MSDI (Fose) Counseling Powerpoints and Lectures

Communication roadblocks are obstacles that counselors inadvertently put up that block self-exploration. These happen when __ to __

counselors impose their own views, feelings, opinions, prejudices, and judgments block, stop, divert, or change the direction of communication

CLARIFYING

encourageclientstocontinuetalkingabouttheir concerns and become clear about their feelings and experiences. Communicate "tell me more" through body language Use trailing words, such as "and . . ." or "and then . . .", or the last few words spoken by the client.

social determinants

Socioeconomic factors and issues such as discrimination, racism, and stereotyping are common social determinants of health disparities. Individuals who have experienced or perceived racism are more likely Unconscious biases contribute to disparities in health care outcomes.

PROBLEM SOLVING

Counselor and client work together to identify behavior chain , detect barriers to change, brainstorm possible options and weigh the pros and cons of the alternatives uses the STOP technique

Videotape, Audiotape, or Observation Evaluations

Counselors can conduct self-evaluations of their skills by using a video- or audiotape or have a colleague or mentor conduct an assessment. An assessment instrument can be used to guide the evaluation.

Checking

Counselors can provide periodic summaries, and asking client's reaction to the summary can help counselors to evaluate whether they are on target during a counseling session.

Nutrition counseling helps clients to achieve three main goals:

Facilitate lifestyle awareness Strengthen healthy lifestyle decision-making Take appropriate action to obtain a healthy lifestyle

data collection methods

review of published data, use of facility records, interview with target audience, interview with key informants, nutrition assessments, qualitative research, and quantitative research

Focusing

the goal is to establish a clear direction that allows development of achievable goals. The counselor invites the client to focus on a topic for the session.

Sympathy is what I feel __ you; empathy is what I feel __ you

toward; as

ethics

well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues

behavior

what measureable and observable behaviors will the learners be able to do as a result of the program?

Multiple questions

The client is asked to respond to more than one question at a time. Clients will become confused trying to decide which question to answer first.

Instructional Plan

road-map for the educational session. Should include the following: • Target Audience • Specific Goals, Objectives • Prerequisites • Duration • Teaching Materials and Resources • Lesson Description • Lesson Procedure (Introduction and Learning Experiences) • Summary and Closure • Evaluation • Assignment

Technology

The citizens of the United States put great fate in technology and the scientific method. Diseases are viewed as correctable mechanistic errors that can be fixed by manipulation. Americans tend to think science can help humanity—a view not as highly held in Europe.

nutiriton counseling intent

The rationale for selecting a particular response (to acknowledge, to explore, or to challenge)

stress level

a person experiencing a high degree of stress is automatically generating negative emotional states, thereby creating high-risk situations. There is an increased desire to relapse and connect to the satisfying emotional states associated with previous unhealthy eating pleasures.

self efficacy

developed by Albert Bandura and defined as "the confidence to perform a specific behavior" (e.g., belief in ability to change food patterns).

The 4 Cs of Culture Guideline

developed by Drs. Stuarts Lavin, Alice Kuo, and Geri-Ann Galanti, this mnemonic helps professionals remember what questions to ask to obtain the client's point of view. - Call - Caused - Cope - Concerns Questions should be asked in a curious, nonjudgmental way.

Cultural competence

encompasses the attitudes, skills, and levels of awareness that enable the development of culturally appropriate, respectful, and relevant interventions.

making space

encouraging input from a participant who has indicated by facial expression or body language a desire to speak. "Do you have something you would like to add?"

components of mindful eating

enjoyable eating, eating slowly, focus on eating, recognize inner cues, eat nonjudgmental, be aware of senses, be in the present, reflect on mindless eating, recognize interconnectedness, practice meditation, process-oriented, not outcome based

what are the presenting skills that are desired to be possessed

enthusiasm for subject, technique development, knowledge, and practice

Useful Behavioral Management Techniques for Middle Childhood

- Self-monitoring of diet and physical activity - Cue elimination - Stimulus control - Goal-setting - Action-planning - Modeling - Limit setting - Contingency management - Positive reinforcement - Cognitive modifications

perception of quality care

Nonadherence Counselor Issues

nutrition counseling focus

Placement of the emphasis in the response (information, experience, feeling, though, behavior)

___ is the first step when facilitating a group meeting.

Preparation

CULTURAL INFLUENCE ON COMMUNICATION

When individuals share a common culture, distortions in communication are less likely, and conversation will flow more smoothly.

stacking

When several people indicate a desire to speak at once "Ok first we will hear from ... then from ..."

Key communication differences among cultural groups may involve:

body language variations in use of expressive language degree of directness use of eye contact amount of personal space needed acceptable duration of silence

Lapse management

help clients plan for handling a slip so that it does not escalate into a full-blown relapse.

social support

helping relationships and social network

percentage of verbal, para-verbal, and nonverbal communication out of all communication

verbal - 7% para-verbal - 38% non-verbal - 55%

Funneling questions

A sequence of questions beginning with a broad topic and narrowing down to a specific item

goals

Broadly stated learner outcomes Overall intent of an intervention includes "Who" and "What" (ex: "Participants of this course will learn effective dietary methods for weight management.")

Preparatory Change Talk (DARN)

Client expresses motivations for change without stating or implying specific intent or commitment to make a change. Desire (I want to change) Ability (I can change) Reason (It's important to change) Need (I should change)

STANDARD TOOLS FOR FOOD INTAKE DATA COLLECTION

Food diary and daily food record 24-hour recall Food frequency Usual intake form Diet history interview

ICIC

Interesting, Clear, Informative, Concise

nutrition education settings

consumer marketplace, communities, healthcare settings, worksites, and schools

Health Disparities

differences in health outcomes among groups

affective

feelings or emotions (attitude or feel)

social norm

identification of salient others and their social norms and expectations

Mobilizing change talk

statements that clearly express or imply action to change behavior. Can be remembered with the acronym CATS: commitment, activation, and taking steps.

NUTRITION COUNSELING PROTOCOLS: ANALYSIS AND FLOW OF A COUNSELING SESSION

• Involving Stage • Exploration-Education Phase • Resolving Phase

content

"Instruction or training intended to lead to nutrition-related knowledge"

components of objectives

"SMART", ABCs of objectives, and 3 domains of learning

Preparation's key tasks include the following:

- Define goals that are specific, concrete, positive, realistic, and practical. - Consider who needs to attend, when and where the meeting can take place, and any potential problems that need to be addressed before the meeting. - Evaluate the need for equipment and supplies. - Solicit input of participants. - Identify support roles (e.g., time keeper, recorder). - Develop an agenda and send to participants before the meeting.

advantages of group counseling

- Emotional support - Group Problem Solving - Modeling Effect - Attitudinal and belief examples

beginning a group meeting

- Encourage openness and trust, can use an icebreaker - Go over Agenda, agree on topics - May want to set ground rules - Ask participants to describe their expectations of the group process

process for consensus

- Explain the purpose of the discussion. - Review the values important to a good group discussion. - Explain that the goal is to reach an acceptable agreement in a defined timeframe. - Repeat purpose of discussion. - Ask for someone to start the discussion. - After discussion, the group comes to a consensus agreeing on a course of action.

what should you do in a group setting if a patient is stating something incorrectly

- Handle delicately - Say "That's great that it worked for you, but others have found ... " Or"That's one way of looking at it, but there are authorities that believe..." Or "I see your point, but let's try looking at it this way."

Questions can serve a number of functions in group settings:

- Keep the group on task and moving toward the desired goal - Clarify parts of a discussion - Promote participation - Encourage exploration of possibilities and ownership of outcomes

how to do pair-share

- Supply one to three questions for discussion. - Ask participants to work with a partner to formulate answers. - After an appropriate time period, ask participants to share their ideas with the group.

Explain the health belief model

-Recognition of a threat can motivate action. Perception of seriousness of said threat can determine whether the patient will partake in healthy behaviors -predicts a person's decision about health-related changes -identify client's ability to accomplish behavioral changes -client benefit from explanation of disease risk and links to diet -benefit from pros/cons of actions

SOCIAL COGNITIVE THEORY - ABC'S OF BEHAVIOR

A - antecendant (stimulus, cue, trigger) B - behavior (response, eating) C - consequence (punishment, reward) all lead to the behavior chain

policy

A change in policy can be effective in supporting the desired behavior change. For example, legislative advocacy such as lobbying may be effective in promoting the sale of healthier foods in vending machines located in high schools.

Question-answer traps

A series of questions that may cause clients to feel as if they are under interrogation. As a general rule, ask no more than three questions in a row.

Client Evaluation of Counselor

An evaluation form such as The CARE Measure can be used to evaluate client interactions with counselors

application

Assistance in skill development and interpreting medical results related to a nutrition prescription

Social Liberation (Notice public support) description and examples

Awareness of social support or advocacy for healthy opportunities encourages adopting a new behavior. Social support could include salad bars, calorie data on menus, or neighborhood walking paths.

The Spirit of Motivational Interviewing

By upholding the spirit of MI, counselors can achieve interactions with clients that encourage behavior change.

Examples of ways to mirror/match nonverbal behavior include the following:

Calibrate nonverbal behavior to match the client's (e.g., cocking the head) Incorporate the client's words in responses Mirror a client's silence behavior for those who are culturally accustomed to long periods of silence

NOTING A DISCREPANCY

Discrepancies are contradictions or inconsistencies within the client that usually stem from denial, distortions, and/or resistance to changing familiar patterns of behavior. Counselors who challenge or point out discrepancies help the client to recognize ambivalence to change, resolve self-defeating behaviors, and move forward in making lifestyle changes. When noting a discrepancy, the intent should never be to criticize or attack. Adopt a curious, caring, and nonjudgmental attitude so that the client is more likely to recognize the discrepancy and resolve it.

affective domain

Emphasizes how a learner feels or values a particular entity. • Reflects one's attitude, feels, levels of appreciation includes characterization, organization, valuing, responding, and recieving

The following format can be used for a self-involving response:

I (the counselor) feel (name feeling) about what you (the client) said or did.

drawing people out

If an individual has expressed a vague or unclear idea, paraphrasing is used and then there is a request for clarification. "Can you elaborate on this idea? How so?"

LGBTQ Health Disparities

LGBT youth 2-3x more likely to attempt suicide LGBT youth are more likely to be homeless Lesbians are less likely to get preventive services for cancer Gay men are at higher risk of HIV and other STDs, especially among communities of color Transgender individuals are less likely to have health insurance LGBT populations have highest rates of tobacco, alcohol, and other drug use

High risk situations

Negative emotional states: anger, anxiety, depression, frustration, boredom, loneliness, Positive emotional states: celebrations, events, Conflict with others, arguments, Social gatherings, parties, Holidays etc.

ESTABLISH A SYSTEM FOR TRACKING CLIENT'S PROGRESS

No matter what food management system has been selected, your clients should be encouraged to keep track of their progress. - journaling - food diary - checking off - electronic monitoring - art - empty bowl method

Price

Price refers to the perceived costs of obtaining the social marketing product. The costs may be tangible (money) or intangible (time, effort, inconvenience, or risk of humiliation, or censure) in exchange for the product. Careful research must be done to determine the perceived costs and benefits so as to plan an intervention minimizing the costs and maximizing the benefits. Perception of greater benefits than costs is likely to encourage the consumer to "buy" the product.

Responsibilities of Health Professionals Working with Individuals with Disabilities

Provide an accessible treatment environment Allow for extra time Be mindful of potential "invisible disabilities" Let patient determine level of assistance needed Ask before providing help Speak directly to the person, not a caregiver/guardian Use age-appropriate tone, language and materials Show them courtesy, respect and interest as you do all of your clients Prepare yourself to speak to clients appropriately Address the individual, not the disability

QUESTIONING

Questions are effective responses for gathering information, encouraging exploration, and changing the focus of a discussion. The challenge is asking appropriate questions and timing them well. Questions should be asked only if there is a particular therapeutic purpose in mind—they may interrupt concentration and lead to a discussion of concerns that interest the counselor but not necessarily the client.

