care Program) will be available for those unable to be included in the expansion.

All those who are able to enroll in the program in the first round will receive the full regular Medicaid benefit, the same as what is now provided to families currently eligible for Medicaid.

Please stay tuned for further updates, but in the meantime, feel free to contact Aubrey Hill  or Susan Mathieu if you have any questions or concerns. Also, there is an opportunity for public comment at the advisory committee meetings, a schedule of which can be found here.

Message From HCPF - HIPAA 5010 Implementation

What is HIPAA 5010?
• The Centers for Medicare and Medicaid Service (CMS) HIPAA 5010 regulations establish standards for electronic health care transactions to change from Version 4010 to Version 5010 on January 1, 2012. These electronic health care transactions include functions such as claims, eligibility inquiries, and remittance advices. On this date, providers, insurance companies, Medicare and state Medicaid agencies will be prohibited from processing electronic transactions that are not Version 5010 compliant.
• The CMS fact Sheet on HIPAA 5010 can be found at: CMS HIPAA 5010.

When is implementation?
• The necessary remediation and programming changes the Department’s MMIS will take over 17,000 hours. Though the Department has been working towards implementing the HIPAA 5010 regulations, the Department may not be compliant on January 1, 2012. In determining the order in which HIPAA 5010 transactions will be implemented, the Department has given priority to those critical transactions that directly affect client access to care and provider payments. These critical transactions are expected to be implemented by February 2012. All other transactions are expected to be implemented by May 2012.

What are the contingency plans?
• Contingency plans include the use of paper claims, the use of provider call center services for eligibility and claim status questions, and a continuation of HIPAA 4010 transactions. Claims submitted on paper would continue to process and pay; however, a huge increase in the volume of paper claims would significantly lengthen the time between submission and payment. Currently, less than 3 percent of claims are submitted on paper.

Will late implementation impact clients?
• No, clients can still receive services during this time.

Can clients receive their medications during this time?
• Yes. The Department’s Pharmacy Point-of-Sale transaction, which is a separate system from the MMIS, are scheduled to be implemented on January 1, 2012.

What is the Department requesting of CMS?
• Due to issues that will arise in programming and testing, the Department is requesting that CMS delay the HIPAA 5010 implementation until the Department can certify that all transactions have been tested and are HIPAA 5010 compliant. The Department is requesting that CMS delay implementation and allow the Department to accept HIPAA 4010 transactions until all of the Department’s transactions are HIPAA 5010 compliant.

HCPF needs to understand if the provider community will have the operational ability to submit HIPAA 4010 transactions to HCPF, while still submitting HIPAA 5010 transitions to other payers, such as Medicare.  HCPF requests that you respond with your ability to submit HIPAA 4010 transactions after January 1, 2012.  In addition, if you have different contingency plan you would like HCPF to consider, please include that information. Please send your feedback to: Chris Underwood, 303-866-4766

Colorado Access is gearing up for the transition to HIPAA version 5010.  For clearinghouses and providers who submit directly (e.g., trading partners):
•    Colorado Access is finalizing the 4010 to 5010 project plan and should be ready to begin testing 837 5010 files with our trading partners
      mid-July 2011
•    Colorado Access will use industry standard file validation program(s) for testing
•    Testing will occur with each trading partner individually and will include testing business rules, structural changes and errata changes
•    Reports will be provided upon completion of testing
Each provider should verify with their clearinghouse if there are any new requirements for submitting their claims to the clearinghouse. If you have questions regarding Colorado Access’ transition process please contact Jennifer Hutchings at (720) 744-5172 or jennifer.hutchings@coaccess.com
 
Click here to visit the Centers for Medicare & Medicaid Services website for additional information on the transition to HIPAA 5010.

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The Immunization Quality Improvement Project

The American Board of Pediatrics has developed re-certification requirements that necessitate a candidate to participate in quality improvement efforts.   If this is the situation in which you find yourself, consider the Immunization Quality Improvement Project. Developed by the University of California – San Diego and the Colorado Department of Public Health and Environment, the project is endorsed by the Colorado Chapter of the AAP Board.  The QI tasks involve identifying and reducing missed opportunities for immunization.  The QI project is conducted monthly and on-line and has received ABP certification.

Trained CDPHE nurse consultants experienced in immunization services will visit your office to help get you started.  The nurse consultant does not do the evaluation for you; a central tenet of the QI project is that you investigate the quality of services in your own office.  It is crucial that all clinicians in a practice participate in the project at the same time.  

The online data collection tool is easy to use and provides immediate feedback.  The tool uses recent data to help understand and reduce or eliminate root causes for missed opportunities.

