MDS Alert

Find out how to use echoing, probing, unfolding, and other techniques.

Even the most expert interviewer can benefit from a review of interview methods to keep information flowing and on target for answering important assessment questions. And CMS has provided the following strategies for doing the mood interview in Section D of the MDS 3.0.

The RAI Version 3.0 Manual notes that "some residents may be eager to talk with you and will stray from the topic at hand. When a person strays, you should gently guide the conversation back to the topic."

Example: "Say, 'That's interesting, now I need to know..."; "Let's get back to..."; "I understand, can you tell me about ....'"

"If the resident has difficulty selecting a frequency response," the manual states, "start by offering a single frequency response and follow with a sequence of more specific questions. This is known as unfolding."

Example: "Say, 'Would you say [name symptom] bothered you more than half the days in the past 2 weeks?' If the resident says 'yes,' show the cue card and ask whether it bothered her nearly every day (12-14 days) or on half or more of the days(7-11 days).

"If the resident says 'no,' show the cue card and ask whether it bothered her several days (2-6 days) or never or 1 day (0-1 day)."

The manual directs the interviewer to explore noncommittal responses such as "not really." "Residents may be reluctant to report symptoms and should be gently encouraged to tell you if the symptom bothered them, even if it was only some of the time. This is known as probing. Probe by asking neutral or nondirective questions such as:

'What do you mean?'

'Tell me what you have in mind.'

'Tell me more about that.'

'Please be more specific.'

'Give me an example.'"

"Sometimes respondents give a long answer to interview items," the manual observes. "To narrow the answer to the response choices available, it can be useful to summarize their longer answer and then ask them which response option best applies. This is known as echoing.

Example: Item D0200E, Poor Appetite or Overeating. The resident responds 'the food is always cold and it just doesn't taste like it does at home. The doctor won't let me have any salt.'

"Possible interviewer response: 'You're telling me the food isn't what you eat at home and you can't add salt. How often would you say that you were bothered by poor appetite or over-eating during the last 2 weeks?'"

"If the resident has difficulty with longer items, separate the item into shorter parts," the manual directs. Then "provide a chance to respond after each part. This method, known as disentangling, is helpful if a resident has moderate cognitive impairment but can respond to simple, direct questions.

"Example: Item D0200E, Poor Appetite or Overeating. You can simplify this item by asking: 'In the last 2 weeks, how often have you been bothered by poor appetite?' (pause for a response) 'Or overeating?'" directs the manual.

Source: Excerpted from Section D of Chapter 3 of the RAI User's Manual. MDS Alert has added the subheads. Information from the manual is in direct quotes or identified as coming from the manual. CMS may revise the manual.