The Motivational Interviewing Toolkit for the Metabolic Clinician

Understand how to incorporate motivational interviewing (MI) when counseling your patients and caregivers affected by metabolic disorders.

The Motivational Interviewing Toolkit includes:

  • A detailed understanding of the principles of MI as it relates to the metabolic patient
  • The stages of readiness to change as well as tools to use and questions to ask at each stage as it relates to the metabolic patient
  • An assessment containing interview questions and an algorithm to help you utilize MI with your metabolic patients
  • Questions to help determine what motivates your patients to change
  • Questions to help identify and overcome the obstacles preventing your patients
  • Forms to use as you work with your patients
  • Tips for effective counseling sessions
  • Tips for handling challenging patients
  • Frequently asked questions
  • Case studies and more
  • Improving Dietary Compliance

    As a clinician working with inborn errors of metabolism, you understand the complexities involved in patients adhering to a metabolic diet. Providing education and resources to patients and families may not be enough to empower the patients to follow their diet.

    Motivational Interviewing (MI) is a style of interacting and communicating that increases likelihood of dietary compliance and decreases clinician burden and frustration. In consultation with experts in the field of MI and inborn errors of metabolism, the Mead Johnson Pediatric Nutrition Institute has developed The Motivational Interviewing Toolkit to help you learn and utilize MI in your practice.

  • Challenges of Dietary Compliance

    We hear the challenges you face when working with metabolic diets, which may include:

    • The patient refuses to consume medical food or does not consume enough medical food
    • As children do well, parents become less restrictive
    • Reimbursement is limited leaving the family with a financial burden
    • The teen patient does not want to be different
    • The patient feels good and doesn’t notice any immediate negative effects of going off the diet
    • The patient denies going off the diet although blood values indicate otherwise
  • Why motivational interviewing?

    MI is an evidence-based treatment proven effective across practice venues with ethnically and culturally diverse populations. It is a patient-centered approach that focuses on the patient’s own goals and desired behavior changes. It focuses on the individual’s concerns and barriers to change and provides the structure that gives responsibility, control and satisfaction back to the patient for change.

  • How motivational interviewing works?

    MI is purposeful conversation where you assess the patient’s readiness to change and elicit the patient’s own arguments for change. MI is a style of communicating and a method of interacting and not necessarily a set of techniques.* The counseling style is referred to as the “spirit” of MI. The style is collaborative where you and your patient are on equal ground. You accept ambivalence as normal and expected. Instead of imparting wisdom and insight, you elicit and draw these things out from your patient. Change arises from within rather than being imposed from without.

    * Rollnick, WR et al. Motivational Interviewing in Health Care. Helping Clients Change Behavior. NY, Guilford Press, 2008

  • Stages of Change and Guiding Principles

    MI is most connected with the Transtheoretical or “Stages of Change” model of behavior change. Included in The Motivational Interviewing Toolkit you will find suggested questions you can ask to help you determine your patient’s readiness to change with tools to use at each stage.

    Stages of Change

    ** Projaska, JO et al. Changing for Good. New York, NY: WIlliam Morrow and Co., 1994

    MI consists of four guiding principles. The Motivational Interviewing Toolkit will elaborate on these guiding principles and provide examples of effective questions and statements that facilitate dietary compliance.

    Principals for MI

    Using MI can help to improve your patient’s dietary compliance.


  • Metabolic Toolkit

    To use the toolkit in your clinic, please follow the steps below. We appreciate your support and hope that you find this service helpful to your clinical practice.

    Step 1: Read the booklet before implementing in your clinic.

    The booklet will provide you with an overview of motivational interviewing (MI) and the in2action MI Toolkit.

  • Step 2: Have the patient fill out the Nutrition Questionnaire.

    This form can be sent to the patient ahead of time, completed while in the waiting room, or discussed during the appointment (time permitting). It will help you identify the patient’s readiness to change.

  • Step 3: Assess readiness to change and determine goals and strategy for counseling session using the Pocket Guide.

    Using the Guide to Matching Stage of Change with Strategy (found on the back side of the Pocket Guide), identify your patient’s stage of change based on their Nutrition Questionnaire responses. Once the patient’s stage of change is identified, use the Pocket Guide to determine the goals, strategies, and questions to ask during your counseling session.

  • Additional tools

    There are additional tools developed to assist you in the application of MI skills. Descriptions for these tools are located in MI toolkit booklet.