1 RAPPORT BUILDING Bridget Swinney MS, RD .

1

RAPPORT BUILDINGRAPPORT BUILDING

Bridget Swinney MS, RDBridget Swinney MS, RDwww.healthyfoodzone.com

www.babybitesbook.blogspot.com

How to build rapport with your clients and how it can improve nutrition assessment.

Cultural, language, and other barriers to effective communication in WIC and strategies that can help you overcome them.

How to use non-verbal communication techniques which result in positive and effective communication.

Effective interpersonal communication techniques that promote a participant-centered approach to nutrition assessment.

LOVE Method of Counseling.

What Will You Learn?What Will You Learn?

3

The VENA Nutrition Assessment Process-

How Does Rapport Building Fit In?

• Use limited time to collect relevant nutrition assessment information

• Use critical thinking skills to link assessment information to a participant’s individual needs and concerns

• Engage the participant in dialogue and goal setting

• Weave nutrition and diet throughout the assessment process

• Plan a personalized nutrition intervention

4

Rapport BuildingRapport Building

• Importance , per USDA–One of the VENA Essential Competency Areas

• Rationale , because it works!

5

What comes to mind when you What comes to mind when you think “Rapport Building”?think “Rapport Building”?

Rapport defined: “relationship between people--especially one of mutual understanding or trust”

What does Rapport Building Mean to You?

6

How to Build Rapport?

• Smile!• Remove as many

barriers as you can!• Engage the Participant!

7

What are the Communication Barriers in Your Setting?

• Cultural• Language • Socio-Economic

– Generational/Situational Poverty

• Environmental/Physical• Emotional• Appearance/Dress

8

Discuss Handouts

Cross-Cultural Nutrition

Awareness

Barriers to Effective Barriers to Effective CommunicationCommunication

9

Handout 2.1 : Effective Cross-Cultural Communication

Handout 2.2 : Guidelines for Cross-Cultural Communication

What About Language Barriers?

Handout 2.8: Little or No English

Handout 2.9: Working with An Interpreter

Talking Technical—DON’T!• Sometimes we forget that not everyone

is familiar with nutrition and/or WIC lingo!– Postpartum– HCP– CA– BMI– Cert/Subcert– Hematocrit

11

Other Barriers to CommunicationOther Barriers to Communication

• Cultural• Language • Socio-Economic

–Generational Poverty–Situational Poverty

• Environmental/Physical• Appearance/Dress• Emotional

12

Can We Overcome Environmental Barriers…or Just learn to Deal

with Them?• Physical: Desks, windows, counters,

crowded areas, uncomfortable temperatures

• Noise distractions: kids, phones, co-workers

• Smells…• Overcoming Appearances• Others? Stress, number of people waiting

to see you, personal problems

13

Take 5 and Think about Take 5 and Think about These 5 Must-Do’s…These 5 Must-Do’s…

• Create a positive environment• Limit your teaching objectives• Communicate clearly and simply• Use multiple ways to get message across• Verify understanding

14

Nonverbal Communication Nonverbal Communication TechniquesTechniques

• Have perceived meanings

• Exhibited by counselor and participants

•Can Help or Hurt Communication

15

Effective/Ineffective Counselor Effective/Ineffective Counselor Nonverbal BehaviorNonverbal Behavior

Handout 3.1 Nonverbal Behavior/Body Language

16

Establishing a Establishing a Participant-Centered ApproachParticipant-Centered Approach

Handout 4.1 Interpersonal Communication: Characteristics of Effective Nutrition Counselors

Handout 4.2Interpersonal Communication:

Getting Permission

17

LOVE CounselingTechniqueLOVE CounselingTechnique

Listen & Observe

Open Ended Questions

Validate

Empower/Educate

18

What’s the Scientific Basis?Motivational Interviewing

• As defined by William Miller and Steven Rollnick: “Client Centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence”

• Transtheoretical Model of Change-Prochaska & DiClemente

19

Listen and Observe• Listen to what the participant says as

well as the feelings behind her words• You may need to ask questions to

clarify what she says• What are the hidden factors,

feelings… the story behind the story, the real issues?

• What does body language tell you?

20

What is Reflective Listening?• Paraphrasing the response, which:

– Shows you’re listening!– Helps clarify or correct info– Shows acceptance– Encourages a response or expanded answer– Gives you a chance to summarize her feelings and

actions

• You’re wondering…• You feel worried about…• You’ve heard• You’re wanting information

about…• …..do I have that right?

21

Reflective ListeningReflective Listening

Handout 4.6: Reflective Listening TechniqueExercise 4.2: Practice Reflective Listening 1Exercise 4.3: Practice Reflective Listening 2

22

What makes an What makes an Open Ended Question?Open Ended Question?

