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For Nutrition Professionals
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Nutrition
Program Directors and Professors
Internship
Directors and Preceptors
WIC Trainers
These resources help
you teach counseling skills to future nutrition
Professionals...
Newsletter
Archives
February, 2010
March, 2010
June,
2010
February, 2010
In this
issue:
Inspiration
from the field:
Melanie Brede, MS, RD, CSSD, is a preceptor who works at
the University of Virginia’s Student Health Center.
She has this strategy for interns who want to practice
counseling with patients in an outpatient setting when
their skill level is not yet adequate. First, she
assigns Counseling Tips to the interns to read. Then
they observe one of her sessions and use the Counseling Session
Feedback Form to pick out the skills they see
demonstrated. If Melanie is seeing a client who would
feel uncomfortable with an intern in the room, she
lets the interns use the Feedback Form with a previously
recorded session.
Interns get frustrated when we don’t let them counsel real clients. When they do work with clients, they understandably focus on the content of what they need to cover because this is fairly new to them. Their process tends to get off track, and we cringe. This interim step of focused observation gives them experience with attending to the process when it’s easy to get distracted by the content. It may be useful to set up the observation session by promising to discuss the nutrition issues afterward, but emphasizing that you want them to focus this time on tallying open and closed questions or by noticing the client’s “change talk.”
You could choose the Tips or you could let the interns choose a few (thereby demonstrating choice). You and the interns could design the observation exercise based on the Tips chosen. For example, an intern may be fascinated with self-disclosure and what to do when clients ask personal questions. You would assign Tips #1, Self -Disclosure, and #18, How to Handle Personal Questions. Then during the session, the intern can be assigned to jot down any self-disclosure on your part and/or note times she would have been tempted to add something about herself if she were the counselor. Afterward, discuss the pros and cons of each example of disclosure.
Share your
strategies! Got something that is working well? Send
me an e-mail.
In a coming issue, I’d love to see:
• Ideas on coordination to further learning of
counseling skills. Do you have experience coordinating
between a DPD program and a DI program in the same
institution? What ways have you found within a DI
program to coordinate efforts from one placement to
another?
• Formats or checklists that you use to show students
how a session can smoothly incorporate both
client-centered counseling and the Nutrition Care
Process. I’ve been sent one and would love to share
several.
• Methods for feedback to students/interns on their
counseling process. Anyone using the standardized
patient process described in these articles?
o Henry, B.W, Duellman, M.C, Smith, T.J. Nutrition-based
standardized patient sessions increased counseling
awareness and confidence among dietetic interns. Top
Clin Nutr. 2009;24:25-34.
o Henry, B.W, Smith, T.J. Evaluation of the FOCUS
(Feedback on Counseling Using Simulation) instrument for
assessment of client-centered nutrition counseling
behaviors. J Nutr Educ Behav. 2020; 42:57-62.
Q:
I have your Toolbox of materials and am teaching
counseling skills to undergraduates for the first time.
Can you direct me to basic exercises for first-time mock
counseling?
A: I
would start with the Mirroring Exercise since the
process of reflecting is so critical to all counseling.
Some students are natural mirrors, and reflecting will
come easily since they already do it in their social
conversations. For them, you are highlighting a natural
process they can employ strategically with clients.
Other students do not yet mirror out loud in their
social interactions, and the skill will be difficult and
take practice. All students will benefit from your
suggestion to practice it with friends and bring their
experiences to the next class.
The Unpacking Exercise gives students a chance to practice focusing on what is important to the client without the distraction of nutrition content. I have often seen even experienced nutrition counselors get off track quickly when instructed to unpack what is important to their mock client when the topic is nutrition or health. Instructing the “client” to talk about something that matters to him (unrelated to health or food) makes it more likely that the counselor will not get off track and give advice too soon. The counselor can focus on exploring the topic in detail, practicing open-ended questions and reflecting.
The Elicit/Provide/Elicit Exercise works well, too. Students may be excited about providing nutrition advice. Introducing this process for embedding the advice in a client-centered frame early in their training will serve them well later.
Free
Webinar:
Looking
for content on eating disorders for your students
or interns?
Here is a
link to a 75-minute
webinar you are free to share. It was recorded in
January, 2010 for the ARAMARK Dietetic Internship
Program. I serve as a volunteer for A
Chance to Heal, an advocacy and education non-profit
in Philadelphia and conduct several lectures per year
for future health professionals to ensure they will
respond appropriately when they encounter an eating
disorder. I share this to further this mission.
