Transcript Slide 1

Sam Corneille
May 2015
What do you know about Motivational Interviewing?
Would it be OK if I told you a bit about how MI could help in ECI?
Thanks to David Manchester, Bill Miller, Stephen Rollnick
Introductions & a caveat
Sam
Clinical psychologist
Working for ADHC
Practitioner
Publications:
• Gumtree
• ADHC newsletter
What is Motivational Interviewing ?
• Motivational interviewing is a collaborative
conversation style for strengthening a
person’s own motivation for and commitment
to change
(Miller & Rollnick, 2013, p. 12).
• Motivational interviewing acknowledges stages
of change, readiness to change, and
ambivalence.
Motivational Interviewing: History
• MI originated as a precursor to
standard treatments for alcohol
problems.
• It has been used increasingly
as a stand alone treatment.
• It has also been adapted for
use with other health behaviour
change issues including smoking,
diabetes, substance use,
eating disorders, psychiatry.
What’s that got to do with Early Childhood Intervention?
Early Childhood Intervention
aims to ‘work in
partnership with parents,
families and significant
others to enhance their
knowledge, skills and
supports to meet the needs
of a child, optimise the
child’s learning and
development, and ability to
participate in family and
community life’
(ECIA NSW, August 2014, p.2)
What’s that got to do with Early Childhood Intervention?
Who has to make a behaviour change?
Parents:
‘For children with physical disabilities, the participation of their families
in home activity programs is key for successful therapy interventions.
Moreover, the active participation of parents during these activities
has demonstrated positive effects on the children’s Outcomes’
(Lillo-Navarro, et al., 2015, p.81)
Parents and educators:
Students benefit most from Speech-Language Therapy support
when consistent follow-up of their program occurs in the classroom
and at home. (http://education.qld.gov.au/studentservices/learning/disability/specialists/slt/)
Occupational therapists…consult with and provide resources
and training to school staff, parents and the school community
(http://education.qld.gov.au/studentservices/learning/disability/specialists/ot/)
What’s that got to do with Early Childhood Intervention?
How we doing with that?
‘…estimates of how many parents actually complete exercises with their children,
according to prescription, vary; they average around 50%’
(Lillo-Navarro, et al., 2015, p.81)
‘In summary, drop-out rates when reported were generally high across all clusters…’
(Wise, da Silva, Webster, & Sanson, 2005, p.11)
‘Drop-out rate from speech and language therapy is generally felt by therapists to be
high…31% of all new cases did not follow through the recommended treatment…’
(Gupta, 1994, p211)
‘An example of variation in retention rates is provided by a review of parenting
education programs by Assemany and McIntosh (2002) that reported dropout rates
ranging from 8 per cent to 48 per cent.’ (DEECD, 2011, p. 9)
Some examples of MI approach being applied in early
childhood areas
Occupational therapy:
With you, not against you: Applying motivational interviewing to
Occupational therapy in anorexia nervosa (Orchard, 2003) tutorial article
Exploring the impact of motivational interviewing techniques on
Caregiver perception and therapy home programming in occupational
therapy and physical therapy (McQuiddy & Roell, 2014) – preliminary evidence
to support the use of MI techniques in pediatric therapy practice
Family work/parenting:
The early childhood check up: A brief intervention for at-risk families
with preschool aged children (O’Leary, 2001)
parents in the intervention group were observed to use more
structure with their children and parental verbosity and permissiveness
also decreased
The application of motivational interviewing techniques for engaging
‘resistant’ families (Iannos & Antcliff, 2013) – tutorial article
Enhancing retention of foster parents: the role of motivational
interviewing (Cohen, 2010) – did reduce ambivalence, and increase commitment
Some examples of MI approach being applied in early
childhood areas
Speech Therapy:
Facilitating behavioural change in voice therapy:
The relevance of motivational interviewing (Behrman, 2006)
– MI holds promise as an approach to address adherence
to vocal behavioural change.