Reinforcement Management (Use rewards) description and examples

Rewards from self or others can be an incentive to change an unhealthy behavior. Contingency contracts, group recognition, and positive self-talk can provide positive reinforcement.

BEHAVIOR CHANGE STRATEGIES

Select an appropriate strategy based on clients motivational stage, resources, lifestyle, educational, and emotional needs social cognitive theory is common Sets a framework for a discussion of behavior change strategies by focusing on points in the sequence of behaviors.

open groups

Support groups Participation encouraged but not required

condition

The condition by which their performance will be assessed. May be the resources used, location, limitations, or time imposed.

I think therefore I am is which theory?

Theory of Planned Behavior (TPB)

Increased Use of Traditional Therapies

There has been a substantial increase in the use of complementary interventions and traditional therapies (e.g., meditation, acupuncture, herbal medicine), which are often culture-based.

psychomotor domain

This domain involves action, control, and movement of the body. Skills could include: • Providing insulin injections • Sauteing fresh vegetables • Conducting a food experiment includes complex overt response, mechanism, guided response, set, and perception

Assessing Client's Nonverbal Behavior.

Throughout a counseling session a client's non-verbal behavior can be a key to his or her emotional state and can indicate how the counseling session is going.

cultural pre-competence

Weaknesses in serving culturally diverse populations are realized, and there are some attempts to make accommodations. Teachers, learners, and organizations recognize and respond to cultural differences and attempt to redress non-liberating structures, teaching practices, and inequities Individuals and organizations recognize the need for cultural competency and this serves as a first step in extirpating some of the debilitating practices that limit the educational progress of diverse learners

Concerns

What concerns do you have regarding your condition?

Call

What do you call your problem?

Caused

What do you think caused your problem?

Consider requesting members of the group to contribute to the summary. Some possible questions include the following:

What do you think has benefitted you the most from our meeting today? What strategies have you learned here that you can picture using?

distance support buddies

a relative, associate, or friend in a distant location could be involved through telephone conversations, email, or text messaging.

Registered Dietitian Nutritionist (RDN)

a trained nutrition professional who has met the educational and experiential standards set forth by the Commission on Dietetic Registration (CDR) of the Academy of Nutrition and Dietetics (AND).

EFFECTIVE COMMUNICATION FOR SPECIAL POPULATIONS: older adults

a variety of physical, social, economic, cultural, and psychological factors affect food behavior of older adults. Nearly half of older adults are considered individuals who are low income or living below the poverty line, which limits access to healthful foods. Can experience loneliness, depression, social isolation, reduced taste, smell decline, appetite changes, disabilities, reduced mobility, etc. aging reduces several physiological processes and impacts nutritional needs. Need increased vitamin D, calcium, B12, whole grains, dark green/orange veggies, legumes, dairy, zinc, iron, folate, fluids, and calories (83 percent of older adults do not have a good quality diet)

learning

acquiring the knowledge, skills, and attitudes needed to become an effective nutrition counselor

perceived susceptibility

address health risks via persuasive communications to convey personal threat

Functional medicine

addresses the underlying causes of disease

evaluation in closing a group session

allow time for feedback during the meeting. Evaluations can be done verbally by the group, or a paper assessment can be done individually.

covert antecedents

apparently irrelevant decisions (AIDs), stress level, cognitions, and urges/cravings

balancing

asking for additional opinions "So far hear you saying is..." we have heard from two people who believe... are there additional viewpoints we should consider?"

social cognitive theory constructs

behavioral capability reinforcements observational learning social support

healthcare settings

can include physicians' offices, health maintenance organizations, hospitals, public health clinics, nursing homes, and various assisted- living facilities

classes

classes related to your client's condition may be available in community education programs, supermarkets, or health centers. By taking part in these programs, clients enhance their skills and make contacts that can support their behavior change efforts

Three approaches to learning form the basis for behavior modification:

classical conditioning, operant conditioning, and modeling

audience

clearly define the learner

social support group

clients can explore support groups that may be available through local medical centers or the Internet (e.g., interactive forums)

Which type of therapy works at changing harmful thinking?

cognitive behavioral therapy (CBT)

cognitions

cognitive factors (e.g., rationalization and denial) set the stage for a relapse. Rationalization that the indulgence is justified adds to the creation of a relapsing environment.

communities

community-based programs target specific population groups using media and interpersonal strategies to encourage healthy food behaviors.

Client Rights

confidentiality, procedures and goals of counseling, and qualifications and practices of the counselor

To develop cultural sensitivity, understand the role of __ in your life as well as in the lives of clients from cultures other than your own.

cultural values

cue management (stimulus control)

deals with the antecedent component of a behavior chain by prearranging cues to increase a desired response or to suppress a detrimental one Identify stimulus/cue/trigger Develop strategy to counteract cue with the client

starting a private practice steps

define a focus, professional credentials and achievements, learn and connect, create a business roadmap, learn business basics, look at brand image, create a sound bite

planning

develop commitment to change and formulate a plan of action

Social Support Options

distance support buddies, clubs, organizations, social support groups, classes

positive outcome expectancies

during a stressful or high-risk situation, previous pleasurable experiences associated with particular foods and the significance of those perceptions can add to the desire to lapse.

Nutrition and Dietetics Technicians, Registered (NDTR)

educated and trained at the technical level of nutrition and dietetics. In a clinical setting, NDTRs work under the supervision of a RDN.

The "marketing mix"

encompasses product, price, place, promotion, and can often incorporate publics, partnership, policy, and purse strings.

Behavioral determinants

factors over which individuals have control, such as: - being overweight or obese - exercise choices - use of illicit drugs, tobacco, or alcohol

Environmental determinants

factors such as lead exposure, asthma triggers, workplace safety factors, and unsafe or polluted living conditions

how many counseling sessions are there usually?

four

attending

giving undivided attention to your clients, listening for verbal messages, and observing nonverbal behavior active listening Attending is the foundation of all other counseling skills. Most attending behaviors are nonverbal; also include nondescript verbal sounds used to convey an impression of being engaged.

Counseling strategies that incorporate behavioral modification approaches include

goal setting, self-monitoring, relapse prevention

Level 1: Not ready to change (pre-contemplative)

have indicated that they are not ready to change their behavior or are not doing well at attempting to change. These clients do not need solutions; they need to know they have a problem. Major goal: raise doubt about present dietary behavior Major task: raise awareness of the health and diet problems related to the client's dietary pattern

Enhancement of self-efficacy

help clients to enhance self-efficacy through the following strategies: -Adopt a collaborative counseling style -Set clear, modest, and achievable goals -Provide feedback

subjective norm has to do with __

how others will perceive you

Biological and genetic determinants

include family history of diabetes as well as inherited conditions such as hemophilia, cystic fibrosis, and sickle cell anemia

perceived severity

incorporate impact and consequences of disease to convey personal threat

behavioral intention

increase desire and resolve to engage in health behavior

self-efficacy

increase self-confidence to perform health behavior via social modeling of behavior and guided practice for mastery of behavioral skills

conscious awareness

increased comfort level with a skill, but the counselor is still consciously aware of the process

Preparatory change talk

indicates that the client is thinking about a change but is not making a solid commitment. Can be remembered with the acronym DARN: desire, ability, reasons, and need statements.

perceived benefits

information highlighting benefits of taking action to reduce threat of disease or condition

traits

inherent qualities of mind or personality characteristics; may enhance or influence counseling skills

Explore concerns regarding a selected option: __

investigate any concerns you have about an option selected by your client.

reflection (empathizing)

labeling a client's expressed verbal and nonverbal emotion verbally acknowledging a client's feeling helps the client to feel understood, communicates empathy, and facilitates self-acceptance and self- understanding. 1. Correctly identify the feeling being expressed. 2. Reflect the feeling you have identified to the client. 3. Match the intensity of your response to the level of feeling expressed by the client. 4. Respond to the feelings of your client, not to the feelings of others.

observational learning

learn to perform new behaviors via family peer and media models

psychomotor

manual or physical skills (do)

food group evaluations

many forms used for this assessment have the standards on the collection form or as an attachment, allowing for a speedy evaluation and immediate feedback.

Questions that put members "on the spot" by asking for justification for their actions or identifying blame are __

not likely to promote positive group dynamics.

food component analysis

nutrients can be analyzed using: food composition tables the U.S. Department of Agriculture (USDA) Nutrient Database a nutritional analysis software program

Consumer marketplace

nutrition education initiatives can take place anywhere consumers purchase food items.

schools

nutrition education is an important part of a comprehensive school district health intervention targeting children, families, administrators, staff, and food service operations

examples of roadblocks

ordering or commanding manner, trying to domineer the conversation instead of being mostly passive can also be agreeing too much or trying to easily "fix" the problem promising/reassuring everything will be fine questioning withdrawing or "putting things on the back burner"

Strategies to guide participation and flow of content:

paraphrasing, drawing people out, stacking, tracking, encouraging, balancing, making space, and identifying common ground

health belief model constructs

perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy

theory-informed intervention

pertains to the partial use of theory elements to design intervention components.

cultural values

principles or standards that members of a cultural group share in common

the health belief model

proposes that cognitive factors influence an individual's decision to make and maintain a specific health behavior change.

reinforcements

provide internal and external reinforcements

behavioral capability

provide nutrition and food related knowledge and behavioral skills to perform behavior

addition social marketing P's

publics, partnership, policy, and purse strings

formative evaluations

qualitative data may be conducted before a program begins to assess certain design elements for effectiveness and to determine what theory variables should be included in an intervention. At the beginning of a program, an evaluation may be conducted to provide a baseline to measure the impact of an intervention. For ongoing projects, formative evaluations are implemented periodically to assess progress and to make necessary adjustments to improve methodology as indicated by the analysis.

goals are __ whereas objectives are ___

quantitative; qualitative

perceived barriers

reduce perception of barriers to engaging in health behavior

To break the silence, the counselor may

repeat the last sentence or phrase spoken by the client ask the client what she or he was thinking about during the silence wait for the client to speak.

self disclosure

revealing intimate aspects of oneself to others

Cognitive restructuring

self-talk related to lapses is particularly important in the relapse prevention model.

A number of interrelated barriers to good health can lead to health disparities:

social, behavioral, environmental, biological and genetic determinants

cultural comparisons of communication styles: african americans

speak quietly with affect and rhythm; direct eye contact when speaking, may avert if prolonged-look away when listening interject often (taking turns) very quick response expressive, demonstrative respectful, direct approach assertive questioning firm handshake, smile touching common-reluctance to touch may be interpreted as rejection-stand and sit closer than majority whites high-context use of pictures, graphs, charts useful polychronistic (multi-tasker)

Change talk

statements by the client that indicate an argument for change; there is preparatory and mobilizing

Successful health behavior changes have been found to correlate with a __

strong self-efficacy

The effect of the client-counselor relationship is frequently cited as the reason for __. Clients have often identified their personal interaction with their therapist as __

success or failure of a counseling interaction; the single most important part of treatment

ORID

the ORID discussion method uses a progression of questions that takes a group through four consecutive stages: objective, reflective, interpretive, and decisional. The facilitator asks probing questions that follow the natural sequence people generally use to contemplate an issue. This process is useful for reflecting on experiences and invites a variety of perspectives in a non- confrontational manner. The questions should flow naturally from one stage to the next.

self-sufficiency

the ability to fulfill all of one's needs without assistance.

stress definition

the body's nonspecific response to threats or requirements for action or change

Perceived barriers are associated with which model?

the health belief model

awkwardness

the initial period of discomfort that must be experienced to develop effective counseling skills

the dietetics profession defined

the integration, application and communication of principles derived from food, nutrition, social, business and basic sciences, to achieve and maintain optimal nutrition status of individuals and groups

Behavioral and cognitive strategies to deal with high-risk situations

the metaphor of a toolbox can be used to describe the availability of a variety of coping strategies.

perceived power

the perceived ability of the control belief to facilitate or inhibit the performance of the behavior

Engaging

the process of establishing a mutually trusting and respectful helping relationship This is accomplished by showing warmth; appearing curious; and using nonthreatening, open-ended questions. The counselor listens carefully to understand the client's story and uses reflective listening to demonstrate that what the client has to say is important.

skill development

the sequence of steps involved in mastering new skills

automatic response

the skill becomes an automatic reaction with little or no forethought or discomfort.