Resources
from others:
Run into articles, textbooks, videos, websites or other
resources that help you do a better job? Let me know and
I’ll post them here.
Here’s one of my favorite articles: Miller, W.M, Rose,
G.S, Toward a theory of motivational interviewing.
American Psychologist. 2009; 64:6, 527-537.
It reviews the latest research on the effectiveness of
Motivational Interviewing. I particularly appreciate
that it includes research on training for MI. It’s
probably most appropriate for graduate courses, though
I’d love to hear feedback from others who have
assigned it.
March, 2010
In this issue:
Fascinating conversations on the spring
conference call!
Topics included:
- How to include body image in curriculum
- What should be included in a new textbook that one of the callers is working on
- The role of supervision in our profession (or lack of it) and how to bring this into training for future RDs
- Incorporating concepts and practical aspects of collaboration in health care teams
- An interesting way to develop “cases” to use in nutrition counseling
practice
- Using discussion boards for responses in courses
Here's the recording.
The next call will be scheduled in the fall. Look for an announcement in
this newsletter.
Q. Should I introduce
supervision to
my students and interns?
A. Yes. Early and often!
The concept of supervision has been only sporadically
adopted in our field. In simple terms supervision is
any interaction with a professional colleague for the
purpose of maximizing the quality of practice. It is
used extensively in counseling fields both in
training and on-going practice. This process includes
case consultation as well as counseling designed to
advance the supervisee's skills.
Students, even at the undergraduate level can be introduced to the term and given an explanation
of it's purposes and value. In classes where
counseling skills are taught and practiced, the feedback process employed in the
training is a type of supervision. Urge
students to look for such support and guidance throughout their
careers.
Interns expect to receive supervision in their
work. They can be encouraged to continue this
learning process as they begin their careers and
on-going! Let them know that they will need to actively seek out
this feedback once they are practicing.
Resources
Here is a pdf of Counseling Tip
# 11, Professional Supervision. Feel
free to use as a class handout. It is included in
Chapter 11 of Counseling Tips for Nutrition
Therapists: Practice Workbook, Vol 1.
This recent article in the New York Times may be
useful for class discussion of the effect of health
professional prejudice on patients:
Essay by Harriet Brown: For Obese People, Prejudice in Plain Sight
March 16, 2010
Looking for Resources
Several callers on the recent conference call
asked for ideas of materials to help teach students
about body image. If you have some you like, e-mail
me and I will share them.
It's ready!
Step By Step: A Program for
Dietetic Interns to learn counseling skills
- Designed to complement Dietetic Internship
outpatient rotations.
- Focus is on the basic skills that are the
foundation of quality nutrition counseling.
- All on-line and available immediately upon
purchase.
Find out more.
June, 2010
In this
issue:
- Inspiration from the field: Giving interns
useful counseling experience
- Q & A: What teaching
materials will best support my program?
- Resources: New JADA review
article
- Updated on-line training for
Interns
Inspiration from the field: Providing counseling experience for interns
Melanie Brede, MS, RD, CSSD
Molly shared with me the program
she has developed for training interns counseling
skills. I tried it out this winter. The
University
of
Virginia
interns spend one week each with me in the
Student
Health
Center
. They have one other outpatient rotation through the
hospital’s outpatient nutrition counseling center
(all sorts of patients), and bits of outpatient woven
into rotations through the oncology, diabetes, and
renal clinics. These clinic experiences are much more
education focused than counseling focused. My
department houses a Peer Health Education (PHE)
program with 40+ undergraduate PHEs who do limited
nutrition education in one-on-one sessions and group
presentations. I was able to use these PHEs to
enhance the experience for the interns.
All the interns very much
enjoyed using the materials. They were able to absorb
the content efficiently/effectively by listening to
the podcasts. They used the accompanying articles
primarily as supplements. The case examples helped
illustrate points. They also found the sample
“Protocols” helpful. For example, the list of
steps to take in dealing with resistance.
Prior to experimenting with your
new materials, to structure their rotation with me, I
had selected a number of your Tips as part of their
required reading for the rotation. Then during the
week I’d have them sit in on as many of my sessions
as possible and/or listen to sessions I’d recorded.
I’d have them complete the Counseling Session
Feedback Form for several of these sessions, and
we’d debrief after sessions. As much as possible,
I’d have them conduct some sessions and I would sit
in to evaluate their work and be available when they
needed help.