Motivational Interviewing: Practical strategies for speech-language
pathologists and audiologists (McFarlane, 2012) – tutorial article
Physiotherapy:
Motivational techniques for improving compliance with an exercise program:
Skills for primary care clinicians (Scales & Miller, 2003) – tutorial article
interest and
A systematic review of motivational interviewing within musculoskeletal health
(Chilton, Pires-Yfantouda, & Wylie, 2012) – positive effects on various domains of
treatment outcomes; but not consistent.
Motivational strategies for Physiotherapists (McGrane, Cusack, O’Donoghue, & Stokes, 2014)
tutorial article
How do people change?
The stages of change:
The Transtheoretical Model Prochaska & DiClemente (1983)
Stage
Definition
1. Precontemplation
A person that is not seeing a need for a
lifestyle or behaviour change
2. Contemplation
A person is considering making a change
but has not decided yet
3. Preparation
A person has decided to make changes
and is considering how to make them
4. Action
A person is actively doing something to
change
5. Maintenance
A person is working to maintain the
change or new lifestyle, possibly with
some temptations to return to the former
behaviour or small lapses
Supporting change
Some ideas from Motivational Interviewing:
•
‘when a helper uses a directing style and argues for change
with a person who is ambivalent, it naturally brings out the person’s
opposite arguments’ (Miller & Rollnick, 2013, pg.13)
•
Discord predicts lack of change.
•
’People are more likely to be persuaded by what they hear
themselves say’ (Miller & Rollnick, 2013, pg.13)
•
Confidence is a predictor of behaviour change
•
“The counsellor, doctor, or teacher also holds beliefs about a
person’s ability to change, and these beliefs can become self fulfilling
prophecies…a study in which patients were identified to staff as having
high potential for recovery (but were in fact just randomly assigned)
were significantly more likely to be sober and working a year after discharge”
(Miller & Rollnick, 2002)
Supporting change
Resist the righting reflex
Understand your client’s motivation
Listen to your client
Empower your client
The righting reflex – what not to do
Mrs Jones and a support worker
Mrs Jones: You are in two minds about sending little Jimmy to
preschool
Support worker: Ask Mrs Jones what she is in two minds about,
then…..
1.
2.
3.
4.
5.
Explain to Mrs. Jones why she should send little Jimmy to preschool
Give at least three specific benefits that would result from sending Jimmy to
preschool
Tell Mrs. Jones how to send Jimmy to preschool
Persuade Mrs. Jones to send Jimmy to preschool
If you meet reluctance, repeat the above.
Supporting change
Resist the righting reflex
Understand your client’s motivation
Listen to your client
Empower your client
RULE - An example
Resist the righting reflex
RULE - An example
Understand your client’s motivation
Sleep overs Partner for mum? Too old
Importance
Not at all
important
Very
Important
RULE - An example
Listen to your client
Because I’ve done it before
Confidence
Not at all
confident
Very
Confident
Rule – An example
Empower your client
Bath after
dinner
Stories at
bedtime
Reward
chart
Special
doona
Wanna try it? A taste of MI
Mrs Jones and a support worker
Mrs Jones: You are in two minds about sending little
Jimmy to preschool
Support worker:
1. Ask Mrs Jones what she is in two minds about and
then…
2. Ask Mrs Jones to explain why she should send Jimmy
to preschool
Interested in MI? Want to learn more?
www.motivationalinterview.org
www.mi-campus.com
FACS MI practice guide
http://www.adhc.nsw.gov.au/__data/assets/file/0007/30
1876/Motivational-Interviewing-Practice-Guide.pdf
FACS MI appraisal
http://www.adhc.nsw.gov.au/__data/assets/file/0006/30
1875/Motivational-Interviewing-Appraisal.pdf
Books
Miller, W. R., & Rollnick, S. (2013). Motivational
interviewing: helping people change (3rd ed.). New
York: The Guilford Press.
Rosengren, D. B. (2009). Building Motivational
interviewing skills: A practitioner workbook. New York:
The Guilford Press.
References
Behrman, A. (2006). Facilitating behavioral change in voice therapy: The relevance of motivational interviewing. American Journal of Speech Pathology, 15 (3), 215-225.