Description and introduction

to begin, describe the relapse prevention model and introduce the concept of high-risk situations.

steps of health belief model

to make behavior change, individuals must believe that.... they are susceptible, it is a serious threat, it can be prevented, and they are capable of actions

Open-ended questions

used to explore and gather information from the client's perspective They usually begin with the words what, how, or tell me and tend to elicit change talk.

Social Support

when clients perceive sense of support from others, it helps them feel more in control, thus increasing their self-efficacy

advantages of self disclosure

▫ Normalizes client's feelings ▫ Encourages disclosure from client ▫ Broadens client's thinking ▫ Models behaviors that client may need to work on

Relationship Building Responses

Attending Reflection Legitimation Respect (Affirmation) Partnership Personal support

ASOAP

Audience, Subject, Objective, Angle, Publication

outcome expectations definition and implications for interventions

Beliefs about the likelihood and value of the consequences of behavioral choices • Provide taste tests • Educate about health implications of food behavior

Stimulus Control (Manage your environment) description and examples

Change the environment to alter the prompts that encourage the unhealthy behavior and add reminders to engage in the healthy behavior. Remove unhealthy food from sight or possibly the home, provide easily seen tasty and healthy options, and participate in self-help groups.

Charting

Charting can be a valuable tool to evaluate counseling effectiveness as well as client progress.

Resource needs

Consider factors that could enhance or hinder the adoption of new food behaviors. Evaluate food availability, income, lifestyle factors, food prices, transportation resources, cooking facilities, social support, and availability of food assistance programs for the target audience. The evaluation should also include possible channels for promoting nutrition education (e.g., social media, traditional media outlets)

The pressing need for cultural competence in health care is driven by issues such as the following:

Demographic diversity and projected population shifts Increased utilization of traditional therapies Disparities in health status Underrepresentation of culturally and linguistically diverse health care providers Legislative, regulatory, and accreditation mandates

Reasons to focus on Cultural Competence

Demographic trends, health disparities, quality care, legislative and accreditation requirements

components of relapse prevention counseling

Description and introduction Identification of high-risk situations Behavioral and cognitive strategies to deal with high-risk situations Strategies to minimize the occurrence of high-risk situations Enhancement of self-efficacy Lapse management Cognitive restructuring Urge management techniques

HOW TO CHANGE THINKING PATTERNS

Educate client that they can choose the way they think Help client identify dysfunctional thinking Explore validity of self-destructive statements Practice "Thought Stopping"

nutrition assessments

Food frequency questionnaires, 24-hour recalls, food apps, photos or written records of food intake

what should you do in a group setting if a patient has side conversations

Friendly reminder. "Please, one conversation at a time. Let's get down to business." Pause until disruption stops. Ask talker a question, or restate last opinion expressed and ask for an opinion Stroll over and stand casually behind or next to the participants who are talking If there are numerous side conversations, ask "Do we need to take a break?"

Place

In commercial marketing, place often refers to the distribution channels in which customers are able to obtain the product. From a social marketing perspective, one could pose the question as: "Where is the behavior available to the target audience?" Nutrition messages should reach people in a place where they are making decisions about the behavior. For a program promoting low- sodium diets for hypertensive individuals, what are some venues to promote the message to the target audience? Perhaps viable settings would include doctors' office waiting rooms, Internet websites, shopping malls, grocery stores, television news programs, and radio talk shows.

behavior chain positive consequence example

Juanita comes home from work hungry. There are an orange and walking clothes and shoes prominently displayed on a chair in the kitchen (antecedent). Juanita eats the orange, changes her clothes, and goes out for a half-hour walk (behavior). When she returns, Juanita is in good spirits, and she prepares dinner. She eats a healthy meal with whole grains and vegetables; she is content (consequence).

food management tools

Meal replacements Detailed Menus and Meal Plans Food lists for weight management MyPlate DASH Food Plan Goal setting

Tips for Working with Interpreters

Meet with interpreter in advance, if possible Look and speak directly to patient Speak in short sentences and pause Use even pace and normal tone Use calm voice and respectful body language Don't say anything you do not want the patient to hear Be prepared to rephrase if not understood Ask only one question at a time

intervention strategies for middle childhood

Multicomponent, school, and community-based interventions: policymakers looking for solutions to the growing obesity problem have paid closer attention to school and community environments. Differential attention Develop, consistently follow, and routinely revisit a Family Media Use Plan Use activity-oriented nutrition interventions (e.g., books and games for promoting nutrition education).

level 1 generalization

Simple Description- Ex: Cancer is a chronic disease.

Substantial health inequalities exist based on __

age, gender, race, ethnicity, education, income disability, residence, or sexual orientation.

paraphrasing

can highlight an important point ("what I'm hearing you say...")

3 domains of learning

cognitive, affective, and psychomotor

modeling

observational learning (e.g., learning by watching a video or demonstration, observing someone else, or hearing a success story)

Cues to action example and intervention possibilities

"My roommate always has savory snacks and potato chips on the kitchen counter." Link current symptoms to health problem; discuss media to promote health action; encourage social support; use reminder systems (sticky notes, automated cell phone messages, mailings).

Title VI of the civil rights act of 1964

"No person in the United States shall, on ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance." The Academy of Nutrition and Dietetics and the Accreditation Council for Education in Nutrition and Dietetics (ACEND) has integrated diversity requirements into numerous components of the organization

WORK ON COGNITIVE RESTRUCTURING FOR LONG-TERM SUCCESS

"Opportunity Thinking" instead of "Obstacle Thinking" Identify irrational thoughts and modifying them Change behavior by changing destructive thinking patterns (internal dialogue, mental images, beliefs and assumptions)

what should you do in a group setting if a patient is an expert ("you should just do ____")

"Sounds as if you know a lot about this. Now, let's hear what others think. Who would like to share next?"

Perceived barriers example and intervention possibilities

"The foods I need to eat to lower my blood pressure are tasteless." Explore strategies to overcome barriers, such as inconvenience, cost, and unpleasant feelings. Offer incentives, assistance, and reassurance; correct misinformation and misperceptions; provide taste tests.

The following questions can help select a focus:

"Which of the options would you like to work on first?" "You have mentioned several concerns this afternoon. Which one would you like to cover today?"

Each society has a conscious and unconscious series of expected reciprocal responses American example: __ when expected responses do not happen, __ ensues

"You're welcome" is expected to follow a "Thank you."; discomfort

Communication Do's

- Learn and use the correct pronunciation of a person's name - Give examples to illustrate a point - Look at the situation from the other person's perspective - Simplify or rephrase what is said - Use language that is inclusive - Pause between sentences - Ask for clarification - Remain aware of biases and assumptions - Be patient

what are some examples of follow-up activities?

- Maintain contact with members through websites, email, group chats, etc. - Review the accomplishments and concerns of the meeting with colleagues. - Write thank you notes, if appropriate. - Provide minutes of the meeting to participants. - Provide information about the meeting to people who were absent.

process for ORID

- Objective discussion: questions focus on getting the facts. - Reflective discussion: questions focus on emotions and feelings. - Interpretive discussion: questions focus on values, meaning, purpose, and significance to the group. - Decisional discussion: questions focus on making a group decision or personal response to the experience.

process for corners

- Post the name of each task in a corner of the room. Example: for health fair, the tasks may be divided into developing publicity, locating and contacting participating agencies and businesses, organizing the facility on the day of the event, and coordinating volunteers. - Ask participants to consider what part of the project interests them most. - Ask individuals to move to their desired task corner. - Ask participants to address the specific questions related to the task at each corner. - After corner discussions, have a speaker from each group report back to the whole group.

theory of planned behavior constructs

- behavioral intention - attitudes - social norm

MyPlate advantages and disadvantages

- easy to understand - flexible - need to use the website to obtain a more detailed plan

Goal setting advantages and disadvantages

- easy to understand - flexible - designed to take into consideration a client's lifestyle - approach may move too slow when aggressive intervention is needed

DASH Food Plan advantages and disadvantages

- easy to understand - flexible - rich in various nutrients believed to benefit good health - some of the foods may not be part of a client's usual intake (ex. nuts, beans, and seeds)

Functions of Cultural Values

-Provide a set of rules by which to govern lives -Serve as a basis for attitudes, beliefs, and behaviors -Guide actions and decisions -Give direction to lives and help solve common problems -Influence how to perceive and react to others -Help determine basic attitudes regarding personal, social, and philosophical issues -Reflect a person's identity and provide a basis for self-evaluation

disadvantages of group counseling

-individual responsiveness -group member personalities -possibility of poor role models -meeting the needs of all group members

Most relapse prevention programs incorporate three main categories of strategies:

1. Skills training 2. Cognitive restructuring 3. Lifestyle balancing

overview of what is motivational

1. Knowledge of consequences 2. Self-efficacy 3. A perception that a course of action has been chosen freely 4. Self-analysis (giving arguments for change) 5. Recognition of a discrepancy between present condition and desirable state of being 6. Social support 7. Feelings accepted

how to develop a target audience

1. conduct needs assessment 2. determine educational approach 3. design theory-based intervention 4. establish goals and objectives 5. plan instruction and learning strategies 6. develop mass media 7. conduct evaluations

Putting It All Together: Successful Behavior Change Attributes Based on Theories and Models

1.Strongly desires and intends to change for clear, personal reasons 2. Faces a minimum of obstacles (information processing, physical, logistical, or environmental barriers) to change 3. Has the requisite skill and self-confidence to make a change 4. Feels positively about the change and believes it will result in meaningful benefit(s) 5. Perceives the change is congruent with his or her self-image and social group(s) norms 6. Receives reminders, encouragement, and support to change at appropriate times and places from valued persons and community sources, and is in a largely supportive community or environment for the change

social pressures

A client's immediate social environment can sometimes exert a negative influence on eating behavior. If so, seek ways to reduce the impact without causing undue social stress. encourage the client to show assertive behavior: Suggesting an alternative restaurant Calling a host ahead of time to discuss potential problems Offering to bring a vegetable platter to a social function Scenarios for dealing with difficult issues and social pressures can be developed in counseling sessions using role playing, microanalysis of the scenario, or mental imagery.

substitution suggestions

A healthier food alternative An active diversion or hobby Physical activity Relaxation activity

Expectations definition and implications for interventions

A person's beliefs about the likely outcomes of a behavior • Motivational interviewing • Model positive outcomes of diet and exercise

the health belief model explained

A person's beliefs interact with each other to determine the client's willingness to take action. Cues to participate in a program or seek counseling can come from a number of sources: ▫Physical symptoms ▫ Observation of another person taking action ▫ A media report ▫ Advice of a physician Counselors and clients can brainstorm together to design workable prompts, which provide reminders to cue action (e.g., note on the refrigerator).

Facilitator Likeability Behaviors

Acknowledge and compliment Let people know you like them and enjoy them Be enthusiastic, always allowing your joy for living to be visible Listen fully, without interpreting, rather than waiting for someone to finish so you can talk. Show a genuine interest in participants and their lives Take time to build relationships rather than being task-oriented Accept each person with unconditional, positive regard. Smile Like yourself- it's contagious.

