Empowering Parents, Guiding Children

Guide for Pediatricians

How pediatricians can use Motivational Interviewing (MI) to support mental health conversations with families

By Micah Munro, Psychotherapist, LCSW

In this article, you'll learn:

• Why mental health conversations with families can be tough

• What Motivational Interviewing (MI) is and how it helps

• Four key MI principles pediatricians can use

• A simple framework (OARS) for supportive conversations

• How to apply MI with children, teens, and parents

• How to address resistance

• Tips for recognizing readiness for change

• Resources to help you get started with MI

As pediatric professionals, we are all driven by a love for children and a desire to make a positive impact. When a child is struggling, our instinct is to facilitate conversations that lead families to the support they need as soon as possible before the situation escalates. However, navigating these discussions, particularly around sensitive issues like mental health and therapy, can be challenging for pediatricians. That's where motivational interviewing (MI) becomes invaluable. Even if therapy isn't part of your practice, your regular interactions with children and families place you in a unique position to initiate crucial conversations with parents and guide them toward appropriate support. Motivational interviewing can empower you to do this effectively.

As a Licensed Clinical Social Worker (LCSW) with more than 28 years of experience, I’ve spent years providing virtual therapy for kids, teens, and adults. I know that to work effectively, it’s all about fostering trust and meeting people right where they are, so no matter the age of the client, my priority is to provide a supportive and welcoming space. The best part of my job is witnessing those incredible “aha” moments when clients truly realize their own strength and start to grow in ways they never thought possible. The techniques and tools used in MI are often an excellent starting point for getting to those breakthroughs.

“At the core of MI is its spirit. It’s all about emphasizing authenticity, compassion, and a true partnership. And this isn't just for therapists and pediatricians!”

Understanding motivational interviewing
In a nutshell, Motivational Interviewing is a collaborative, goal-focused approach to facilitating a meaningful conversation. It's designed to strengthen motivation for change by exploring and addressing any ambivalence someone might be feeling toward a specific issue. In MI, we use open-ended, non-judgmental, and empathetic questions to really encourage self-reflection on personal motivations. Starting therapy can be a really challenging decision, especially for teens. And as a parent, it can be frustrating or difficult to know how to approach the idea of therapy, or how to support your child when they’re resistant to the idea. No matter the issue, MI is a tool for everyone to use—parents, pediatricians, educators—and sets the tone for a productive conversation.

At the core of MI is its spirit. It’s all about emphasizing authenticity, compassion, and a true partnership. And this isn't just for therapists and pediatricians! These are many ways we can also encourage parents to use MI questions and techniques in their daily lives. For now, let’s focus on the practical strategies and questions that pediatricians and educators can use when introducing the topic of mental health to their patients.

First, here are the four key principles that guide MI and how each can be incorporated through the eyes of a pediatrician:

Engaging
This is about building trust and setting a collaborative tone from the start. It's the foundation for any meaningful conversation — whether you're talking about everyday concerns or something more serious.

Try this: "I'm really glad you brought Sarah in today. What led you to schedule the appointment?"

This simple question acknowledges the parent’s effort and opens the door for honest dialogue.

Focusing
This step is about gently guiding the conversation toward a specific concern or goal. It helps families gain clarity and gives you a clearer path for support.

Try this: "What are your biggest concerns about [child’s name]’s behavior right now?" This helps surface what matters most to the parent and sets the stage for a more targeted discussion.

Evoking
This is where we draw out the individual’s own motivations for change. It’s about tapping into their inner drive. Here it’s appropriate to invite parents to articulate their own motivations for seeking support.

Try this: "What would be the benefits of addressing this issue now?" This encourages the parent to think about positive outcomes.

Planning
Finally, we develop a commitment to change and create an actionable plan. It’s about moving forward with clarity and purpose and gently guiding parents toward actionable steps while respecting their autonomy.

Try this: "What resources or support might you need to move forward?" This identifies the practical needs of the parent and opens the door to the next steps.

Practical Application: The OARS Technique
When speaking to parents, the techniques easily remembered with the acronym OARS are particularly effective:

• Open-ended questions: Instead of “Does Connor have behavioral issues?” try “What concerns do you have about his behavior?” 

• Affirming their experience: Acknowledge and validate parents' feelings. For example, “It sounds like you’re worried about how this might look as a parent” or “You’re doing a great job recognizing that Marcus may be struggling.” 

• Reflective listening: Paraphrase what you hear. For instance, “It sounds like you’re worried but also unsure about what steps to take next” or “I hear you saying he’s committed to school, but quite often he struggles to get out of bed?”

• Summarizing: Bring it all together with brevity and neutrality. Like, “You’ve noticed changes in your child’s mood and are wondering whether professional support could help.”
  
  

“Building on the OARS technique, it's important to understand how to adapt Motivational Interviewing for children versus parents.”

MI for children, teens, and young adults
Building on the OARS technique, it's important to understand how to adapt MI for children versus parents. When I’m working with children and adolescents, my approach is all about validating their experiences. For example, to validate their experience, I might ask: 

• "It sounds like you've been dealing with a lot lately. What's been the hardest part for you?" 

• "I can see that this situation is really impacting you. Can you tell me more about how it feels?"

• "What's it been like for you trying to manage this on your own?" 

I really focus on helping the child identify their own goals for change and empowering them to take ownership of their well-being. Some examples of this are:

• "If things could be different, what would you want to change?"

• "What's one thing you wish you could do differently in this situation?"

