Transcript Motivational Interviewing - Home | National Health Care

How to Keep Motivational Interviewing
(MI) Alive! Tools for MI Champions and
Supervisors
Stephanie Ballasiotes, M.C.
2 Steps Forward Training
National Healthcare for the Homeless Council
Regional Conference
July 12-13, 2012
Overview
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What us MI?
Why MI?
Before considering…
Post-Training blues: What now?
Why coaching and supervision is necessary
What we know works best for integrating MI into
agency practice
Examples
Hands on tools for on-site practice
Definitions of Motivational
Interviewing (MI) from MI-3
MI
is…
 a collaborative, goal-oriented style of communication
with particular attention to the language of change.
 designed
to strengthen personal motivation for and
commitment to a specific goal by eliciting and
exploring the person’s own reasons for change within
an atmosphere of acceptance and compassion.
Miller & Rollnick, 2011
Four Fundamental Processes
Planning
Evoking
Focusing
Engaging
Four Fundamental Processes
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Engaging our clients helps focus on what is important to
them
Focusing on what is important to them may evoke a
discussion about their own reasons for change
Evocative discussions about their own reasons for
change may lead to them planning change
Planning change leads to potential change
Yet what seems simple requires practice, patience and persistence!
Sballasiotes, MC., 2012
Adapted by Miller & Rllnick, 2011
Why MI?
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Programs often require or desire “evidence-based”
programs—funding based
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Evidence-based: Research shows better client
outcomes. If done right, it is effective
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Used in any setting/around the world
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Not just for work!
Why MI?
Training participants say….
o “I don’t have to work as hard to “fix” anyone
o “I am enjoying my job for the first time in a long
time
o “I don’t feel like I’m fighting all of the time with
my clients”
o “It isn’t rocket science isn’t rocket science: it’s
really common sense.
o “I realized it is not my responsibly to make them
change.”
o “It just makes sense—being respectful”
Practitioner
Organizational
Competency
support
Leadership
What is needed for full implementation?
Let’s imagine…
Learning
Opportunities to perform
Post-Training: What We Know
About Becoming Proficient
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2 to 3 days core training
Core training is not enough
Coaching and feedback is necessary
If none- after 6 months, return to initial
skill level
Practice does NOT make perfect--perfect practice does
Best Practice
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Coached/supervised by someone who can
demonstrate, knows it
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Consistent and regular
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Observation with feedback
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Identified goals that are challenging, but not too
challenging
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Agency culture that nurtures
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Some kind of evaluative process
Supervisor VS. Champion
Supervisor/supervision may involve some kind of
authority or influence
Performance reviews
Evaluation
But not always.
Yet is most experienced
“Champion” is someone who takes on keeping MI alive.
Sets up activities, exercises, videos, etc—may change
Does NOT have to be the most skilled or experienced.
Your Process
Engage : Have a conversation. Get to know them.
Tell me about what you do in your position at work?
Focus on what is important to them at work:
What would you like to see your agency change or do differently
regarding how they work/interact with clients?
Evoke a discussions about their own reasons for agency change:
What would you want your agency to consider changing,
modifying or improving how they work with clients
Planning change leads to potential change
What ideas do you have about how a change can begin?
Sballasiotes, MC., 2012
Adapted by Miller & Rllnick, 2011
It’s All Related!
Agency-Wide Involvement
Continued Training
Staff Satisfaction
Client Satisfaction
Supportive Agency Culture
On-Site Activities Examples
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Viewing video or Reading transcripts and “coding”
Peer Observation (or listening) with coding and/or
feedback
Group Coaching Series: Phone or live
Work Book Activities (Rosengren, D.B)
Group Practice: Real Play to Client Practice
Coding
Used for research, but also have clinical utility
 Way to identify and improve skills & provide
feedback
 Simple to begin
 Skills OARS-O
 Transcripts
 Videos
 Peer recordings
 Live
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Rosengren, D.B. (2009). Building Motivational
Interviewing Skills: A Practitioner’s Workbook. New
York: Guilford Press.
Demo
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What I did well. What resonated
with you/stood out
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Skills you identified congruent with
MI
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What would you like to see more
of?
Coaching & Feedback
Fundamental Skills Necessary When
Providing Feedback
Open-ended Questions
 Affirmations
 Reflections
 Summaries
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Offering Information
Fundamental, but not easy
Providing Feedback: PreObservation
Providing feedback should be a two-way
process
 Clarify WHY you are doing it.
 Clarify how the process will go ahead of time
 Share any forms you will be using while
observing mentees
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Providing Feedback
1. Allow enough time for observation and/or
feedback
2. Set the stage
o Create a safe and confidential space
o Discuss the process
o Ask permission to go forward
o Answer any questions
3. Be immediate-Give feedback as close to the time
of observation/performance as possible
Providing Feedback
4. Begin debrief: Person RECEIVING FEEDBACK talks
first
o “How do you feel it went?”
o “What went well?”
o “What would you do different next time?”
5. Be specific and provide example
o “I liked the reflection where you said…”
o “You did a great job the other day when you..”
Providing Feedback
6. Focus on behavior, not the person
o Quantity, quality
o Careful of assumptions and judgments
7. Avoid giving too much feedback
o no more than 2-3 areas of focus
8. Take a strength-based approach
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Encourage the increases of positive behavior
rather than decreasing less-positive behavior
Providing Feedback
9. Be curious and collaborative
o “How would it have be if you….?
o “What do you think about…?
o “I’m curious about…?
10. Avoid giving direct advice
o “You should try…”
o “The best approach for me is…”
o “You really need to…
Offering Feedback
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End with them
What questions do you have for me?
How was this process for you?
Value is in the relationship more than the
content!
You CAN play like this!
Resources
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Rosengren, D.B. (2009). Building Motivational Interviewing
Skills: A Practitioner’s Workbook. New York: Guilford
Press.
Arkowitz, H. Westra, H. Miller, W.R., & Rollnick, S. (2008).
Motivational Interviewing in the Treatment of Psychological
Problems. Guilford: New York.
Miller, W.R., & Rollnick, S. (2002). Motivational
Interviewing: Preparing People for Change. Guilford: New
York.
Training Tapes: MI Series
MI Website: www.motivationalinterview.org
Debrief
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One thing you learned (or relearned)
One thing that surprised you
One thing you will do differently