Chilton, R., Pires-Yfantouda, R., & Wylie, M. (2012), A systematic review of motivational interviewing within musculoskeletal health. Psychology, Health and Medicine, 17 (4),
392-407.
Cohen, J. L. (2010). Enhancing retention of foster parents: The role of motivational interviewing. Thesis, The University of Arizona Campus Repository. Retrieved from
http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCwQFjAB&url=http%3A%2F%2Farizona.openrepository.com%2Farizona%2Fbitstrem
%2F10150%2F195528%2F1%2Fazu_etd_11159_sip1_m.pdf&ei=yThUVbv_EIKhmgWM8YDACA&usg=AFQjCNGoaWnaJivGtQieuUVZwRSnZc-zEQ&bvm=bv.93112503,d.dGY
Department of Education and Early Childhood Development (2011). Parental engagement – A review of the literature. Retrieved from
www.education.vic.gov.au/Documents/about/.../parentalengagelitrev.pdf
ECIA NSW (August 2014). Early childhood intervention best practice discussion paper. Early Childhood Intervention Australia NSW Chapter.
Gupta, A. F. (1994). The Step-tongue: Children's English in Singapore. Avon: Multicultural Matters Ltd.
Iannos, M., & Antcliff, G. (2013). The application of motivational interviewing techniques for engaging “resistant” families. Australian Institute of Family Studies. Retrieved from
https://www3.aifs.gov.au/cfca/publications/application-motivational-interviewing-techniques
Leake, G. J., & King, A. S. (1977). Effect of counselor expectations on alcoholic recovery. Alcohol Health and Research World, 1 (3), 16-22.
O’Leary, C. C. (2001). The early childhood family check up: A brief intervention for at-risk families with preschool children. Thesis. Retrieved from
http://www.motivationalinterviewing.org/content/early-childhood-family-check-brief-intervention-risk-families-preschool-aged-children
Lillo-Navarro, C., Medina-Mirapeix, F., Escolar-Reina, P., Montilla-Herrador, J., Gomez-Arnaldos, F., & Oliveira-Sousa, S. L. (2015). Parents of children with physical disabilities
perceive that characteristics of home exercise programs and physiotherapists’ teaching styles influence adherence: A qualitative study. Journal of Physiotherapy, 61,
81-86.
McFarlane, L. (2012). Motivational Interviewing: Practical strategies for speech-language pathologists and audiologists. Canadian Journal of Speech-Language Pathology and
Audiology, 36 (1), 8-16.
McGrane, N., Cusack, T., O’Donoghue, G., & Stokes, E. (2014). Motivational strategies for Physiotherapists. Physical therapy Reviews, 19 (2), 136-142.
McQuiddy, V., & Roell, E. (2014). Exploring the impact of motivational interviewing techniques on caregiver perception of therapy home programming in occupational therapy and
physical therapy. Paper presented at the AOTA Conference, Baltimore, MD.
References
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: helping people change (3rd ed.). New York: The Guilford Press.
Orchard, R. (2002). With you, not against you: Applying motivational interviewing to occupational therapy in anorexia nervosa. British Journal of Occupational Therapy,
66, 325-328.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self- change of smoking: Toward an integrative model of change. Journal of Consulting and
Clinical Psychology, 51 (93), 390-395.
QLD Department of Education and Training. Speech-language therapy: Information for parents and carers. Retrieved from
(http://education.qld.gov.au/studentservices/learning/disability/specialists/slt/)
QLD Department of education and Training. Educational Queensland Occupational therapy services information brochure. Retrieved from
http://education.qld.gov.au/studentservices/learning/disability/specialists/ot/
Scales, R., & Miller,J. H. (2003). Motivational techniques for improving compliance with an exercise program: Skills for primary care clinicians. Current Sports Medicine
Reports, 2, 166-172.
Wise, S. da Silva, L., Webster, E., & Sanson, A. (2005). The efficacy of early childhood interventions. Retrieved from
www.aifs.gov.au/institute/pubs/resreport14/aifsreport14.pdf