As we’ve experimented with
various strategies and your materials, I’m
beginning to find a structure that seems to flow
well. I have
one of our PHEs do a “practice session” with the
intern early in the week. I’m finding this step
extremely helpful in assessing their baseline skills.
I can more efficiently direct the intern in our
limited time. For example, if the intern is doing
well with open ended questions, I have her focus on
another skill. It seems that both I and the intern
feel more confident and less. And in situations where
it is hard to give the intern the opportunity to
practice with a real patient (patients that aren’t
well matched, cancellations/no-shows, etc), having
the practice session guarantees an opportunity for
the intern to gain some experience.
I’m also finding that when the
interns listen to the podcasts, use the notes, and do
the readings, they are more ready to use the
Counseling Session Feedback Form. Since the podcasts
are short, it is easy to productively and flexibly
structure their time between reviewing materials,
sitting in on sessions, listening to recorded
sessions, conducting their own sessions, and
completing other health promotion programming
assignments.
It makes sense that interns (and
all of us!) develop counseling skills over time. I am
hopeful that I will be able to coordinate with the
other preceptors in this internship program to have
the interns utilize parts of the materials you’ve
developed during their rotation with me and parts in
their other rotation(s). I think that the way
you’ve structured the materials will make this
easily doable, and I’m confident that we’ll be
putting our heads together before the next class to
develop a schedule and plan.
Q. What materials would best supplement our
internship or didactic program?
A. It depends.
I often get phone calls or e-mails from DI
directors and professors looking for books, videos
and other materials to help them teach counseling
skills to future nutrition professionals. Here are
some of my thoughts and suggestions...
1. Textbooks: I hear this complaint often. Professors struggle to find one text book that
provides the basics of counseling theories and
strategies along with case studies and ways to
practice the skills. For a discussion of what others are using,
you might want to listen to some of the conversations
we had on the Educators
Conference Calls over the last few years. Many
courses and DI programs are using my Practice
Workbook as either required or supplemental
reading. For a full course, the workbooks are not
sufficient alone. Because they were developed
to be practical guides for practicing dietitians,
they do not cover research on behavior change
theories and strategies. They are practical tips based on the
research.
2. Videos: There are several
excellent motivational interviewing training videos
available at www.motivationalinterview.org.
Many of the good ones are too long to show during a
class and I have gotten feedback that students find
it difficult to "translate" the skills
shown to nutrition settings. They may work better in
graduate courses. There are 18 short videos
demonstrating counseling skills in nutrition settings
included in the Toolbox
for Nutrition Counseling Education. These videos
are designed to fit into a course taught by a
clinician who is comfortable teaching counseling
skills. A professor can choose to develop his/her own
lectures or save some time by using the slides
included in the Toolbox. These materials also fit
into the didactic portion of an internship if the
program has a faculty person who is skilled at
counseling.
3. On-line learning: Modular resources that
interns or students can access in their own time can
fit well into a busy schedule. The Step-by-Step
Program uses short podcasts and supplemental
readings. It can be assigned either during the
introductory portion of a DI program and/or during
ambulatory rotations. Many Internships schedule
a counseling class in the first weeks of the program
and are then frustrated that the interns have
forgotten much of it by the time they reach
out-patient rotations. Adding the modules timed to
these rotations can layer in practical learning.
A final thought... I often hear that
Internship Directors (and some interns) are
frustrated with a discrepancy
between the up-t0-date, evidence-based skills
they want to teach and the skill level of some
preceptors. I anticipate that the Step-by-Step
Program will addresses this concern. The program
involves the preceptors in the learning process. They
are encouraged to listen to the podcasts and do the
reading in order to earn CPE credits.
Resources
In this month's JADA:
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior
Change;
Joan
ne M. Spahn, MS, RD, FADA, Rebecca S. Reeves, DrPH,
RD, Kathryn S. Keim, PhD, RD, LDN, Ida Laquatra, PhD,
RD, Molly Kellogg, RD, LCSW, Bonnie Jortberg, MS, RD,
CDE, Nicole A. Clark, DCN, RD, LDN, CDE; J Am Diet Assoc, 2010;110:879-891.
It's ready!
Step By Step: A Program for Dietetic Interns to learn counseling skills
- Designed to complement Dietetic Internship outpatient rotations.
- Focus is on the basic skills that are the foundation of quality nutrition counseling.
- All on-line and available immediately upon purchase.
- Four credits for preceptors at no additional
cost!
Find out more.
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