This QI project has no direct cost to you.  If you are nearing recertification time and immunization services could be improved, please contact Lori Quick, RN (Colorado Immunization QI Project Coordinator for CDPHE) at 970-375-2579 or toll free at 877-375-2579.    

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The Role of Religion in Providing Culturally Responsive Care

by Marcia Carteret M.Ed.
Copyright 2011. All rights reserved.

Skillfulness in cross-cultural communication with patients can be demonstrated by a provider’s comfort with asking key questions so that he or she may discover the broader context in which a patient is operating. This broader context includes the patient's cultural-religious beliefs which have a tremendous impact on health behaviors. Our beliefs about what helps restore us to health can be amazingly powerful - as the placebo effect demonstrates very well.

Culture, Religion & Spirituality
Participants in cross-cultural trainings often ask how to separate an individual's cultural beliefs and behaviors from those that are based on the person's religion. The best answer to this very complex question is to think of culture and religion as being two sides of the same coin - it may not be very useful to struggle with separating them (unless perhaps you are a theologian or philosopher).
 
When interacting with patients and their families, religion can be a touchy subject. It isn't always exactly clear where health care and religious practices intersect. According to Brick Johnstone, professor of health psychology at the MU School of Health Professions, “Some professionals may feel uncomfortable obtaining information about patients’ religious beliefs, (but) it is no different than inquiring about their sexual or, psychological beliefs, substance abuse, etc...” (1)
 
In this Dimensions of Culture article, and as part of the cross-cultural communications “toolkit” we have developed for providers and their staffs in all CCHAP pediatric and family practices, we suggest six key areas of intersection between a patient’s health care and their cultural-religious beliefs. We will also delineate five health events of particular interest in cross-cultural health care, suggesting examples of associated cultural-religious tenets from various faiths. Finally, resources for more specific in-depth cultural-religious information appear at the end of the article.

Six Key Areas Where Health Care and Cultural-Religious Beliefs Intersect
Communication with Spiritual Leaders: The need for adequate language interpreters in health care settings is uniformly addressed, but it is also imperative for people to be able to communicate with leaders of their faith community. These people can help interpret what is happening in a health crisis at a deeper spiritual level for the patient and family, which is very important to many people. For example, in the Catholic faith, a person may gain great strength and peace from the sacrament of the sick being administered by a priest. In Judaism, it is important to know the variations in practice among Orthodox, Conservative, and Reformed traditions. Religious leaders can clarify which tenets cut across the branches of their faith in matters ranging from birth control to life support. In the Muslim faith it is considered a taboo topic to talk about death with a patient, and a religious leader may be a crucial go between in conversations between providers and second degree male relatives who decide how to inform immediate family members about a terminal illness.
 
Religious leaders assist individuals in making connections between their “inner life or spirit” and their communal, social and cultural reasons for practicing a formal religion. ” Collaboration with the leaders of a faith community can result in strongly positive outcomes for a patient and family.(2)
 
Gender: It is ethically egregious not to be aware of gender-specific rules for patient care that are extremely important for many faith traditions – for example, among Orthodox Jews and Muslims. People of opposite genders may be forbidden to be touched by someone of the opposite gender. Male Muslims should be examined by men and only female nurses and doctors should examine Muslim women.
 
Modesty: Nakedness is anathema to members of some faiths, notably Muslims, and health care situations, including hospitalization, do not lessen this sensitivity. This is especially true for women and elderly people. Requirements for putting on a hospital gown may be met with opposition. Studies indicate that concerns about modesty contribute to health disparities among certain segments of the population. Asian women, in particular, if they are very traditional, may often avoid seeking care if a physical examination is involved.
 
Diet: Concerns about dietary restrictions are most important in hospital settings where patients have little control over what they are served. Still, general awareness of food taboos predicated by culture/religion is important for all health care providers. Doctors in private practice settings and clinics need to be aware of how dietary restrictions affect patient compliance and should know to ask, for example, if a Hindu patient is vegetarian. Some do eat meat, but do NOT eat pork or beef. Eggs may not be allowed. Hindus and Muslims may both observe strict fasting. Mormons follow a dietary code that prohibits tea, coffee, and cola drinks. It is not as important to try to memorize specific dietary rules as it is to understand something about the beliefs driving the rules. For example, where fasting is practiced, it is related to a widely-held belief that physical cleansing is associated with spiritual cleansing.

