Using Motivational Interviewing with Juvenile Offenders

Joan Leary, LPCjleary@uab.edu

May 7, 2014National TASC Conference

Experts in Audience

• YEARS IN FIELD• POPULATION I WORK WITH• What do I know about MI? 0……………10• Glean from today’s workshop?

• DO I CONSIDER MYSELF AMENABLE OR RESISTANT TO CHANGE?

Juvenile Arrest Rates

Frustrations with Juvenile Offenders?

• Failure to comply• “Back talk” _______________• Disrespect/defiance _______________• Tired of arguing and convincing• No follow through• “Know it alls”• Burn-out• Paperwork

Approach

• Harsh verbal discipline increases the likelihood that teens will misbehave and exhibit symptoms of depression.

• Teens are more likely to exhibit problem behaviors such as anger, aggression, vandalism and misconduct. Wang et al.

MI

• is adapted to each individual and the specific behavioral problems that the individual

presents • it is a collaborative effort between the

therapist/PO/case manager and the individual to identify and forge a path to

behavioral change using the client’s own motivations

WHO, What, When, Where?

The concept of motivational interviewing evolved from experience in the treatment of problem drinkers, and was first described by Miller (1983) in an article published in Behavioural Psychotherapy

30 yrs later- MI has Exploded!

Definition

• A person centered, goal directed method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

Motivational Interviewing

• Encourages positive behavior change in offenders

• Evidence based practice

What is Motivation?• Process that initiates, guides and maintains

goal-oriented behaviors, which cannot be forced

• The reason or reasons one has for acting or behaving in a particular way

• Cannot be given to someone• About the choices we make/don’t make• Variable with different times/situations

Motivation is NOT a Personality Problem or trait

• Motivation is a STATE of readiness or eagerness to change

• It may fluctuate from one time to another or situation

• It CAN be influenced

Client Motivation

• READY: right time to make a change• WILLING: person themself makes a decision• ABLE: confidence to change

How?

• Do you motivate a client to change a pattern of destructive behavior?

• Do you help someone to stop offending and committing anti-social acts?

• Do you motivate a client to keep appointments, participate in programs etc?

The Nature of Our Interactions• When your objective is to change a person’s

behavior, what style works best? – Confrontation– Demonstrating our power over someone– Lecturing– Demanding– Cheer-leading– Pleading– Begging – Bribing– Shaming

More Effective Approach

• Helping the person to appreciate the value in changing themselves.

• Sparking Intrinsic motivation

An Effective Style

Is NOT• Confrontational• Blaming• Hostile• Demanding• Commanding• Wishy-washy• Non-Direct• Non-specific• Unclear• Touchy-feely• Sympathetic• Parenting• Friend

IS• Empathic• Genuine• Honest• Supportive• Trustworthy• Solution-focused• Fair• Consistent• Contingency Based• Interested• Non-argumentative• Non-judgmental• Respectful

Helping Change Occur

• Interviewing style is a significant factor in dropout, retention, adherence and outcomes.

• Individuals who believe they can and will change (self-efficacy) do change.

• Officers/practitioners who believe their clients can and will change, influence them positively to do so.

Enhance Intrinsic Motivation

• Staff should relate to offenders in interpersonally sensitive and constructive ways to enhance intrinsic motivation in offenders.

• Research strongly suggests that motivational interviewing techniques, rather than persuasion tactics, effectively enhance motivation for initiating and maintaining behavior changes.

Listening Matters

What doesn’t work! - Famous programs based on flawed theories/models

Scared Straight – deterrence theory; “make them fear prison.”o Nearly every study over the past 25 years has found dismal results, many even showing

higher recidivism rates for Scared Straight participants. Has been characterized as criminal justice malpractice.

Drug Abuse Resistance Education (DARE) – didactic model; “kids don’t know drugs are bad for them.”o Most studies have found neutral effects for DARE. More recent versions of DARE,

based upon cognitive-behavioral principles, have been more promising

Sheriff Joe Arpaio’s (Maricopa County Jail, Arizona) Tent Cities and Chain Gangs – more deterrence theory; “make them hate prison.”o By the jail’s own admission, its recidivism rate exceeds 60 percent.

NIJ

Ambivalence

is a normal part of considering and making change and is

NOT pathological.

Smoking cessation

Weight loss

Alcohol use

Drugs

NutritionExercise

Therapy

Balance

WorkHIV

Teens

Where is MI Used?

Prevention

Condom use ART

Therapy

MD appts

Medication compliance

Stress

Healthcare

Corrections

Why Use MI in Corrections?