• Asks one question• Can’t be answered with a yes or no• Is broad based• Incorporates clients own words/language• Does not introduce bias or assumptions

– “what did you cook for breakfast today?”

• Explores feelings and facts

23

Closed vs. Open Questions

• Do You…?• Will you…?• Can You…?• What is your…?

• To what extent…• How often do you

feel…• Why…• Tell me about…• Help me understand• What, if any…• What else…• How do you feel

about…

24

Practice Using Open Ended Questions

How much do you weigh?

Does your child drink juice?

Can you switch from whole milk to 2%

How much weight did you gain during your last pregnancy?

Do you take any drugs?

25

Now ask the same questions,

a different way…• How do you feel about your current weight?• Does your child drink anything besides milk

and water?• How easy would it be to switch from whole

milk to 2%• How did you feel about your weight gain

when you were pregnant with Joshua?• Pregnancy is a good time to improve habits.

Do you have any habits that you want to stop but can’t?

26

Open Ended Questions

Handout 4.4: Tried and True Open-ended Questions

27

Conversation Starters• What is the greatest concern you have about your

child’s health today?• Regarding your child’s health, what are you most

interested in learning about today?• How do you feel about your child’s overall eating?

What are your biggest concerns and challenges in feeding your child?

• What are some traditional practices that affect your mealtime planning and mealtime setting?

• What do you do when you have little time to prepare meals?

• Tell me what activities your child likes? How much time does he/she spend doing the activities each day? What kind of activity do you do as a family?

28

Validate/AffirmValidate/AffirmValidate: “Your feelings are OK and have been

expressed by others”

Affirm: Validating feelings or actions with a positive spin. “Your feelings/actions are more than OK—they will help you meet your goals.”

Validating acknowledges that you hear and support her concerns and that what she’s feeling is acceptable.

Affirming helps supports changes.

Validating and Affirming also:

• Establishes rapport, builds trust and will help the participant “engage” in conversation

• Uses simple phrases to acknowledge participant’s knowledge and strengths

• Builds client confidence and avoids a defensive reaction

30

Sample Validations• I hear you!• That can feel scary…• Many moms feel the same way when…• Some of our other clients have said the same

thing.• I can see how that would concern you• Your feelings are completely normal (…

expected, typical, OK)• I know how that feels…• I know it’s hard to…• That’s a tough situation…

31

Sample Validations/Affirmations

• I know it’s sometimes hard for you to get here so I really appreciate you being on time today.

• Congratulations on switching your family to skim milk!

• I can see that you are working hard to help your daughter give up her bottle.

32

More Affirmation• That’s a good point• I think that could work• Your Mom has some great ideas

about feeding babies and I know you want to respect that….

• You must be so happy that your daughter’s BMI has gone down!

• You’ve really got it together when it comes to cooking healthy

33

Empower/EducateRemember, VENA counseling is

Client Centered!

• Instead of telling clients what they’re doing wrong…find something they’re doing right!

• Guide the conversation to address client’s concerns first

• Provide information so that she can set a goal or make an informed decision

• Help her find her own solutions by giving options

• Build client confidence so she feels she can do it

34

Let’s Practice!• Pretend you are a WIC client. Choose an

issue common to WIC and tell your counselor about it.

Hint: I’m not making enough milk, fruits and vegetables are so expensive, my son cries when I don’t give him the bottle…

• Counselor will practice the LOVE method of counseling until the client feels the counselor understands her concerns and has given her adequate options for to set a goal and steps to reach it.

35

LOVE Counseling TechniqueLOVE Counseling Technique

Listen and Observe

Open Ended Questions

Validate

Empower/Educate

36

Rapport Building Rapport Building ̶ ̶ Putting it All Together!Putting it All Together!

Focus on Positive Health Outcomes

Exercise 5.2 - Case Study

Did I Do a Good Job? How to build rapport with your clients and how it

can improve nutrition assessment. Cultural, language, and other barriers to effective

communication in WIC and strategies that can help you overcome them.

How to use non-verbal communication techniques which result in positive and effective communication.

Effective interpersonal communication techniques that promote a participant-centered approach to nutrition assessment.

LOVE Method of Counseling.

38

Concerns/Questions?•Remember, Change DOESN’T happen overnight!

•You’ll need to practice these new assessment/counseling habits!

•It’s normal to slip back into old ways, but keep trying!

•VENA Works!!VENA Works!!

39

YOU CAN MAKE A

HUGE DIFFERENCE

WITH VENA.

YOUR CLIENTS WILL

THANK YOU FOR IT!