Sacred objects: Be they amulets, figurines, portraits of saints, crosses, intaglios – sacred object should be allowed in a patient’s physical space and on the body. All caution should be taken to safeguard them. They should not be removed (or even moved) without talking with the patient/family. Evil eye pendants or charms are common worldwide. In Mexico they are very important and should never be removed, especially from babies, without permission of family members. Similarly, Sikhs wear a steel bracelet on the right wrist that – like a wedding ring – should not be removed unless absolutely necessary. Called a Kara, this bracelet is a symbol of unbreakable attachment to God. It is in the shape of a circle which has no beginning and no end.

Sacred Time: In our Dimensions of Culture trainings we talk a great deal about how people’s concepts of time vary by culture. In addition to differences between clock time and "fluid" time, health care providers should be aware of sacred time. What day do the patient and family observe as a day of rest? It is Friday for Muslims, Friday at sunset until Saturday at sunset for Jews and Seventh-day Adventists, and Sunday for Christians. Institutions should post calendars that note the holidays for all traditions served. Meetings with families should not be scheduled on these dates, and office appointments should be offered on days other than sacred days. Clergy within certain faith traditions can provide the dates for holidays, like Ramadan, that shift year to year.

Possible Health Events and Associated Cultural-Religious Tenets
(Based on Table 5-1 presented in Rachel Spector's "Cultural Diversity in Health and Illness)    

• Use of Birth Control- Sterilization may be forbidden. In some circumstances, Jews may seek rabbinical consultation before deciding about the use of birth control. People of some other faiths may only use natural means of preventing pregnancy.
• Surgery (including Cesarean) In some faiths surgery is acceptable with the exception of abortion. In others, all invasive procedures are avoided. In the Hmong culture people fear soul loss during surgery.  A Muslim woman may avoid a cesarean because she believes only Allah can decide whether a baby is born. Jehovah's witnesses are not opposed to surgery but the administration of blood during surgery is strictly prohibited.
• Use of Blood and Blood Products - Typically no restriction except for Jehovah Witnesses and possibly Christian Scientists
• Autopsy - Tenets about autopsy range from being permitted for medical or legal purposes only to actually being required by law.
• Organ Donation - Forbidden by Jehovah's Witnesses. For many who follow Judaism this is a complex issue requiring rabbinic consultation.

Summary
Health care providers may sometimes be uncertain how to talk about cultural-religious health beliefs and behaviors with patients/families. We have suggested six key areas of intersection between a patient’s health care and their cultural-religious beliefs to assist in these important conversations. In addition, we have presented five health events of particular interest in cross-cultural health care. Discovering the broader context of a patient's life is critical to providing responsive care and assuring good health outcomes.  Resources for more specific in-depth cultural-religious information on appears below.

Resources
0.    The study has been published in the journal Disability and Rehabilitation. It was co-authored by Bret Glass, of the MU College of Education’s Department of Educational, School and Counseling Psychology and Richard Oliver, dean of the MU School of Health Professions. The study was conducted under the MU Center on Religion and the Professions, a $1.5 million center funded by the Pew Charitable Trusts.  http://shp.missouri.edu
1.    Testerman, John K. Md, Ph.D. "Spirituality vs. Religion: Implications for Health Care" by John K. From lecture given at 20th Annual Faith and Learning Seminar June 1997.
2.    Kennedy, Maria MD. "Role of Patient's Religion inn Delivery of Culturally-Responsive Care." MD Anderson Cancer Center Chaplaincy Department
3.    Spector, Rachel E., "Cultural Diversity in Health and Illness" (7th Edition) July 19, 2008 Publisher: Prentice Hall; 7 edition (July 19, 2008)Language: English

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Announcing the RIGHT START Program for Mental Health
Services for High-Risk Medicaid Children 0-5

Dr. Bridget Burnett, a licensed psychologist specializing in working with families with children ages 0-5, has announced that she will be joining the RIGHT START Program at the Mental Health Center of Denver (MHCD) in mid-September 2011.  MHCD provides mental health services to very high risk families with children ages 0-5 in Denver County.  Services take place in the home or in the clinic.  Currently, RIGHT START clinicians are licensed psychologists who have completed the Irving Harris Fellowship in Child Development and Infant Mental Health at the University of Colorado Denver.

Please feel free to use MHCD as a referral resource for your Medicaid children ages 0-5.  Concerns around attachment, caregiver functioning, and postpartum depression are especially relevant. Families may call Dr. Shannon Bekman @ 303-504-6605 to schedule appointments.  Referrals to the Right Start Program can actually bypass the general intake process.  This is a wonderful opportunity for families to get involved in the system of care at MHCD more efficiently! Due to the newness of the RIGHT START Program, a limited number of spots are available at this time, but the hope is that the program will continue to grow based on community need.