• Helps to get offender to be honest/open in assessment process

• Helps create a more engaging environment with less defensiveness from offender

• Elicits more accurate information which aids in determining– Supervision levels -Placements– Types of treatment

Paradigm Shift

• Gone are the days of;– Shouting insults at offenders– Denial busting– “Alcoholics are liars”– Abusing addicts because it was “good for them”– Confrontation and polarization

– 20 yrs ago a punitive, moralistic and arrogant stance was common in U.S. treatment

Hierarchical Environment

• Corrections staff often use;• Coercive power• Authority• Dynamics which increase defensiveness and

resistance

MI

• More collaborative• More respectful• Supportive• Directive

Simpler Definitions

• 1. It’s a way of using questions and statements strategically to help people think and talk in a positive direction.

Simpler Definitions

• 2. It’s a way of helping people find their OWN reasons for change.

Spirit of Motivational Interviewing

• Collaboration• Evocation• Autonomy

5 MI Principles

• 1. Express empathy• 2. Develop discrepancy• 3. Avoid argumentation• 4. Roll with resistance• 5. Support self efficacy

4 Fundamental Processes in MI

•1. Engaging – The Relational Foundation•2. Focusing – The Strategic Focus•3. Evoking – The Transition to MI• 4. Planning – The Bridge to Change

“Changes attributed to oneself are more likely to endure.”

Davison, Tsujimoto & Glaros, 1973

Rolling with Resistance“Discord””

• Like Verbal Martial Arts• Resistance is not challenged• Use the client’s energy to take you where you want

to go• Decreases the client’s tendency to play devils

advocate

Roll with Resistance/Discord

• Opposing resistance can reinforce it• Counselor/interviewer rolls or flows with it• Reluctance & ambivalence are acknowledged

as normal & understandable• Interviewer invites client to consider new

information or ways of thinking about things

• Our desire to fix people and set them on a better course

Righting Reflex

Righting reflex

Argument for the change• Change is important because..• You should change…• Drinking is serious you need

to quit.• Your baby is going to be

impaired due to your drug use.

• DHR will take your kids away..

Argument against the change

• I don’t want/need to change

• You don’t know me…• No I shouldn’t…• I don’t have a

problem…• Yes, but…

Counselor Client

Sustain Talk

• “Who are you to tell me what to do?

• ” I’m not going to do it and no one can make me.”

• Status quo• We blame client for

being difficult• One side of

ambivalence

Learning is not a one-way "push" model.

http://headrush.typepad.com/creating_passionate_users/2006/01/crash_course_in.html

“ASK”ratherthan“TELL”

Confrontation

• A confrontational and directive approach may = more client resistance

• May lead to poorer client outcomes• 1993, Miller study found, the more a client

was confronted the more alcohol the client drank

• Confrontational counseling included; challenging, disputing, refuting and sarcasm

ASSESS Offender

• URICA• Prochaska and DiClemente’s Stages of Change• Most change happens slowly

– Offenders may make small incremental positive steps toward change

Stages of Change

From DOC

• Motivational Interviewing principle is– Listening to offenders and following up on positive

aspects of their speech– Awareness that corrections professionals can help

INCREASE an offender’s motivation– Positive behavior changes are possible which

reduce likelihood of re-offending

Goal

• The interviewer/case manager/PO must have a GOAL in mind;– a GOAL of “Directed change”

• Not just talking/chatting with offender but have an intention in helping the offender set and achieve positive life changes

Win/Win

• Secure compliance/impose sanctions+

• Increase readiness to change/establish a helping relationship

=Behavior Change

=Better outcomes

Participants

• How might an increased motivation for change from the offender

BENEFIT YOU in your job??

Considerations

• 1) offender be more involved in making life changes

• 2) we won’t force change on the offender• 3) we will have less burn-out• 4) more sustained change likely when a person

makes their own decision

Motivational Interviewing is;

• NOT about forcing change• Is about encouraging the use of self-

perception• Using open-ended questions to generate a

DESIRE for change

1..2..3..4..5..6..7..8..9..10

How important is it for you to make a change? How confident are you that you are going to be able to change?

Scaling Ruler

MI

• Use your acute listening skills• Careful listening• Listening for meaning• Building upon cues heard from client

MAKING REFLECTIVE STATEMENTS:

• repeat –rephrase –paraphrase – or make reflective summary

statements of what the client said

Group Exercise• Pick one speaker and one listener (switch roles)• Pick a topic you would like to change (something you

are ambivalent about)

• Listener– Give no advice– Ask these questions

• 1) Why would you like to make this change?• 2) How might you go about it, in order to succeed?• 3) What are the best reasons to do it?• 4) On a scale of 1-10, how important is it to you?• 5) why are you at __ and not __?