REINFORCEMENT/REWARD

Adds incentive to maintain behavior change Provides POSITIVE consequences They should be: Individualized Age-appropriate Well-defined (what and how much) Timed to come after the behavior, not before Given as soon as possible after behavior is accomplished

developmental needs of adults

Adults are relevancy-oriented and need to know why, what, and how. Adults are autonomous and self-directed learners. The Educator facilitates their learning.

__, typically experience higher incidences of chronic disease, disability, and mortality as compared to non-Hispanic whites.

African Americans, Hispanic-Americans, American Indians, Asian-Americans, Alaska Natives, and Pacific Islanders

Possible Times to Use Silence During a Session

After an open-ended question After a client has been given the results of an evaluation During instructions for a complex dietary regimen After an emotional reaction to the demands of coping with a newly diagnosed illness If it appears that your client needs some space to process information

DIETARY ASSESSMENT: STEP 2 DATA ANALYSIS

After dietary information is collected, analyze the data in food group evaluations and food component analysis An electronic dietary analysis may be available if the client is using a food app that allows sharing information with a coach or counselor.

Determining an Educational Approach

After you have conducted a needs assessment, tailor your nutrition educational approach to address the needs of your target population, availability of resources, and any guidelines of the organization sponsoring the intervention. Types of Approaches: - Focus on information dissemination - Focus on Behavior Change - Focus on the environment and public policy

Specific intervention topics and strategies focused on adolescents may include the following:

Analyze media and peer-based messages; restaurant menus, Consider role-playing scenarios for problem behaviors, Create food demonstrations and taste tests, and Direct adolescents to helpful teen-friendly educational websites.

intervention strategies for preschool-aged children

As recommended by the American Academy of Pediatrics (AAP), "limit digital media use for children 2 to 5 years to no more than 1 hour per day." Involve family and caregivers in interventions Provide action-oriented behavior change activities: because children learn best through hands-on activities, interventions should be creative and fun (e.g., food tastings and food parties). Creative food records: if keeping a diary of food is essential, consider having the child draw pictures of food consumed or put a line through pictures of foods after they are eaten. Parental food diaries can also be used when more detailed information is needed.

useful questions for MI

Ask about the pros and cons of the client's present eating pattern and the contemplated change. Ask about extremes related to the problem. For example, "What worries you the most?" Ask the client to envision the future after the change has been accomplished: "How would life be different after this change?" Ask about priorities in life (that is, what is most important to the client). Then ask how the contemplated behavior change fits into the hierarchy.

Before the last meeting, ask the group to honor and acknowledge accomplishments of the individual members. Some include:

Ask members to either write or think about their journey of change and address the next chapter in their story (e.g., how they plan to continue the new behaviors and possibly make some additional healthy changes). At the final meeting, summarize the evolution of the group and ask participants to share their stories.

4 Ways to Conduct Readiness Assessments

Ask specific questions and follow an algorithm Ask open-ended questions Ask a ruler question Use readiness to change graphic

affirmation (respect)

Attentive listening, nonverbal behavior, and explicit affirmation show respect for your client and his/her coping abilities. Statements of respect help build rapport, increase confidence in the ability to cope with difficult situations (self-efficacy), and encourage change talk.

cultural destructiveness

Attitudes, practices, and policies are destructive to other cultures. Individual or groups refuse to acknowledge the presence or importance of cultural differences in the teaching/learning process Any perceived or real differences from the dominant mainstream culture are punished or suppressed

cultural blindness

Belief that culture makes no difference. Treat everyone the same. Approaches of the dominant culture are applicable for everyone. Individual or organization actively proffers the idea that cultural differences are inconsequential and of no importance Cultural differences may be noted, but being color blind (and culture blind) is the desired state. No resources, attention, or time are devoted to understanding cultural differences

Self Efficacy definition and implications for interventions

Beliefs about personal ability to perform behaviors that lead to desired outcomes • Skill development training and demonstrations • Small, incremental goals and behavioral contracting • Social modeling • Verbal persuasion, encouragement • Improving physical and emotional states

MODELING

Behaviors are learned by observation and imitation Clients gain confidence in their ability to succeed by seeing others (they can identify with) succeed

When giving feedback, remember these guidelines:

Be positive and specific. Note behavior, not traits. Do not put the client on the defensive.

partnership

Because of the complexity of social and health behavior change, collaboration with other organizations or groups within the community can increase resources and probability of a successful intervention.

what should you do in a group setting if a patient is searching for leaders opinion ("what's wrong with GMO's?")

Before giving a direct answer, you could open up discussion to other participants " Let us get some other opinions about this issue. How do you view this point?" Direct your question to another participant.

ACEND 2022 Standards for understanding yourself through personality and culture

CRDN 2.11 - Show cultural humility in interactions with colleagues, staff, clients, patients and the public. CRDN 2.12 - Implement culturally sensitive strategies to address cultural biases and differences CRDN 5.1 - Perform self-assessment that includes awareness in terms of learning and leadership styles and cultural orientation and develop goals for self-improvement.

Self-Liberation (Make a commitment) description and examples

Clients believe a new behavior can be attained and make a firm commitment to change. New Year's resolutions, public testimonies, writing a plan, and making a choice among several options can increase commitment to change.

Provide training

Clients gain a better understanding of the process when hands-on activities are included as well as complete instructions of how to keep a journal.

Action

Clients have altered the target behavior to an acceptable degree for 1 day or up to 6 months and continue to work at it. Although changes have been continuous, the new behaviors should not be viewed as permanent.

Contemplation

Clients recognize a need to change but are in a state of ambivalence. Perceived barriers (e.g., unacceptable tastes, economic constraints, or inconvenience) are major obstacles to change.

Objective

Clearly understand what you are trying to accomplish: is your primary objective to inform, stimulate interest, or change behavior?

Mobilizing Change Talk (CAT)

Client expresses or implies action to change. Commitment- Patient states: "I will", "I plan to" Activation- Patient states: "I have bought dental floss" Taking Steps- Patient states: "I just started flossing twice a week".

When is it time to end a counseling relationship?

Client has met goals Insurance coverage ends Client requires referral to other specialty Client or counselor is moving or changing jobs Client does not keep appointments

when evoking change talk, evaluate importance and confidence: this technique usually involves two questions—

Clients are asked to rate on a scale of zero to ten (with ten being the highest) the importance of the behavior change (for example, increase intake of fruits and vegetables). Clients are asked to rate again on the same scale their confidence in making a change.

Termination

Clients are not tempted to relapse and are 100 percent confident that the behavior will continue.

qualitative research

Collection and analysis of non-numerical, unstructured information from sources (Interview transcripts, emails, notes, feedback forms, photos, and videos) Analysis of data reveals common themes and relationships

Developmental needs

Consider the intellectual, social, emotional, and physical development of the target audience. Investigate the following questions:1. What is relevant and important to the learner at this life stage?2. What life events are affecting the target audience? 5

tips for providing affirmation

Convey respect with words of appreciation on the client's ability to overcome adversity and adjust to difficult situations. Make statements that help clients to recognize their strengths and capabilities. Remember that affirmations are not the same as compliments or praise, which have a tone of judgment. Example: "You are determined to make this new food plan work. Removing soda from your home could not have been easy." (Affirmation) vs. "Congratulations! I am so proud of you." (Praise) Avoid the use of "I" in an affirmation response. Affirmations should be about the client.

what are the Cultural Competence Models

Cultural Competence Continuum Campinha-Bacote Model of Cultural Competence in the Delivery of Health Care Sevices Development of Cultural Self-Awareness

Campinha-Bacote Model of Cultural Competence in the Delivery of Health Care Sevices

Cultural competence is "a process of becoming culturally competent, not being culturally competent." Consists of: - Cultural self-awareness - Cultural knowledge - Cultural skill - Cultural encounter - Cultural desire

STRATEGIES TO PROMOTE CHANGE

Develop an action plan to achieve goals Recommend appropriate food management tools (A variety of tools are available to help design food plans and track eating behavior) Establish a system for tracking progress Employ effective behavior change techniques Work toward cognitive restructuring for long-term success

Publication

Develop printed materials that the audience can understand, accept, and use. The publisher or platform may define a particular style and format. In some instances, government guidelines or institution policy may require a certain template. Choose an appropriate tone based on your audience norms and expectations.

Counseling responses are designed to accomplish three objectives:

Develop productive relationships Enhance listening and exploring to understand clients' messages, needs, and concerns Provide the tools needed to use motivational strategies

cultural competence

Differences are accepted and respected, self evaluations are continuous, cultural skills are acquired, and a variety of adaptations are made to better serve culturally diverse populations. Organizations and individuals learn to value cultural differences and attempt to find ways to celebrate, encourage, and respond to differences within and among themselves Teachers and students explore issues or equity, cultural history and knowledge, social justice, and privilege and power relations in our society

RESOLVING STAGE

Direction depends on client's readiness to change • Level 1: Not ready to change (pre-contemplative) • Level 2: Unsure (low confidence) • Level 3: Motivated/confident/ready

what should you do in a group setting if a patient is a rambler

Discontinue eye contact Interrupt with a new question "I think we need to move on."

length and frequency of counseling sessions

Each patient may require more or less sessions with the Dietitian to produce favorable outcomes. Sessions should typically be 30-60 minutes. In DSMT, 10 hours has shown to be most effective on A1C improvement.

EDUCATION DURING COUNSELING

Education is the primary step to changing dietary behavior and maintaining dietary objectives

Dramatic Relief (Experiencing and expressing feelings) description and examples

Either positive or negative emotional arousal can influence a decision to make a behavior change. Personal testimonials, media campaigns, stories, and role playing can move people emotionally.

close ended questions

Elicit yes or no or short answers. They do not allow for expansion of ideas, so usefulness is limited. Useful for ending a lengthy discourse or for soliciting a specific answer.

cognitive domain

Emphasizes thinking, knowing, understanding, and comprehending. 6 Major Levels developed by Bloom in 1956. (evaluation, synthesis, analysis, application, comprehension, and knowledge)

Educational needs

Evaluate knowledge, attitudes, motivational level, self-efficacy, and skills of the target population to plan an appropriate intervention.

General Motivational Interviewing Counseling Strategies

Encourage clients to make their own appraisals of the benefits and losses of an intended change. Do not rush clients into decision-making. Describe what other clients have done in similar situations. Give well-timed advice emphasizing that the client is the best judge of what can work. Provide information in a neutral, non-personal manner. Do not tell clients how they should feel about a medical or dietary assessment. Present choices. Clarify goals. Failure to reach a decision to change is not a failed consultation. Make sure clients understand that resolutions to change break down. Expect commitment to change to fluctuate, and empathize with the client's predicament.

cultural proficiency

Engages in activities that add to the knowledge base, conducts research, develops new approaches, publishes, encourages organizational cultural competence, and works in society to improve cultural relations. Engages is activities that add to knowledge base Conducts research Develops new approaches Encourages organizational cultural competence Works in society to improve cultural relations

The engaging process should include the following activities:

Establish the reason for the client's visit Provide an overview of what the client can expect Ask permission to explore the client's thoughts and feelings about a possible change

health needs

Explore disease prevalence, mortality rates, disability issues, and physical symptoms of the target audience via a review of literature, results of national and local surveys, and findings from epidemiological studies and health records.

FRAMES for brief interventions

F - feedback R - responsibility A - advice M - menu E - empathy S - self-efficacy Research has shown these are common components of effective brief interventions.

The Transtheoretical Model: Motivational Stages

For an intended behavior change, the client can begin at any one of the motivational levels or stages shown in Figure 2.2. Although clients progress through a sequence of stages, there is backward and forward movement toward change. It is normal for people to slip back one or more stages or even to have a relapse before progressing toward maintenance again (See Lifestyle Management Form 7.5, Appendix C).

Processes in Motivational Interviewing

Four broad processes can provide structure for using MI. Although these steps appear to be linear, they are not distinct processes. An adept counselor will move backward or forward as needed.

