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Motivational Interviewing

Motivational Interviewing. An Evidence-based Practice By Jean Henry, LCSW Suzanne Carrier, LCSW. MI Introduction. “ Motivation is a state of readiness or eagerness to change which may fluctuate from one time or situation to the another” Ray Gingerich.

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Motivational Interviewing

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  1. Motivational Interviewing An Evidence-based Practice By Jean Henry, LCSW Suzanne Carrier, LCSW The Divison of Mental Health and Substance Abuse

  2. MI Introduction “ Motivation is a state of readiness or eagerness to change which may fluctuate from one time or situation to the another” Ray Gingerich

  3. MI Introduction • Motivational Interviewing is a set of principles, philosophies and techniques that assist the helper in engaging the client in the process of change. • MI is client-centered, integrates well with other methods, effective with a diverse array of problems and increases understanding about the client’s perception and willingness to enter the treatment process.

  4. The Spirit of Motivational Interviewing • Autonomy • Collaboration • Evocation • Empathy

  5. The Spirit of MI A way of being with people.

  6. The Principles of MI • Roll with Resistance • Enhance Empathy • Develop Discrepancy • Support Self-Efficacy

  7. Key Techniques of MI • Open-Ended Questions • Affirmations • Reflections • Summaries

  8. How to implement MI • Support from Leadership • Assess readiness of staff • Investment of training • Practice, Practice, Practice • Supervision • Practice based evidence

  9. Support from LeadershipMI Works • Clinicians respond more favorably to guidelines based on principles and procedures rather than session-by session prescription of content. Miller, Sorensen, Selzer & Brigham (2006)

  10. Support From Leadership • “One session of MI improved retention: Clients who received one MI session were more likely to continue to engage in treatment one month later and to have attended more session than clients who received treatment as usual.” NIDA & SAMHSA blending initiative (2006)

  11. Brief Intervention for Alcohol Positive Older Adolescents in an Emergency RoomMonti, et al.,1999; Journal of Consulting and Clinical Psychology, 67:989–994. • Design Randomized clinical trial • Population Emergency room • Nation US (Providence, RI) • N 94 adolescents (18-19) • MI 1 session (35-40 min) • Comparison Standard care • Follow-up 6 months

  12. Brief Intervention in Emergency Room After 6 Months Better p<.05 p<.01 p <.05

  13. Brief Intervention for High-Risk College Student Drinkers: 2-year Follow-Up ResultsMarlatt et al., 1998; Journal of Consulting and Clinical Psychology, 66:604-615 • Design Randomized clinical trial • Population College students • Nation US (Seattle, WA) • N 348 heavy drinkers • MI 1 individual session • Comparison Assessment only • Follow-up 2 years

  14. Brief MI for College Students: 2-year Follow Up Better p<.05 p<.001 p<.05 p<.05

  15. Meta-analysis motivationalinterviewing.org

  16. Assess Readiness of Staff • Stages of Change – the people we serve go through a natural change process and so do we

  17. MI/Assess for Readiness • 5 factors – perception of the new practice by staff • Relative advantage: better than current practice, more effective, cost effective • Compatibility: fits with the provider’s experience, values, and goals • Simplicity: perception that the new practice is easy to understand and use

  18. MI/Assess for Readiness • Trialability: extent it can be sampled or tried out before a decision is made • Observability: how readily the benefits of the practice can be observed by others

  19. Assessing readiness • Incentives to change • Barriers to change • At what stage of change is the target audience • How will the practice of those involved be affected by change • Can we identify the opinion leaders The Change Book

  20. MI/Investment of Training • The cost of staff time to learn MI skills • The cost of ongoing Supervision, including reviewing taped interviews and giving feedback • The cost of a tape recorder and tapes NIDA & SAMHSA blending initiative (2006)

  21. MI/Practice, Practice, Practice • 3 General Learning Aids • Preparatory knowledge: Interactive workshop (results in moderately large changes in professional practice where didactic alone is not enough to change) John Corbett Miller, Sorensen, Seizer & Brigham (2006)

  22. MI/Practice, Practice, Practice • Monitored Practice with Feedback • Audio tapes: coded with written feedback • Supervision and Coaching • Supervisor needs strong MI skills • Include at least one role play with focus on issue that needs work • Supervise in the MI spirit

  23. EMEE STUDY • 50% proficiency after workshop • 75% proficiency with 6 half hour individual coaching consults • Train to CRITERION Miller, 2004

  24. MI/Supervision • MI skills can be taught and implemented at a high fidelity level when agencies utilize: • Focused clinical supervision • Audio taped MI assessment sessions • Tape coding • Feedback and instruction for improving skills NIDA & SAMHSA Blending Initiative (2006)

  25. Learning MI • Eight stages • Overall spirit of MI • OARS • Recognizing change talk and resistance • Eliciting and strengthening change talk • Rolling with resistance • Developing a change plan • Consolidating commitment • Transition and blending

  26. Practice-based evidence • “Research makes clear that regardless of type or intensity of approach, client engagement is the single best predictor of outcome.” Orlinsky, Grawe, & Parks (1994)

  27. Practice-based evidence • Move away from diagnosis and program driven treatment towards individualized assessment-driven treatment. Dr David Mee-Lee (2006)

  28. Practice-based evidence • Instead of trying to “fit” clients into “fixed” treatment approaches via “evidenced-based practices”, work with individuals, by gathering ongoing feedback with regard to the process and outcome of care they receive and use this data to construct and guide services. Miller, Mee-Lee, Plum and Hubble (2005)

  29. MI & ME Tools • MI Assessment (MI Sandwich) • MI strategies during the 1st 20 min (building a bond with the client) • Agency intake or assessment (gathering essential information) • MI strategies during the last 20 min (summarizing and reconnecting with the client)

  30. Experience • Required training of outside program staff • No choice – where is that MI spirit? • Minimal influence with upper level staff on “how to do this” • Resistance

  31. Experience • Requiring a program to utilize MI as part of a package change • That’s not my role • I am not a counselor • I already know how to do reflective listening

  32. KIDS NOW Plus • Incentives to change: continued funding, reach higher risk pregnant women • Barriers to change: existing program good, minimal funds, adding a stronger tx focus, changes happened quickly • At what stage of change is the target audience: pre-contemplation to action

  33. How will the practice of those involved be affected by change: more involved in transfer to case manager, fewer Prevention activities • Can we identify the opinion leaders: two CMHC’s took lead in making changes, recognized the possibilities of reaching high risk women, flexible

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