Welcome
Minnesota WIC Program
Participant-Centered Skills Training
Bernadette Landers, MPA, RD, IBCLC
Senior Associate
Karen Deehy, MS, RD
Senior Associate
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Participant-Centered Communication Skills
▲ Uncover participants own inner motivations for adopting
healthy behaviors
▲ Help participants feel confident in their abilities and in their
role as parents
▲ Promote participant autonomy – what they change is up to
them
▲ Actively involve participants in goal setting and problem
solving
▲ Share information and strategies to help participants
achieve their goals
▲ Invest in relationships to build rapport, trust and connection
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Think of something about yourself that you
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
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Want to change
Need to change
Should change
Have been thinking about changing
…but haven’t changed yet
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Ambivalence and the Righting Reflex
▲ Most people that want to change are ambivalent
▲ When we advocate for change – the natural human instinct
is to offer the other side of the argument
▲ People are driven to change based on what they
themselves say
▲ The more participants talk about the disadvantages to
change, the more committed they are to stay the same
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The Paradox of Change:
When a person feels accepted for
who they are and what they do –
no matter how unhealthy – it allows
them the freedom to consider
change rather than needing to
defend against it!
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Experience “Not PCS”
 Ask what the change goal is
 Ask why they haven’t done it
 Explain why the person should make this change
 Tell them the specific benefits that would result from
making the change
 Tell the person how they should make the change
 Emphasize how important it is to change
If you meet resistance, repeat the above
No reflective listening! This is not participant-centered.
Activity courtesy of MINT
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Most Important Communication Skill
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Mining for Gold
Change Talk
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Change Talk
▲ Any talk that favors movement toward change
▲ Goal is to encourage change talk and reinforce it
– Small achievable changes
▲ The more they talk about change, the more likely they
are to do it – break the cycle of ambivalence
– We are convinced by what we say
▲ What does change talk sound like?
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Different Types of Change Talk
DANCR STEPS
▲ DESIRE:
I wish; I want to; I would like to
▲ ABILITY:
I can; I could; I am able to
▲ NEED:
I need to; I can’t keep doing this; I must;
It is important
▲ COMMITMENT: I am ready to; I am going to
▲ REASONS: There are good reasons to
▲ TAKING STEPS
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Activity…Drumming for Change
Activity courtesy of MINT
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Is this person ready for change?
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Open-Ended Questions
▲When to use OEQ:
– To evoke change talk
– To explore reasons for change
– To identify barriers
– To set goals and make plans
▲ When not to use them?
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Driving Action …Motivation
Motivation is the meeting of :
 Importance
 Confidence
 Readiness
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Activity: Encouraging Change Talk with Questions
▲ Ask them what change they have thinking of making
▲ Ask some questions to build importance and confidence:
• What are some of the best reasons to make this change? (I)
• What will it be like if you made the change? (I)
• If you did decide to make that change, what do you think
would work for you? (C)
• What are the first steps you would need to take to make that
happen? (c)
▲ Give a short summary/reflection of the speaker’s
motivations for change
Activity courtesy of MINT
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Affirmations
“The greatest good
you can do for another
is not just to share
your riches but to
reveal to him his own.”
- Benjamin Disraeli
Affirmations
▲ Pointing out strengths and resources
▲ Tie the affirmation to the behavior
▲ “You” statements are more powerful than “I” statements
▲ Reframe failure
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What Do You Say To Yourself In The Mirror?
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Example: A participant reports that she smokes.
She knows it isn’t good for her but is fed up with
people nagging her about it. At some point she will
stop, but not yet. She is under lots of stress with her
job and with taking care of her three kids and
smoking helps to relieve her stress. She feels guilty
and does not smoke around the kids much. She will
quit when she is ready.
Participant Strengths?
Affirmations?
Reflective Listening
Reflections
▲Think to yourself:
o What do I think she means?
o What is she really trying to say?
o How does she feel about this?
o What is she not saying?
o What is her tone / body language saying and
is it different than her words?
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When to Reflect
▲ After an open-ended question
▲ When you hear change talk
▲ When you hear ambivalence or inconsistency
▲ When you hear strong feeling
▲ When you sense resistance
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Getting Started… Helping Words
▲ It sounds like…
▲ It’s kind of like
▲ It’s as though…
▲ You are…
▲ So you…
▲ You don’t think…
▲ You’re feeling like…
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Types of reflections
▲ Simple reflection : Slight rewording of what client said
▲ Complex refection: Moving beyond what was said
Meaning // Emotion // What is not said //
Finishing the thought
▲ Double-sided reflection: Highlighting ambivalence or
discrepancy
▲ Amplified reflection:
Exaggerating to the point that a
participant may disagree
▲ Summary reflection:
Putting together a summary of
all the key points
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Reflecting Emotion - Example
P: “I am breastfeeding my baby, but she cries
a lot so I wonder if she needs to start
drinking formula?”
C “You’re worried that she is not getting
enough breast milk.”
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Reflection with a Twist - Example
P: Yeah I know exercise is important. I don’t want to
get diabetes like my uncle and wind up without my
leg but I hate running, I hate aerobics or any kind of
team sport and I really don’t like to sweat.
C: It is important to you to exercise to avoid
complications from diabetes and you haven’t
found a form of exercise that works for you yet.
(a twist)
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Finishing the Thought - Example
P: They both never like what I make for dinner. They
are so picky. They only eat a certain amount of
things. The same things all the time.
C: And you end up becoming a short order cook and
making multiple meals.
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Double-Sided Reflection - Example
P: I want to give them healthy things, but then
we are in the store and she says mommy,
mommy can I have that. I can’t say no.
C: You want to give her things that will make
her happy and yet you worry about her
health.
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Amplified Reflection - Example
P: It is not like I have time to go to the gym like
other women. I wouldn’t have the time.
C: There is not time for any sort of exercise or
activity for you right now.
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Activity: Practice Reflections
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Dosey Doe
Activity courtesy of MINT
Instructions: Dosey Doe
▲ Round 1:
Blue and Green
Yellow and Red
▲ Round 2:
Blue and Yellow
Green and Red
▲ Person one reads their stem 3 times.
▲ Person two offers 3 different reflections.
▲ Then switch
▲ Notes:
– Try different types of reflections: complex,
double-sided, emotion, finish the thought.
– Try to drop the helping stem
▲ Round 3:
Blue and Red
Yellow and Green
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Purpose of the Assessment
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Slide 50
Projective Assessment
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Metaphor Images
Card Sort/Topic Cards
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For more information:
Gettingtotheheartofthematter.com
Practice Projective Assessment
Giving Advice or Information
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GOAL
SETTING
“A goal without a
plan is just a wish.”
- Antoine de Saint-Exupery
Change always comes bearing gifts.
~Price Pritchett
Thank you for:
Listening
Participating
Sharing
Exploring