Core Counseling Skills of Motivational Interviewing: OARS

Four skills are found to be the most useful for MI and can be remembered with the acronym OARS: - open ended questions - affirmations - reflective listening - summaries

Examples of Nonproductive Nonverbal Behaviors

Frequently looking at a watch Yawning Slouching Tapping or swinging feet Playing with hair or a pencil

To give effective advice, follow these guidelines:

Give advice in a nonjudgmental manner Identify the problem Explain the need to change Advocate an explicit plan of action with options if possible End with an open-ended question to elicit a response from the client

GIVING FEEDBACK

Giving feedback involves telling clients what you have directly observed about their verbal and nonverbal behavior. Feedback invites the client to examine the implications of behavior and increase self- awareness.

Legislative and Accreditation Requirements

Government and professional organizations mandate culturally appropriate services. The United States Department of Health and Human Services (DHHS) has national standards for culturally and linguistically appropriate services in health care. Title VI of the civil rights act of 1964 In addition, suppliers of health care need to include "reasonable steps to provide services and information in appropriate languages other than English to ensure that persons with limited English proficiency are effectively informed and can effectively benefit." Patient Protection and Affordable Care Act of 2010.

Patient Protection and Affordable Care Act of 2010.

Has a number of provisions to improve the health of underserved populations including insurance reform, improved access to health care, quality improvement, cost containment, and public health initiatives.

Working with Interpreters

Health care providers should not use nonprofessional interpreters (e.g., the client's friends, children, or relatives), as this approach presents several problems: Studies of untrained interpreters have documented many interpretation errors. Sometimes, clients are reluctant or embarrassed to discuss certain problems in front of close relations. The nonprofessional interpreter may decide that certain information is irrelevant or unnecessary, failing to provide a complete interpretation. Untrained interpreters may be unfamiliar with medical terminology and unknowingly make mistakes.

Needs Assessment Categories:

Health needs Educational needs Resource needs Developmental needs

needs assessment categories

Health needs Educational needs Resource needs Developmental needs

Underrepresentation of Culturally and Linguistically Diverse Health Care Providers

Health professionals currently represent limited ethnic and linguistic diversity. Diversity in the composition of the health care workforce is important because it affects outcomes, quality, safety, and satisfaction. Practitioners are frequently challenged to provide services for cultural groups they have never encountered, underscoring the need for cultural competence.

According to the 2014 National __, "a more diverse health care workforce has been shown to help improve access to health and health care for communities of color."

Healthcare Disparities Report

Brief Encounters Using Motivational Interviewing

Healthcare practitioners are often involved in brief interventions that do not allow for full development of the MI approach. Using components of MI and providing the "spirit" of motivational interviewing has been successful when time is limited. For brief encounters, the goal may be to encourage a client to think about changing health behaviors and to accept a referral.

Immediate Determinants

High risk situations, coping skills, positive outcome expectancies, and the reaction to a lapse

Cope

How do you cope with your condition?

Development of Cultural Self-Awareness

Ideas for Expanding Your Cultural Knowledge: - Eat at ethnic restaurants - Explore stories about other cultures in the media - Establish focus groups to gain insight into a target population's culture Read about cultural customs and etiquette - Read local newspapers - Travel - Take language lessons - Familiarize yourself with diverse neighborhoods - Attend professional development and training classes

identifying common ground

If group members are expressing contrasting opinions and losing sight of the common goal "We appear to have very different opinions about this matter. I would like to summarize the differences... However, we seem to agree on ... Is this accurate?"

Summary of Behavior Change Attributes

Making a decision to change one's diet is guided by a complex interaction of psychological and environmental factors. Nutrition professionals must use their professional judgment regarding selection of an intervention. A health professional can use an eclectic approach merging the most useful ideas from various models.

level 3 generalization

Includes some form of explanation, prediction, or interpretation- Ex: An individual's intake of dietary fats may predict serum triglyceride levels.

Additional social factors found to limit utilization of available health care services include the following:

Inconvenient location, Unawareness of services, Feelings of discomfort with providers, Health provider attitudes, Lack of translators, Long waiting lines

Consciousness Raising (Learn the facts) description and examples

Increase awareness of the causes, Experiential Processes (Learn the facts) consequences, and available treatments regarding a problem to help the client formulate a decision to make a change. Increase understanding through nutrition education, observations, and personal feedback about the behavior.

DIETARY ASSESSMENT: STEP 3— INTERPRETATION OF ANALYSIS

Interpretation involves comparing the data analysis to a standard. The most commonly used standards include the following: MyPlate: a nutrition guide published by the UDSA Dietary Reference Intakes (DRIs) Dietary Approaches to Stop Hypertension (DASH) Eating Well with Canada's Food Guide eaTracler: a consumer-focused program created by Dietitians of Canada with options to log food and exercise, plan meals, analyze recipes, evaluate nutrient intake, and track progress

Self-Reevaluation (Create a new self- image) description and examples

Involves emotional (feeling) and cognitive (reasoning) self-appraisal of how a healthy behavior fits into an individual's self-image Values clarification activities, healthy role models, or imagery can encourage reassessment of a desired image.

behavior chain negative consequence example

Juanita comes home from work hungry. She walks into the kitchen to fix dinner. There is a bag of her favorite potato chips on the counter (antecedent). Juanita tells herself she will eat just a few and opens the bag, leaving it on the counter as she prepares dinner. She ends up eating the whole bag of chips (behavior). When dinner is ready, Juanita picks at her food because she is not hungry. She is frustrated because she knows a bag of potato chips is not nutritious and she is not getting enough vegetables and fiber in her diet (consequence).

This taxonomy of 3 domains of learning has different shorthand versions of the three categories, including:

KSA(knowledge-Skills-Attitude) Do-Think-Feel

Behavioral capacity definition and implications for interventions

Knowledge and skill to perform a given behavior • Provide comprehensive education, such as cooking classes • Show clients how to properly shop to meet their personal nutritional goals

Overview of Relapse Prevention

Marlatt's relapse prevention model The premise is to ascertain which factors are threats for relapsing and then to develop cognitive and behavioral strategies to prevent or limit relapse episodes. There are two major categories of factors: 1) immediate determinants and 2) covert antecedents.

People who are minorities are disproportionally impacted by the following barriers to health:

Lower levels of income, employment, and education, Reduced access to transportation and quality health care, Poorer housing, unsafe neighborhoods, and food deserts (areas where nutritious food is expensive or unavailable), Fewer opportunities to engage in health-promoting behaviors

level 2 generalization

Makes comparisons or shows relationships- Ex: Cancer risk may be affected by encironmental exposure to toxins.

Materialism

Many people around the world believe that materialism dominates the worldview of Americans, that is, the need to acquire the latest and best possessions. This may have contributed to the popularity of "supersize food portions."

intervention strategies for adolescents

Motivational Interviewing (MI): encourages critical thinking skills, which are thought to be important for adolescent interventions Use of behavioral strategies: useful strategies include development of decision-making skills, self- regulation and self-evaluation, personal action plans, and goal setting. Multicomponent, school-based interventions: school-based interventions incorporating multiple strategies have been shown to be successful for this age group. Collaborative approach

closed groups

No new members after 1st or 2nd session 8-12 members allow for good bonding and elicits behavior change

Goal setting is a key strategy that is incorporated into the following models and theories:

Nutrition Care Process (comprehensive model developed to standardize the process of nutrition care delivery) Social Cognitive Theory Motivational Interviewing Cognitive Behavioral Theory

intervention strategies for older adults

Nutrition education messages should address physical, emotional, and social needs of older adults: - Keep message content clear and direct with practical dietary applications, such as "eat green leafy vegetables every day." - Use visuals and nutrition education materials that are clearly visible and easy to read. - Engage audiences in discussion and respect older adults' knowledge and prior experiences. Be a good listener as well as an effective facilitator of discussion. - Use action-oriented activities to stimulate older adults' attention and motivation for learning. - Consider using mobile applications for tech-savvy individuals. Wearable technology has been used successfully with older adults aged 55-79 years

What settings are relevant for nutrition education?

Nutrition interventions have occurred in public, government, and commercial settings. Possible locations for nutrition interventions include the consumer marketplace, communities, health care settings, worksites, and schools.

verbs with objectives

Objectives should contain behavioral verbs such as: Identify, recite, differentiate, classify, construct, write, compare These verbs reflect behaviors that can be observed, measures, and evaluated.

PARAPHRASING

Paraphrasing responses are a rephrasing of what the client said and meant— can summarize prior statements or several statements of a conversation. Use paraphrasing to let clients know you are listening, encourage them to continue talking, and assist them in clarifying concerns to themselves and the counselor.

Self-regulation (control) definition and implications for interventions

Personal regulation of goal-directed behavior or performance -Provide opportunities for decision-making, self-monitoring, goal setting, problem solving, and self-reward -Stimulus control

mirroring

Parroting or mirroring responses repeat back to a client exactly what was said or with few words changed

cultural incapacity

Paternalistic attitude toward the "unfortunates." No capacity to help. Cultural differences are neither punished nor supported The individual or organization chooses to ignore differences There is no attention, time, teaching, or resources devoted to understanding and supporting cultural differences

use of facility records

Patient knowledge, dietary behavior, biochemical profiles, types of medications, compliance issues with med or diet recommendations

Factors to explore with client when developing the action plan

Physical environment Social support Client's cognitive environment Does client need to replace negative self-talk with positive self-talk? Does a goal need to be modified or deleted from plan? What tracking technique will be effective for the client? Have client verbalize goal Write down goal for client

what should you do in a group setting if a patient is a griper ("All this is useless")

Point out that we can't change policy here and that we must operate as best we can under the system. Say you'll discuss problems with person privately later. Ask group, "How do the rest of you feel?"

Preparation

Preparers have identified a strong motivator, believe the advantages outweigh the disadvantages of changing, and are committed to take action in the near future (within the next 30 days). They may have taken small steps to prepare for a change (e.g., making an appointment with a nutrition counselor).

Benefits of Theoretical Behavior Change Theories and Models

Present a road map for understanding health behaviors Highlight variables (for example, knowledge, skills) to target in an intervention Supply rationale for designing nutrition interventions that will influence knowledge, attitudes, and behavior Guide process for eliciting behavior change Provide tools and strategies to facilitate behavior change Provide outcome measures to assess effectiveness of interventions

Counseling Checklists (Interview Guides)

Previously prepared counseling guides can be reviewed to assess whether all planned counseling interventions were addressed.

review of published data

Prior research, census data, statewide morbidity rates

How do you end a counseling relationship?

Provide time for transition Final session ⚫ Review progress the client has made ⚫ Highlight the client's successes ⚫ Summarize client's current status ⚫ Discuss how behavior changes will be maintained long-term ⚫ Offer follow-up meetings ⚫ Provide and elicit feedback Follow-up with post-treatment evaluation Document client outcomes Self-assess your skills

four P's of marketing

Product, Price, Place, Promotion

interview with key informants

Professionals that work with the target population (employers, teachers, clergy)

Promotion

Promotion is an integral part of the marketing mix. It focuses on strategies to convey the message to persuade the target audience. Promotional strategies generally integrate the other Ps, such as defining the product, emphasizing the benefits, and distributing in appropriate places. Promotional messages need to match the "target population preferences and information processing styles." There are a variety of styles to choose from including emotional or rational appeals, use of humor, and social value emphasis, to name a few. The objective is to create and sustain demand for the product. Promotion can involve various methods of communication, including the following: - Advertising - Public relations - Promotions - Media advocacy - Special events - Entertainment

Cultural Competence Models

Provide a framework for program and curriculum development as well as assessment

open ended questions

Provide the client with freedom to answer and encourage elaboration. This question type is generally preferable; it is non- threatening and communicates interest and trust. However, open-ended questions may lead to rambling, lengthy answers.