Roles

• Do we often give advice?• Do we tell the clients what to do?• Do we make suggestions?• Do we make threats?

Benefits When Using MI

• Clients feel– Heard– Like they are really being listened to– Understood– More like being open– More safe– More empowered– More free to be honest

MI

• Is built on internal desire for change• We can’t force change to happen!• We don’t have all the answers/all of the

time• Ex; we tell offenders they can’t leave the

county, when in actuality they can do whatever they please, but if they make the wrong choices they may experience consequences.

MI Interviewing Relationship w/Offender

• Is more like a DANCE

• NOT a Wrestling match

You as a GUIDE

• A guide to motivate offender to change• You will point out pitfalls of poor decisions

• But the offender ultimately– Makes his/her own decisions

MI

• Changes the process• Instead of telling the offender what to do,

• We listen for the offender to express a need for change, and then we capitalize on it.

3 aspects of a successful MI interview

• 1) collaborative– Not authoritative– Is a “partnership”– Team approach

– Example, Not- “I have what you need.”» But- “You have what you need and I’m

going to help you find/access it.”

2.) Evocative statements are part of a successful MI interview

• It promotes self-discovery• Offenders see problems through their own

eyes

3.) AutonomyWhat can we do?

• 1. How can we help facilitate change?• 2. What kinds of things can we say to get

client “buy-in?”• 3. What do we say that might encourage client

momentum towards change?

We Use MI Techniques

• Open ended questions• Listen reflectively• Develop discrepancy/dissonance• Support self-efficacy• Roll with resistance; deflection• Avoid argument, lecture, shaming, threats or

sympathizing

Video Clip

• http://nicic.gov/MotivationalInterviewing

Traps to Avoid

Traps to Avoid

1. Question-Answer Trap– Stifles client elaboration– Reduces collaborative effort

2. Taking Sides Trap– The most important trap to avoid– Arguing one side elicits the other

Traps to Avoid

3. Expert Trap– The client is the expert on themselves– Opinions will come later

4. Labeling Trap– Pressure to label can lead to wrestling– Data does not support need to accept label

Traps to Avoid

5. Pre-mature Focus Trap– May elicit dissonance– Start where client is…

6. Blaming Trap– Render blame irrelevant in the counseling context. – “[Counseling is not about deciding who is at fault. That’s

what judges do, but not good counselors.”

Eliciting & Responding toChange Talk

Change Talk is the river on which we row.

What is Change Talk?

Clients are more convinced by arguments they have presented to themselves more so than arguments presented by others.

In MET we strive to elicit their own arguments for change and the value in such change.

Change Talk Model (2.0)

DesireAbilityReasonNeed

Commitment}

DARN-C

• Desire to change:– I want a better life.– I would like to be happier.– I want to stop using.

• Ability to change:– I could do it if I decided to.– When I put my mind to something, I don’t quit until I’m

done.– If I could give up drinking, I could quit weed too.

DARN-C

• Reasons to change:– I would get to see my family.– They would send me home.– I would have some money.– I’d feel a lot better.

• Need to change:– I got to get out of jail.– I need to stop hurting other people.– I have to go to group.

DARN-C

• Desire: Why would you want to make this change?

• Ability: How would you do it if you decided? • Reason: What are the three best reasons? • Need: How important is it? and why? • Commitment: What do you think you’ll do?

Benefits/Pros Costs/Cons

Making a Change

Not Making a Change

Decisional Balance

Change Plan Worksheet

1. The changes I want to make (or continue making) are:

2. The reasons why I want to make these changes are:

3. The steps I plan to take in changing are:

4. The ways other people can help me are:

5. I will know that my plan is working if:

6. Some things that could interfere with my plan are:

7. What I will do if the plan isn’t working:

Resources

• Impact: Motivational Interviewing, Innovation Means Prisons and Communities Together, EU

• NAADAC.org• NIC, “Motivational Interviewing in Corrections: A comprehensive Guide to

Implementing MI in Corrections”• SAMHSA Gains Center, 2011 “Motivational Interviewing”• William Miller, Motivational Interviewing,” 3rd Edition• www.offenderchange.org/programs/motivational-interviewing• www.buildmotivation.com• http://aspe.hhs.gov/hsp/08/boys/FactSheets/