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 CouncilRegional Conference

July 12-13, 2012

Overview 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

Engaging

Focusing

Evoking

Planning

Four Fundamental Processes

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., 2012Adapted by Miller & Rllnick, 2011

Why MI?

Programs often require or desire “evidence-based” programs—funding based

Evidence-based: Research shows better client outcomes. If done right, it is effective

Used in any setting/around the world

Not just for work!

Why MI?Training participants say….

o “I don’t have to work as hard to “fix” anyoneo “I am enjoying my job for the first time in a long timeo “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”

Organizational

support

Practitioner

Competency

Leadership

What is needed for full implementation?

Let’s imagine…

Learning

Opportunities to perform

• 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

Post-Training: What We Know About Becoming Proficient

• Coached/supervised by someone who can demonstrate, knows it

• Consistent and regular

• Observation with feedback

• Identified goals that are challenging, but not too challenging

• Agency culture that nurtures

• Some kind of evaluative process

Best Practice

Supervisor VS. ChampionSupervisor/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 ProcessEngage : 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., 2012Adapted by Miller & Rllnick, 2011

It’s All Related!

Staff Satisfaction

Client Satisfaction

Continued Training

Supportive Agency Culture

Agency-Wide Involvement

On-Site Activities Examples 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

Rosengren, D.B. (2009). Building Motivational Interviewing Skills: A Practitioner’s Workbook. New York: Guilford Press.

• What I did well. What resonated with you/stood out

• Skills you identified congruent with MI

• What would you like to see more of?

Demo

Coaching & Feedback

Fundamental Skills Necessary When Providing Feedback

Open-ended Questions Affirmations Reflections Summaries Offering Information

Fundamental, but not easy

Providing Feedback: Pre-Observation

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

Providing Feedback1. Allow enough time for observation and/or feedback

2. Set the stageo Create a safe and confidential spaceo Discuss the processo Ask permission to go forwardo Answer any questions

3. Be immediate-Give feedback as close to the time of observation/performance

as possible

Providing Feedback4. 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 exampleo “I liked the reflection where you said…”o “You did a great job the other day when you..”

Providing Feedback6. Focus on behavior, not the person

o Quantity, qualityo Careful of assumptions and judgments

7. Avoid giving too much feedbacko no more than 2-3 areas of focus

8. Take a strength-based approacho Encourage the increases of positive

behavior rather than decreasing less-positive behavior

Providing Feedback9. 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 adviceo “You should try…” o “The best approach for me is…”o “You really need to…

Offering Feedback

11. End with themo What questions do you have for me?o How was this process for you?

Value is in the relationship more than the content!

You CAN play like this!

Resources

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 One thing you learned (or relearned) One thing that surprised you One thing you will do differently