• "Imagine things were going really well. What would that look like for you?"

• "What are some things you might want to work on or improve?"

To focus on empowering the child improve their own well-being, I would ask:

• "What do you think you need to feel better or more in control?"

• "What are some of your strengths that could help you through this?"

• "What do you think you can do to take care of yourself right now?"

• "What steps, even small ones, could you take to start making things better?"

• "What would you like to try first?"
  
  

“Parents may be wondering ‘How long will it take?’ or ‘What if Stephen doesn’t want to go?’ Encourage them to ask questions about anything that is on their mind. ”

MI for parents
When working with parents, the focus shifts to addressing their concerns, increasing their motivation for seeking help, and reinforcing their crucial role as supportive caregivers. Parents may have their own feelings about therapy, such as questioning their own actions or believing their child doesn't need it. Motivational Interviewing allows pediatricians to address these concerns and others without judgment. Here are a few of the most common scenarios a pediatrician may encounter when talking to parents and some examples of MI questions that can help break through.

• Ambivalence
  Parents face numerous challenges often compounded by fear of judgment, which MI addresses by fostering a non-judgmental space for sharing worries. Uncertainty about mental health services and what to expect can be alleviated by providing clear, personalized information about the process. They may be wondering “How long will it take?” “Will I be involved in the appointments?” or “What if Stephen doesn’t want to go?” Encourage them to ask questions about anything that is on their mind. 

  Questions like, “What are your worries about how this might look?” can be used to focus on what they want for their child. Validating their experience and acknowledging ambivalence, such as saying, “It makes sense that you’re wondering if this is just a phase, especially since you’ve seen this for six months,” is important. I also explore potential consequences, asking, “How would it feel if things didn’t improve?” And I highlight potential benefits, saying, “Getting support now could prevent bigger challenges later.”

• Stigma
  One of the most rewarding aspects of using Motivational Interviewing is its ability to reduce stigma surrounding mental health. MI respects cultural and personal beliefs while gently exploring the potential benefits of support, fostering collaboration and empowering parents to make informed decisions. By emphasizing strengths and solutions, rather than deficits, MI helps parents view mental health as an essential part of a child's overall well-being, interconnected with physical and social-emotional health, rather than a sign of failure. 

  Many parents feel uncertain, overwhelmed, or even ashamed about seeking mental health services, making discussions about it awkward and unwelcome. Fortunately, MI provides a non-judgmental space where concerns can be acknowledged and addressed with sensitivity and practicality, effectively reducing resistance and shifting the narrative to one of hope and growth. To underscore your point and help parents gain perspective about mental health, try following up with outside resource. 

• Denial or resistance
  When I encounter denial or resistance from a parent or a child, I use reflective listening to acknowledge their concerns. I offer information without putting any pressure on them. And I help parents explore the pros and cons of seeking help, allowing them to come to their own conclusions. It’s about guiding, not pushing. Sometimes when parents are moving out of denial or resistance and becoming open to an idea, their willingness to discuss the topic comes some time later after some thought.

• Conflicting values
  Using culturally competent language is crucial when parents feel mental health is not aligned with their family values. It's essential to emphasize the shared goal of supporting the child's well-being and to frame mental health as a natural and important aspect of overall child development. Neutrality and support are absolutely key. We need to normalize discussions about mental health, using empathetic language to truly validate parents' concerns. It's about meeting them where they are and showing genuine understanding.

“Real-life success with MI might look like a hesitant parent agreeing to an initial consultation after I acknowledge their concerns and explore their motivations.”

Motivating action: Recognizing “change talk” in parents
I listen carefully for “change talk.” This might sound like, “I’ve noticed my child struggling more lately,” or “I just want to make sure I’m doing the right thing,” or even, “Maybe talking to someone wouldn’t hurt.” These are all signs that parents are considering change, and they're important cues. Help them reach for the gray area and explore the possibilities that a challenging scenario could improve with help.

Real-life success with MI might look like a hesitant parent agreeing to an initial consultation after I acknowledge their concerns and explore their motivations. Or it could be a family who was initially resistant following through on a referral after we discussed small, manageable steps. These small victories are huge!

Overcoming barriers to using MI in pediatric practice
Of course, there are challenges. Time constraints are a big one. But even brief MI techniques can be effective. There might be worries around a lack of training. Short MI workshops can provide essential skills. And parental resistance is always a possibility, but consistent, empathetic engagement helps build trust over time.
For those interested in learning more, I highly recommend the Motivational Interviewing Network of Trainers (MINT), the American Academy of Pediatrics MI Training Modules, and online MI courses through healthcare education platforms like this one at University of British Columbia Continuing Professional Development. There are so many resources available!

Ultimately, by incorporating Motivational Interviewing (MI) into your practice, whether as a pediatrician or educator, you can create a supportive environment that encourages parents to consider mental health services, destigmatize mental health, and guide children towards a healthier future. It's about walking alongside families, not telling them what to do, and empowering them to make the best choices for their children. This approach leads to better outcomes for children and adolescents, and at the end of the day, that is what we are all working towards.

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Micah Munro is a psychotherapist and licensed social worker with more than 28 years experience. Her specialties include anxiety, depression, ADHD, OCD, trauma, and school-related challenges.

How can Blackbird help?
Our goal is to help pediatricians, educators, and families connect to support as quickly and as smoothly as possible. To speak to a Blackbird Care Navigator or to schedule a professional development workshop or training for your group on this topic, email Blackbird Health at info@blackbirdhealth.com.