# Presentation: 139620

## RAPPORT BUILDING

## 
Define rapport building and provide a rationale for its use by WIC counselors in nutrition assessment
Describe cultural, language, and other barriers to effective communication. Identify these barriers within the WIC environment and develop strategies to overcome them
Demonstrate non-verbal communication techniques which result in positive and effective communication
List, describe, and demonstrate effective use of interpersonal communication techniques that promote a participant-centered approach to nutrition assessment
Effectively use rapport building and interpersonal communication techniques in response to WIC scenarios 

- Define rapport building and provide a rationale for its use by WIC counselors in nutrition assessment
- Describe cultural, language, and other barriers to effective communication. Identify these barriers within the WIC environment and develop strategies to overcome them
- Demonstrate non-verbal communication techniques which result in positive and effective communication
- List, describe, and demonstrate effective use of interpersonal communication techniques that promote a participant-centered approach to nutrition assessment
- Effectively use rapport building and interpersonal communication techniques in response to WIC scenarios

- Instructional Objectives

**Notes:**
Module II: Rapport Building, Topic 1                                   Handout 1.1

Instructional Objectives for Rapport Building Module
Define rapport building and provide rationale for its use by WIC counselors in the initial WIC participant interview and on-going nutrition counseling sessions.
Describe cultural and language barriers to effective communication. Identify these barriers within the WIC environment and develop strategies to overcome them.
Demonstrate non-verbal communication techniques which result in positive and effective communication.
List, describe and demonstrate effective use of interpersonal communication techniques.
Demonstrate effective use of rapport building and interpersonal communication techniques in response to WIC scenario presented on video.

## Rapport Building

-   Importance  ̶  per VENA
-   Rationale  ̶  because it works!

**Notes:**

Importance:  as per VENA we want to personalize nutrition education : We want to deliver more participant centered services. Positive approach based on desired health goals rather than deficiencies.

 Rationale: Clinications believe that being empathetic will take more time. Yet research indicates that being empathetic actually saves time. Ex. Patients often provide clues about their social and emotional concerns and when the clinician misses these clues patients repeat them, thus requiring more time. One study found in the primary care setting visits with missed clues lasted 20.1 min. while visits without missed clues lasted 17.6 minutes. 
Use of open ended questions appears to decrease client resistance. specifically clients responded with increased openness and this openness appeared to increase the likelihood of change. In turn, Nutrition educators developed a more positive attitude towards their clients and then one nutrition educator indicated she would use this new approach in the future because it gives the client ownership of the session.
Most importantly brief interventions designed to fit into everyday practice have been found to produce clinically meaningful changes in the population for a growing number of behavioral risk factors.

## What Words Describe Rapport Building?

-  *Let** u**s take a few moments to write down some of your thoughts...*

**Notes:**
Spend 5 minutes using flip chart to write down some thoughts. Lets see how some of the thoughts you came up with fit into the current counseling models that are often used in Nutrition Counseling.

## Barriers to Effective Communication

- 	This module will describe *language, cultural, *and *other barriers* to effective communication within the WIC environment and discuss strategies to overcome them

## 
      2.2 Cross Cultural Awareness

-       2.2 Cross Cultural Awareness

- Barriers to Effective Communication

**Notes:**

Do Exercise 2.1 Cross cultural quiz

Use a flip chart to list some of the barriers.

## Barriers to Effective Communication

- Ex 2.1  Cross-cultural Nutrition Quiz

##  Communicating Between Cultures 

- View and discuss video *Communicating Between Cultures*
- Refer to handouts:
-   H2.1  Effective Cross-cultural Communication
-   H2.2  Guidelines for Cross-cultural       Communications
-   H2.3  Variety of Ethnic Food Practices
-   H2.4  Web-based Resources
-   H2.5  Multicultural Food Pyramids

**Notes:**
Show video and discuss.

Refer to Handouts:
2.1 Guidelines for effective cross cultural communication
2.2 Quick Guide for cross cultural counseling
2.3 Variety of Ethnic food practices
2.4 Web based resources
2.5 Introduce multicultural food guide pyramids 

## Guidelines for Effective Communication

- Handouts:
-   H2.6 Low Literacy
-   H2.7 Deaf or Hard of Hearing
-   H2.8 Little or No English
-   H2.9 Use of Interpreter

## Other Barriers to Communication

- Environmental
- Appearance/Dress
- Generational/Situational Poverty
- Language
- 	2.3 Clarification of Technical
-           Terms
- What Are Some Communication Barriers That You Have Experienced?

**Notes:**
Physical barriers at our work environment may include such things as desks, computers, lack of privacy due to environmental situations.

Dress/clothing both from the participant’s observation and the counselor perspective. Discuss examples:
Children come in with designer clothes
Participant is sporting a professional manicure
Counselor is wearing expensive clothing/jewelry

Generational poverty (poverty within family for at least 2 generations) and situational poverty (poverty experienced due to a specific circumstance in one’s life) may act as barriers to communication due to counselor biases/assumptions made about the participant

It is important to keep an open mind and not let environmental barriers or perceptions about appearance or economic status interfere with our ability to build rapport and effectively communicate.

## If You Only Do 5 Things

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

**Notes:**
When dealing with  cultural, language or physical barriers, review the above to improve communication.

## Nonverbal Communication Techniques

-  Have perceived meanings
-  Exhibited by counselor and participants

**Notes:**
Refer to handout:

3.1 Effective and ineffective counselor non verbal behavior.
Non verbal communication can either assist you in building rapport or become a barrier to communication.

Show video: Non Verbal Communication (male counselor) and discuss

Learning activities:

Exercise 
3.1 Attach meaning to non verbal behaviors
3.2 Identifying effective non verbal behavior
( choose one or both to do in class)

## Effective/Ineffective Counselor Nonverbal Behavior

- Handout
-    H3.1 Effective and Ineffective Nonverbal        Communication
- View and discuss video *Nonverbal Communication*
- Exercises
-    Ex3.1 Attach Meaning to Nonverbal          Behaviors
-    Ex3.2 Identifying Nonverbal Behavior

## Interpersonal Communication Techniques

- Overview
-   • Utilize rapport building to establish      participant-centered approach to      nutrition assessment
-   •  Practice OARS techniques

## Participant-Centered Approach

- Handouts
- 	H4.1 Positive Approach to Nutrition         Assessment
- 	H4.2 Getting Permission

**Notes:**
Refer to handouts and discuss characteristics of effective nutrition counseling.

Handouts:

4.1 Characteristics of Effective Nutrition Counselors
4.2 General Motivational Interviewing Counseling Strategies
4.3 Effective Counseling Responses

## OARS Techniques

- _O_pen Ended Questions
- _A_ffirmations
- _R_eflective Listening
- _S_ummarize

## Open Ended Questions

- Handouts:
- 	H4.3 Open-ended Questions
- 	H4.4 Tried and True Open-ended          Questions
- Exercises:
- 	Ex4.1 Practice Using Questions

## Affirmations

- Handout
- 	H4.5 Affirmations

## Reflective Listening

- Handout
- 	H4.6 Reflective Listening
- Exercises
- 	Ex4.2 Practice Reflective Listening 1
- 	Ex4.3 Practice Reflective Listening 2

## Summarize

- Use handoutH4.7 Summarizing
- Use exercise
- 	Ex4.4 Practice Summarizing

## Rapport Building ̶ Evaluation

- View and discuss video *WIC Scenario*
- Exercise to Accompany VideoEx5.1 Video Checklist
- ExerciseEx5.2 Case Study