Techniques to Improve Positive Feelings and Problem-Solving Abilities

Relaxation training and therapy Mental imagery Thought stopping Meditation Biofeedback Stress management Social support Cognitive restructuring Systematic desensitization

individualization of therapy

Remember to include your clients diet preferences so that they can succeed!

COUNTERING

Replace problem behavior with an appropriate substitution

Counter Conditioning (Use substitutes) description and examples

Replace unhealthy behaviors with healthier alternatives. Relaxation techniques can offset stress, advocacy can counter peer pressure, and positive self-statements can replace demoralizing self-talk.

Designing Theory-Based Interventions

Researchers have documented that a major short-coming of early nutrition education studies was the failure to base research on theoretical models. - theory-driven intervention - theory-informed intervention - grounded theory intervention

STOP technique

S = Specify the problem T = Think of options O = Opt for the best solution P = Put the solution into action

ALLOWING SILENCE

Silence can provide clients with space for internal reflection and self-analysis. Effective silent periods could last about 30 to 60 seconds. The counselor should not always feel compelled to break a silence; you may want to challenge your client to formulate a response.

EFFECTIVE COMMUNICATION FOR SPECIAL POPULATIONS: LGBTQ+

Sexual Orientation Gender Identity Difficult to quantify the numbers of LGBTQ individuals in the US. Lack of historical surveys. Fear of safety and discrimination could cause a person not to give a truthful answer. ~5-10% of the general population (National LGBTQ Task Force Policy Institute)

Why questions

Should generally be avoided because they often sound judgmental, put clients on the defensive, and seem to require an excuse

Interpersonal communication for cross-cultural experiences

Smile, show warmth, and be friendly Learn and use keywords Articulate clearly and speak at a normal volume Limited English-Speaking proficiency does not = Limited Intelligence If you believe something you are doing is causing a problem, ask

purse strings

Social marketing interventions can seek funding from a variety of sources such as foundations, strings donations, and governmental grants.

publics

Social marketing programs include both external and internal groups. Examples of the external publics are the target audience itself, family members, physicians, or even policymakers and media professionals. Internal publics refer to those involved in approval or implementation of the social marketing program, including staff members and supervisors.

What does SMART goals stand for?

Specific, Measurable, Attainable, Rewarding, Timely

objectives

Specifically stated descriptions of what the learner will be able to do after participating in the learning experience.

four stages for writing ICIC communications

Stage 1: Complete ASOAP Analysis Stage 2: Outline and Collect Resources Stage 3: Write Your First Draft Stage 4: Polish Your Paper

quantitative research

Standardized surveys, experiments, census, or epidemiological data

ground rules for group meetings

Start and end meetings on time Listen to and show respect for the opinions of others Attend all meetings and be on time Be willing to share with the group Look for value in every idea Follow the agenda- stay on track Adhere to rules of confidentiality Refrain from engaging in side conversations Turn off cell phone

Some Ways to Note a Discrepancy

State observation without but (a softer approach) State observation with but (a harder approach) Use "on one hand . . .; on the other hand, . . ." expression. Tentatively name the discrepancy (with seems, appears, could there be, have a feeling) Directly name it ("I see an inconsistency"; "I'm hearing two things at once")

what are the three steps for dietary assessment

Step 1: Food Intake Data Collection (Client Assessment Questionnaire, food diary and daily food record, usual diet, diet history interview, food frequency, and 24-hour recall) Step 2: Data Analysis Step 3: Interpretation of Analysis

Stress Management:The RDs role in nutrition counseling

Stress is a normal part of life and can serve as a positive force or motivator, but too much stress can harm health and impair attempts to make lifestyle changes. Stress is shown to be a major predictor of relapse, overeating, and dysfunctional eating patterns and is linked to six leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide. Because food is often used to provide nurturing and stress reduction, finding alternative methods of coping with stress is important.

Angle

The needs assessment will help reveal motivating factors for your target audience. Tapping into motivating factors is shown to increase attention and integration of reading about nutrition information.

Audience

The needs assessment will provide information about your target audience's demographic profile (e.g., age, gender, ethnicity, socioeconomic status) and psychographic profile (e.g., lifestyle, goals, values, beliefs, biases). Consider what your target audience needs to know, what they want to know, and what type of message is likely to inspire them.

Evoking Change Talk

The objective of change talk is to resolve ambivalence by providing opportunities and encouragement for the client to make arguments for change. Guide the counseling session to allow your clients to explore perceptions and see a discrepancy between their current behavior and their values, beliefs, and concerns. As change talk strengthens, commitment increases, as well as the likelihood of behavior change.

The Influence of Social Network on Behavior Change

The social environment can help or hinder behavior change efforts. Social context is a component of several behavior change theories The act of eating is often a social activity, either as an element of daily life or an integral part of special events. Social factors influence the availability, procurement, selection, and preparation of food.

Product

The social marketing product is not necessarily a physical offering. The product can represent a continuum of tangible products (food stamps), services (nutrition counseling), and practices (eating a plant-based diet) or more intangible products (school food policy). To market a viable product, members of a target audience must realize they have a genuine risk or problem and believe that the product is a feasible solution. Having a product that is both attractive and appealing to the target group increases effectiveness of the intervention. Efforts are placed on finding a niche for the product and identifying benefits so the product is perceived as more appealing than the competition. The product should address the question, "What's in it for me?"

Only offer advice when the following criteria are met:

There is a clear understanding of the problem. Previous attempts to deal with the difficulty have been investigated. You have definite ideas for possible solutions.

DIETARY ASSESSMENT: CULTURALLY APPROPRIATE ASSESSMENT INSTRUMENTS

There is a critical need for the development of culturally specific techniques and tools to conduct nutritional assessments. If there are communication difficulties or cultural feelings about invasiveness, a qualitative rather than a quantitative approach may yield more success. To establish trust during the first session, consider using the "typical day" technique or the diet history interview data collection method. These approaches eliminate the need to differentiate meals or categorize food items. A request for additional information (e.g., frequency and portion size) could be delayed until the next meeting.

Subject

Thoroughly research the subject matter. Identify reliable resources, and be sure to ask a colleague familiar with the topic to review your draft.

Culturally Sensitive Health Care for LGBTQ People

To provide culturally competent care for LGBTQ individuals, health professionals need to be knowledgeable about: - the various factors that affect their health status (e.g., discrimination) - health disparities that plague LGBTQ people - how to create a welcoming environment for quality care Nutrition professionals need to be aware of particular nutritional issues for LGBTQ people

Nutrition Education

Transfer of nutrition knowledge from practitioner to patient and/or client through the use of various educational formats including verbal and written materials Education targets needs of a community

Tips for Parroting/Mirroring

Use this response to let the client know you are listening and encourage the person to keep talking and exploring. Take care not to overdo this response, or else your client is likely to talk less. Consider echoing back a key word or key words, especially if your client has used the word repeatedly or if you want further clarification of the word.

tracking

Various lines of thought are tracked and summarized "So I'm hearing X, Y, and Z. Do I have this right?"

Tools to increase self-efficacy

Videos Lay counselors Written testimonials Success stories Counseling buddies Role playing

ENCOURAGEMENT

Ways to provide encouragement Email Cards Notes Voice mail Personalized signs Recorded tapes

CONTRACTING

Written agreement between a counselor and client documenting intended behavior change and specific SMART goals. Clients should define their intended behavior change for the contract. The counselor should never impose a goal.

what should you do in a group setting if a patient is silent

Your action will depend on what you believe is motivating the participant. Use eye contact to encourage participation Ask for their opinion " I do not want to miss what you have to say. What do you think about this?" Break into small groups

Motivational interviewing (MI)

a counseling approach that integrates client-centered counseling and complements the Transtheoretical Model (TTM). Miller and Rollnick, founders of MI, provide the following definition: "a collaborative conversation style for strengthening a person's own motivation and commitment to change". Motivation is viewed as a state of readiness to change that can be altered and influenced by others. MI focuses on strategies that help motivate clients to change and move toward the action stage. MI is particularly useful in the early stages of behavior change, when there is a great deal of ambivalence about making a decision to change. Motivation can come from coerced external forces ("Lose weight or you can't be in my wedding") or intrinsic (internal) factors tied to specific values ("I want to be a good role model for my children"). MI works to cultivate a client's natural motivation for change (intrinsic).

proficiency

a high level of expertise in a skill; the counselor can perform and modify the skill under varying conditions

reaction to a lapse

a lapse is a momentary indulgence or return to prior behavior that increases the likelihood of a full-blown relapse, but the progression is not inevitable. The client's view of the slip is an important predictor of a relapse. If the lapse is considered a personal failure, the probability of a relapse increases. If the slip is viewed as a learning experience for developing more effective strategies, relapse is less likely to occur.

Consensus

a method for making group decisions by encouraging members to share their thoughts, feelings, and suggestions To develop a sustainable agreement, lead the group through four stages: "gathering diverse points of view, building a shared framework of understanding, developing inclusive solutions, and reaching closure."

Mindful Eating

a method that encourages individuals to use their inner wisdom to find joy in the preparation and consumption of food Mindfulness has roots in Buddhist and other contemplative traditions and is defined as "paying attention in a particular way, on purpose, in the present moment, and nonjudgmentally." Without awareness, clients are more likely to behave compulsively or automatically and may not be acting in their best interests. Advocates of mindful eating encourage replacing mindless eating with conscious awareness, allowing individuals to recognize the pleasures of the eating experience. Mindfulness permits attentiveness to feelings of hunger and fullness and helps bring a balanced approach to eating.

apparently irrelevant decisions (AIDs)

a series of seemingly harmless decisions can lead to arelapse. Example: buying a bag of potato chips for the "children" or a bag of cookies "in case guests stop by" creates conditions that can bring the client to the brink of a relapse.

Pair-Share

a strategy that provides an opportunity for participants to discuss their thoughts and feelings about a topic with another individual. When the topic is opened up for general discussion, the comments are likely to be more concisely and coherently formulated after sharing with small groups

To bring closure to a group session, provide __ that emphasizes key topics as well as problems, solutions, and change talk discussions.

a summary

cognitive-behavioral therapy (CBT)

behaviorislearned, and by altering the environment or internal factors, new behavior patterns develop includes a wide range of treatment approaches consists of cognitive therapies and behavioral therapies

Inequalities exist with health disparities in regard to ___

access to healthcare, delivery of quality healthcare as well as health outcomes.

The Theory of Planned Behavior (TPB)

an individual's health behavior is directly influenced by intention to engage in that behavior.

Be aware that certain __ will have a strong impact on health-related attitudes and behavior

beliefs, values, and cultural practices

telenutrition

as defined by the Academy of Nutrition and Dietetics, "the interactive use, by a RDN, of electronic information and telecommunications technologies to implement the Nutrition Care Process (nutrition assessment, nutrition diagnosis, nutrition intervention/plan of care, and nutrition monitoring and evaluation) with patients or clients at a remote location, within the provisions of their state licensure as applicable."

Typical Day Strategy

ask your clients to take about 5-10 minutes to describe a typical day and explain how their health issue (for example, diabetes) and their food needs are affecting their life.

scope of practice entails what domains?

resources, foundational, credentials, education, and management/advancement

ABCs of Objectives

audience, behavior, and condition

Nutrition Education Approaches During Counseling

avoid technical jargon simplify directions incorporate self-help materials repeat important points several times limit the number of learning objectives per session organize material in a logical manner check for understanding incorporate significant others utilize visuals provide meaningful support materials disperse information over a period of time use stories, examples, personal accounts, and comparisons

Synchrony

body language harmony between two people. Harmonize nonverbal behaviors with your client's expressive state so that the client feels "in sync" and comfortable. Mirror and match a client's body language to build rapport.