Your practice staff may email Dr. Burnett directly with any referrals or program questions at Bridget.Burnett@mhcd.org or may contact the Program Manager, Dr. Shannon Bekman at Shannon.Bekman@mhcd.org.

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Motivational interviewing (MI) for behavior change

 
Compiled by Shawn Cochrane, MD/PhD
shawn.cochrane@childrenscolorado.org

What is MI and why try it?

Have you ever felt like you were lecturing a parent/patient about something that they should do and get met with a blank stare or apathy?  MI is a “form of collaborative conversation for strengthening a person's own motivation and commitment to change.”  The goal of MI is to let the patient/parent provide direction to the conversation and provide insight into readiness to change so that the patient/parent will be empowered and enabled to make a change.  Studies have shown that use of MI has made a difference in adults with alcoholism, smoking dependence, and at risk college students; it has also has been shown to help children with weight problems and diabetes management.  It can be used for a variety of health care issues where the patient and parent need to be motivated for the treatment to be effective.

MI BASICS

1. Setting the agenda

• Ask permission to discuss issue (to initiate parent/patient buy-in).  “Can we spend some time now talking about how best to control your (your child’s) asthma with the medications?”
• Try an agenda setting menu (see diagram below) to start the discussion (can be verbal or by handout) “What are the most important issues about his asthma that you want to be sure we talk about today?”  Some people find using pictures to be helpful as a visual aide.

2. Assessing importance, confidence and readiness to change

• Explore barriers and potential solutions.  “Are there any things that make it difficult to give him the medications under the current plan?”  “What would make it easier?”  “What solutions could you try?”
• Steps needed to make this change; can address past efforts/successes.  “Let’s figure out exactly what steps you would have to take to do this?” 
• “My action plan” Success is higher when the patient/parent takes home a plan on a piece of paper (see attached handout) with all of these components listed for parents/patients to fill out; consider making copies and keep for documentation 
• Discuss whether they think they could actually implement the plan.  “Do you think you will be able to do this?”
• How confident are they that they can meet their goal?  (rate 1-10)  Probe for more information (i.e. if they select an 8, then ask “why not a 4?”)   Help them think through any new barriers or issues that arise.

• How important is the change(s)/ (two different scales needed)?  “How important is this to you?   Rate 1-10.  If it is not rated highly, explore why?

3. Tips on communicating using this method

• Use open-ended questions to understand parent’s/patient’s background and base of knowledge about issue at hand
• Praise good things you hear (it really does make a difference - watch their faces!) 
  • Elicit - provide - elicit 
  • Elicit – “How much do you know about ….” 
  • Provide - NEUTRAL suggestions (avoid “you”), “What some people find helpful…” 
  • Elicit – “How does this fit in with how you see things?”

4. Tips on reducing resistance

• Emphasize personal choice and control
• Re-assess importance, confidence and readiness - restate and re-explore 
• Back off and come alongside 
• Praise, praise, praise what they come up with or what they are doing.…it will get you a long way

5. Goal setting

• “Where does this leave you now…” (great concluding statement)
• Have parent/patient come up with goals (not too many and achievable by next appointment)
• Have parent/patient write them down and keep in a visible location (i.e., fridge)

6. Other helpful and interesting thoughts

• Importance + confidence = readiness to change
• Understand the stages of change model (pre-contemplation, contemplation, preparation, action, maintenance and termination) 
• Follow up is crucial to behavior change; phone vs. email vs. visit (let parent/patient choose)

• Office-based motivational interviewing to prevent childhood obesity: a feasibility study.
  Schwartz RP, Hamre R, Dietz WH, Wasserman RC, Slora EJ, Myers EF, Sullivan S, Rockett H, Thoma KA, Dumitru G, Resnicow KA. Arch Pediatr Adolesc Med. 2007 May;161(5):495-501. PMID: 17485627
• Motivational Interviewing for Pediatric Obesity: Conceptual Issues and Evidence Review
  Journal of the American Dietetic Association - Volume 106, Issue 12 (December 2006)
• Clinic-Based Support to Help Overweight Patients With Type 2 Diabetes  Increase Physical Activity and Lose Weight Christian JG, Bessesen DH, Byers TE, Christian KK, Goldstein MG, Bock BC Arch Intern Med. 2008;168:141-146 

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Copyright 2011 Colorado Children's Healthcare Access Program and other entities as noted.

 CCHAP Home > Newsletter Articles > Newsletter 53, September 2011