If your client is from a different culture than your own, learn about and explore that culture through means such as

books, newspapers, and magazines, workshops, movies, cultural encounters in markets, fairs, and restaurants

Strategies to minimize the occurrence of high-risk situations

by minimizing exposure to stressors, the likelihood of encountering high-risk situations declines. Examples of these strategies include the following: Removing foods that are to be avoided from the home, Sitting in a different chair at the dining table, Taking a new route to work to avoid passing a particular bakery

When exploring ambivalence, the client's responses usually fall into two categories:

change talk and sustain talk

Level 2: Unsure (low confidence)

clients in this category indicated that a diet change is possible. They know the problem exists, but something is needed to push the decisional balance in favor of making a change. Major goal: build client's confidence in ability to make a diet change Major task: explore and resolve ambivalence

clubs/organizations

clients may obtain direct or indirect support by taking part in organizations compatible with their lifestyle goals. Examples: joining a walking club, gym, dance troop, or vegetarian society

Urge management techniques

clients should prepare for urges to return to previous eating styles. Strategies to handle urges and cravings include the following: ⚫ Contract to consume only a certain amount of the food causing urges and cravings. ⚫ Plan for a response when the urge arises. Example: clients can tell themselves that they can have the piece of cake after drinking a glass of water or eating an apple. Often the urge to eat the undesirable food has passed by the time the water or apple is consumed. ⚫ Plan for a nonfood countering activity (e.g., relaxation response, knitting, jumping). ⚫ Use an image technique called urge surfing. In this method, the client visualizes the urge or craving as a wave that crests and then washes onto a beach. Clients are told to imagine riding the wave on a surfboard rather than struggling against it or giving in to the want.

Legitimation (Normalization)

communicates acceptance and validation of the client's emotional experience and reactions.

summative evaluations

conducted at the conclusion of a program or learning activity to assess outcomes. often involve quantitative assessment, including: - performance tests - observations - surveys - biochemical and anthropometric measurements - self-assessment tools help program managers determine whether a nutrition education program actually accomplished what it was designed to do.

summarize in closing a group session

consider requesting members of the group to contribute to the summary What has made the greatest impact on you from the time we have spent together today? What strategies have you learned here that you can picture using?

Organizational strategies

consider the organization and flow of the meeting to devise useful strategies for decision making and problem solving.

Cultural Competence Continuum

consists of a hierarchy of needs, starting with the lowest of cultural destructiveness, cultural incapacity, cultural blindness, cultural pre-competence, cultural competence, and cultural proficiency

NCP: Nutrition Education Domain is divided into two categories:

content and application

The National Partnership for Action to End Health Disparities identified five priorities to address health determinants. One key priority is to improve the following:

cultural and linguistic competency of health professionals diversity of the health care workforce

The Academy of Nutrition and Dietetics and the Accreditation Council for Education in Nutrition and Dietetics (ACEND) has integrated diversity requirements into numerous components of the organization, including: ___

curriculum requirements diversity philosophy statement code of ethics strategic planning member resources

five steps of the message development model

define the issue, develop initial message concepts, assess message concepts, fine-tune message, and validate message

telehealth

defined by the Department of Health and Human Services (HHS) as "the use of electronic information and telecommunications technologies to support remote clinical health care, patient and professional health-related education, public health and health administration."

The Haney and Leibsohn model

defines nutrition counseling as "an interaction in which the counselor focuses on client experience, client feeling, client thought, and client behavior with intentional responses to acknowledge, to explore, or to challenge."

follow up with closing a group counseling session

depending on the composition and purpose of the meeting, there may be a need to perform follow-up activities.

EFFECTIVE COMMUNICATION FOR SPECIAL POPULATIONS: Pre-school children aged 2-5 years

family, culture, media, and illness or diseases have a major impact on young children's eating habits and nutritional health. learning is accomplished by exploring the environment rather than passive listening (touch, color, shape, function, observing, modeling, role-playing, role modeling) government survey reports indicate a need for young children to improve their diets. (deficient in iron, zinc, and calcium)

EFFECTIVE COMMUNICATION FOR SPECIAL POPULATIONS: middle childhood aged 6 to 12

family, school, and screen time (about 8 hours per day) are major factors related to food behavior for this age group. middle childhood is marked by major cognitive, social, and physical development. (food influences and how food affects health) national surveys indicate that the diets of children 6 to 11 years of age are worse than children 2 to 5 years old (increase consumption of whole fruits, whole grains, dark green and orange veggies, and legumes) certain dietary aspects need to be reduced (decrease saturated fats, sodium, and extra calories fro fats and sugars)

What are the three steps when completing a dietary evaluation?

food intake data collection data analysis interpretation of analysis

collaborative approach

for treatment of eating disorders, nutritionists should collaborate with psychologists and medical specialists.

roadblocks

frequently made with good intentions and are not meant to impede communication. Though they can be used effectively in counseling, they are often used too soon or too often.

Regardless of the predominant theory or behavior change model used, the relationship between counselor and client is the __.

guiding force for change

behavior chain

had negative consequences and positive consequences

Identification of high-risk situations

help the client identify conditions that precede a lapse to anticipate and prepare for high-risk situations. Identify signs such as stress or apparently irrelevant decisions.

Client-Centered Counseling

humans are basically rational, socialized, and realistic, and there is an inherent tendency to strive toward growth, self-actualization, and self-direction. People realize their potential for growth in an environment of unconditional positive self- regard. Counselors help develop an environment of unconditional positive regard by totally accepting clients without passing judgments on their thoughts, behavior, or physique. This approach means respecting clients regardless of whether they have followed medical and counseling advice. Total acceptance needs to be communicated both verbally and nonverbally for a level of trust to develop in which clients feel comfortable to express their thoughts freely. Clients discover within themselves the capacity to use the relationship to change and grow, thereby promoting wellness and independence.

Level 3: Motivated/confident/ready

indicated readiness to make a lifestyle change. The nutrition counselor serves as a resource person who increases awareness of possible alternatives for solving problems. Major goal: develop an action plan Major task: collaborate with client to select lifestyle changes to alter, clarify goals, and tailor intervention strategies to achieve goals. If possible, past successes should be used to find viable solutions.

SUPPORTING SELF-MANAGEMENT

individualization of therapy length and frequency of counseling sessions perception of quality care

active listening

interrelated with attending; essential for the development of rapport and the communication of empathy. openness, concentration, and comprehension inattentive counselors may focus on problems and issues important to themselves rather than those of concern to the client

Advice

involves providing possible solutions for problems

grounded theory intervention

involves the use and application of qualitative data derived from the target audience to guide the design of an intervention. Grounded theory is a research method underscoring the generation of theory from qualitative data analysis.

Comprehensive reviews of nutrition education research reveal __

key factors contributing to effective nutrition education interventions.

how to know your audience and conduct a needs assessment

know needs assessment categories and developmental needs of adults

Characteristics of Effective Counselors

knowledge self-awareness ethical integrity congruence honesty genuine communicate clearly gender/cultural awareness humor flexibility optimistic hopeful respect others value others care about others trust others empathetic

Ethnocentric

lacking cultural awareness, believing a particular cultural view is best and devaluing alternative views

Minority health care professionals are more likely to work in ___

medically underserved communities.

cognitive

mental skills (knowledge or think)

EFFECTIVE COMMUNICATION FOR SPECIAL POPULATIONS: adolescence aged 13-19

multiple interconnecting factors influence eating patterns and food choices for adolescents. greater reliance on school food, vending machines, fast-food restaurants, and convenience stores dramatic physical, cognitive, and psychosocial changes occur during adolescence. Family values and standards are scrutinized and may be rejected in this period. Poor quality diets of adolescents put this age group at risk for cardiovascular disease, cancer, and osteoporosis. National surveys report high intake of saturated fat, total fat, sodium, calories, and soft drinks and inadequate consumption of fruits, vegetables, whole grains, and calcium.Overweight, obesity, smoking, disordered body image, low levels of physical activity, and disordered eating are major issues for this age group.

cultural groups

nonexclusive groups that have a set of values in common

worksites

nutrition education is often a component of corporate wellness programs.

CLIENT ASSESSMENT QUESTIONNAIRE AND HISTORICAL DATA FORM

oDemographic Data oHealth History oDrug History oDiet History oSocioeconomic History oPhysical Activity History oEducation Interests

Evoking

once there is a focus on a particular change, the counselor elicits the client's ideas and feelings about why and how the change can occur. The evoking process includes the following activities: ▫ Assess readiness to change ▫ Explore ambivalence if there is not a clear commitment to change ▫ Evoke language from the client about change

PROVIDE GUIDANCE FOR RECORD KEEPING

provide training, use estimates, set meaningful and achievable goals, provide a variety of record-keeping options, provide nonjudgmental feedback

Social Cognitive Theory

provides a basis for understanding and predicting behavior, explaining the process of learning, and designing behavior change interventions. According to SCT, there is a dynamic interaction of personal factors, behavior, and the environment, with a change in one factor capable of influencing the others (known as reciprocal determinism).

encouraging

provides and opening for all to participate without calling on a particular nonparticipating individual "Has this raised any questions for anyone?"

attitudes

reflection on personal feelings and predisposition to object or behavior

cultural comparisons of communication styles: anglo americans

speak loudly, quickly-control of listener direct eye contact when speaking and listening-prolonged contact rude head nodding, murmering quick response task-oriented, focused direct approach, minimal small talk for urban whites-more indirect for rural whites ask direct questions firm handshake, smile moderate touching low- to medium- high context monochronistic

cultural comparisons of communication styles: native americans

speak slowly and softly indirect gaze when speaking and listening seldom make responses to indicate active listening or to encourage continuation-rarely interject delayed auditory (silence valued) expression restrained indirect approach-stories about others may be metaphors for self rarely ask questions-yes or no answer considered complete quick handshake, smile minimal touching very high context use of pictures, graphs, charts important polychronistic

cultural comparisons of communication styles: middle easterners

speak softly direct gaze between members of the same sex-women may avert their eyes with men facial gestures express responses mild auditory delay expressive, emotional indirect approach will ask polite questions numerous greetings, salaam-may or may not exchange soft handshake, smile touching common between members of same gender-stand and sit closer than whites high-context use of pictures, graphs, charts useful polychronistic

cultural comparisons of communication styles: asians

speak softly, avert eyes as sign of respect, head nodding may indicate active listening - rarely interject, delayed auditory (silence valued) polite, restrained, articulation of feelings considered immature indirect approach (Japanese) direct approach (Chinese, Koreans) rarely ask questions may or may not exchange soft handshake non-touching culture-stand and sit farther away than majority whites very high context use of pictures, graphs, charts important polychronistic-punctual

cultural comparisons of communication styles: latinos

speak softly-may perceive normal white voice as yelling direct eye contact between members of the same sex-may seem to stare-aversion seen as insult, though women may avert eyes with men seldom make responses to indicate active listening or to encourage continuation-rarely interject mild auditory delay men restrained, women expressive but not emotional indirect approach will ask questions when encouraged firm handshake among men, soft handshake with women touching common-stand and sit closer than majority whites moderately high context polychronistic

personal support

statements that show you are here to help clients address problems and use available strategies Statements should be honest and establish trust. Example of a supportive statement: "There are many dietary options and strategies available to get your diabetes under control. I look forward to working with you to make that happen."

partnership

successful interventions begin with establishing a collaborative relationship with your client. The client and counselor should respect each other and work together to find solutions. Example of a partnership statement: "I want us to work together to find and implement strategies that will work for you."

summaries

summarize periodically throughout an MI session to help organize thoughts, reinforce change talk, clarify discrepancies, provide links during the session, or transition to a new topic.

closing a group session

summarize, evaluation, follow-up

The facilitator's role is to __ the group to accomplish a task and stay __.

support; focused

social marketing

systematic planning model involving client-centered methods to facilitate positive changes in behaviors, values, and attitudes of target audiences and their society.

sustain talk

talking ourselves into continuing the current behavior; indicates that change is unlikely to occur. The client expresses a desire, ability, reason, or need to keep performing the undesirable behavior.

The development of program strategies always begins with __, reflecting a "bottom-up" approach to program design.

target audience members

Nutrition counseling requires __ skills.

technical, social, and conceptual

differential attention

technique that involves giving positive reinforcement for desired behavior (e.g., choosing a nutritious snack) and ignoring undesirable behavior (e.g., a complaint about television restriction).

Change roles

tell your client that you are going to change roles, and ask the client to convince you to make the contemplated behavior change. Gradually allow the client to persuade you.

DIRECTING

tells a client exactly what needs to be done. important educational component of nutrition counseling. Example: a counselor explains to a client with a liver or kidney condition how to calculate fluid intake When giving directives, be clear and concise. To ensure a directive has been accurately communicated, consider asking the client to repeat back the instructions.

Elicit client's ideas for change: __

the client may clearly identify a behavior change to tackle during the assessment interview.

coping skills

the client's coping skills determine whether a high-risk situation will result in a relapse.

SELF-REFERENT

the counselor shifts the focus on himself or herself in support of the client and the therapeutic relationship. provides information about the counselor that is generally related to coping experiences. Example: a counselor could explain how she herself incorporates exercise into her busy schedule. Self-involving responses actively incorporate a counselor's feelings and emotions into a session. These responses can be used to provide feedback or to sensitively confront.

urges/cravings

the desire for immediate gratification can take the forms of urges (sudden impulses to indulge) or cravings (subjective desires to experience the effects of an indulgence).

motivation

the desire to learn

theory-driven intervention

theory elements that are systematically used to design, implement and evaluate the intervention.

Clients need to believe that __. If individuals perceive __, their discomfort may shift to defensive thinking, like denial, rationalization, or projection

there are workable options that make change possible; there is no solution

Corners

this strategy tends to work well with a group when there are distinct tasks that need to be addressed. Participants are allowed to choose their task.

Affirmations

this technique recognizes client efforts and strengths and provides another source of motivation. Pointing out a job well done or persistence in the face of numerous obstacles reminds clients that they possess inner qualities that make behavior change possible. Affirmations should focus on specific behaviors, avoid use of the word I, and highlight non-problem areas. Affirmations can come from your clients by asking them to describe their strengths, past successes, and best efforts.

Empathy

true understanding of another's perspective and experience without judging, criticizing, or blaming should be communicated both verbally and nonverbally to create a supportive environment that is conducive to growth and finding solutions. requires the ability to hear and sense the experiential world of that person.

empathy

understand what people feel from their frame of reference

Social marketing interventions

use commercial marketing strategies to benefit the target audience or society.

cues to action

use relevant and effective cues or stimuli to prompt action

Alternative medicine

used instead of conventional medicine

Complementary interventions

used together with conventional treatments

what are the key components of counseling communication skills?

using focuses and intents, using effective nonverbal behavior, harmonize verbal and nonverbal behaviors, analyze nonverbal behavior of client, and understand communication roadblocks

Self-efficacy is a basic component of behavior change that has been __

widely accepted and incorporated into behavior change models.

Major objective of goal setting: __

work in partnership with your client to develop an action plan.

Generalizations

written as complete statements, representing universal truths that the learners will need to grasp and comprehend for an effective intervention.

EXPLORATION-EDUCATION STAGE

• Address health risks EXPLORATION-EDUCATION STAGE • Collect information for assessment • Consider "typical day strategy" if time permits • Give non-judgmental feedback • Summarize to determine what's next • Assess readiness to change

Questions to aid understanding of food habits and to assist in completing a nutritional assessment

• Can what you eat help cure your sickness? Or make it worse? • Do you avoid certain foods to prevent sickness? • Are there foods you won't eat? Why? • What kinds of foods have you been eating?

Detailed Menus and Meal Plans advantages and disadvantages

• Clearly defined • Useful for someone who expresses a need for structure • Useful for someone who has complex dietary requirements who is not ready or not capable of following a food group plan -Does not allow for spontaneous events -Food items needed for the plan may not be available -May be difficult to design to complement a client's lifestyle

INVOLVING STAGE

• Greeting • Establish comfort • Small talk • Ask an open-ended question • Identify long-term goal(s) • Explain program and counseling session • Discuss weight monitoring, if applicable • Set the agenda for the session • Transition to the next phase

food lists for weight management advantages and disadvantages

• Offers choices • Provides structure • Allows for variety • Meal pattern is individualized • May be too complex for some individuals

communication don'ts

• Pretend to understand • Always assume that you are being understood • Rush or raise your voice • Laugh at misused words or phrases • Use idioms or slang ("keep an eye out for swelling", "Get over it", "Hit the nail on the head", "Icing on the cake") • Assume that using first names is appropriate • Assume that limited language proficiency means limited intelligence

steps to take for level 2 clients

• Raise awareness of benefits of change • Ask open ended questions to explore confidence and promote change talk • Explore ambivalence • Have client imagine the future • Explore past successes • Encourage support networks • Summarize • Choose a goal, if appropriate

how to collect info from assessment

• Refrain from firing a series of questions to gain information, encourage discussion • Verbal and Nonverbal behavior should be viewed as curious rather than investigative. • Do not react with advice, criticism, or judgement as this could inhibit disclosure.

Meal replacements advantages and disadvantages

• Simplifies food choices • Reduces exposure to temptation • Portion size is clear • Some may not find taste acceptable • Can interfere with social plans

Counselor Pitfalls

• Telling the client everything will be fine • Questioning competency • Lack of confidence • Assuming role of expert • Assuming role of sympathizer • OVERSHARING

Questions to understand the view and treatment of health problems

• What name do you call your problem? • What do you feel may be causing your problem? • What do you fear about your sickness? • What kind of treatment will work for your illness?

EFFECTIVE EDUCATION STRATEGIES

•Address psychosocial concerns and initiating behavior change strategies before pouring educational content into an "Empty Bucket." •Review Role of client as self-manager and role of counselor as a source of expertise, support, and inspiration. •Elicit client concerns and questions •Discuss client's experiences and understanding of their condition •Identify what the client wants from the counselor. Specific educational topics. •Explore behaviors the client wishes to alter •Present information to address concerns and questions. •Discuss strategies to address the behavioral aspects of the concerns

Solution-Focused Therapy

▫ Counselors work with their clients to concentrate on solutions that have worked in the past and identify strengths to be expanded on and used as resources. ▫ Rather than focusing on discovering and solving problems during sessions, the counselor looks for an exception to the normal course of action (e.g., the one time the client was able to positively cope). ▫ By investigating the accomplishment, no matter how small, the counselor and client can develop adaptive strategies.

Cognitive therapies help clients achieve the following:

▫ Learn to distinguish between thoughts and feelings ▫ Become aware of ways in which their thoughts influence feelings ▫ Critically analyze the validity of their thoughts ▫ Develop skills to interrupt and change harmful thinking

Nutrition Counseling

▫ Provide support and guidance ▫ A process ▫ Guiding client toward healthy lifestyle ▫ Helping client solve problems that are barriers to change ▫ Interventions guided by needs of individual client

disadvantages of self disclosure

▫ Very powerful ▫ Leaves a lasting impression ▫ Shifts focus away from client ▫ May cross professional boundaries

when evoking change talk, encourage clients to:

▫ clarify important goals ▫ vocalize change talk ▫ explore the potential consequences of present behavior

Language (solution-talk) guides solution-focused therapy. The aim is for clients to use solution-oriented language, in which they speak about:

▫ what they can do differently ▫ what resources they possess ▫ what they have done in the past that worked

Perceived benefits example and intervention possibilities

"Eating more salads would be good for my health." Provide role models and testimonials. Imagine the future. Specify action and benefits of the action.

self efficacy example and intervention possibilities

"I am confident that I can prepare low- sodium pasta dishes." Provide skill training and demonstrate behaviors step-by-step. Encourage goal setting and positive reinforcement.

Perceived susceptibility example and intervention possibilities

"I worry about my chances of developing high blood pressure." Educate on disease risk and link to diet; compare to an established standard.

Perceived severity example and intervention possibilities

"Well, I have high blood pressure, but I feel fine." Discuss disease impact on client's physical, economic, social, and family life. Show graphs and give statistics. Clarify consequences.

With the TTM, __ strategies are more likely to meet client needs in the later stages.

Behavioral (action-oriented)

With the TTM, __ strategies tend to be more effective in the early stages

Cognitive (thinking-related) and affective (feeling-related)

Cognitive Therapies

negative self-talk and irrational ideas are self- defeating learned behaviors and the most frequent source of people's emotional problems. Clients are taught that harmful self-monologues should be identified, eliminated, and replaced with productive self-talk. By influencing a person's pattern of thinking, the person's feelings and actions are modified.

Ways to strengthen self-efficacy include

pointing out strengths, relating success stories, expressing optimism for the future

Supernatural Assumptions

Supernatural assumptions include beliefs regarding God, malevolent spirits, ancestors, fate, or luck being the cause of illness. The concept of soul loss causing depression or listlessness is prevalent in many societies. In order to alleviate supernatural problems, societies have devised ceremonies or rituals.

Helping Relationships (Get support) description and examples

Counselors as well as a positive social network can give emotional support during attempts to change a problem behavior. Phone calls, emails, text messages, online support groups, group counseling, and a buddy system can be beneficial.

reciprocal determinism definition and implications for interventions

Dynamic interaction of the person, behavior, and the environment • Consider multiple behavior change strategies • Motivational interviewing • Social support • Behavioral therapy (for example, self-monitoring, stimulus control) • Change environment

Individual and Nature

Not all societies make a clear distinction between human life and nature as in the United States. Some societies believe that we are subjugated by nature and need to show respect for natural forces and attempt to live in harmony with nature. The dominant culture in the United States sees human beings as having higher value than nature with a need to exploit or protect it.

Environmental Reevaluation (Notice effect on others) description and examples

Realizing the impact of an unhealthy behavior on others can encourage change. Empathy training, documentaries, or testimonials can encourage reevaluation of an unhealthy behavior.

The Transtheoretical Model: Self-Efficacy

Research indicates that self-efficacy tends to decrease between the precontemplation and contemplation stages. Individuals in the contemplation stage may begin to realize the challenges of adopting a new behavior, which may be seen as daunting. As individuals progress through the action and maintenance stages, self-efficacy gradually increases.

Maintenance

The client has been engaging in the new behavior for more than 6 months and is consolidating the gains attained during previous stages. The new behavior has become a habit, and the client is confident that the behavior will persist. The client needs to work to modify the environment to maintain the changed behavior and prevent a relapse.

precontemplation

The client has no intention of changing within the next 6 months and resists any efforts to modify the problem behavior.

operant conditioning

based on the law of effect, which states that behaviors can be changed by their positive or negative effect

Understanding your personality and culture will help you __. All of these aspects can influence the counseling process

determine your attitudes and values, which qualities you want to modify, and how you view yourself

The Transtheoretical Model (TTM)

developed by Prochaska and DiClemente, this model describes behavior change as a process of passing through a sequence of distinct motivational stages (i.e., levels of readiness to take action). TTM has been used as a guide for • explaining how behavior change occurs • supplying effective intervention designs and strategies • evaluating dietary change interventions

Reflective listening

entails using basic listening skills, interpreting the heart of your client's message, and reflecting the interpretation back to your client. Reflective listening shows interest and expresses empathy, creating an environment for self-exploration about the challenges of making a behavior change. Act "as a mirror," reflecting back your understanding of the client's intent or your interpretation of the underlying meaning. This practice encourages clients to keep talking.

classical conditioning

focuses on antecedents (stimuli, cues) that affect food behavior

Behavioral Therapy

many behaviors are learned, so it is possible to learn new ones. The focus is not on maintaining willpower but on creating an environment conducive to acquiring new behaviors.