Motivating Change Towards Employment Using the Stages of Change Model

1. Motivating Change Towards Employment Using the Stages of Change Model

2. Contents Introduction Project Background Research Partnerships Outputs: Present and Future

3. Introduction Opportunities for Employment Inc… • A private not-for-profit employment assistance services agency • 98% government funded • Incorporated in 1996 • 37 staff in two locations in Winnipeg • Have assisted over 6,000 people find meaningful employment in the last 12 years • 2300/year come through intake

4. Introduction Opportunities for Employment Inc… • Provides services to unemployed Winnipeg residents. • Our services include employment consultation, skill development and life skills training. • Specializes in serving marginalized, unemployed, low income people with multiple barriers to employment.

5. Project Background The Need: • Organizations that assist unemployed low-income individuals prepare for, find and keep meaningful employment, experience: • High program drop out rates of 25%-50% after first contact • A disconnect exists between the actual need and • the service offered, this is very demoralizing and discouraging for participants and staff.

6. Project Background The Need: • Identified a need to address motivation prior to engaging individuals in job search activities. • Immediate engagement in employment assistance services, results in an ineffective use of resources and high program attrition rates.

7. Project Background Employment Service Providers must: • Develop new ways to assist clients with multiple barriers to employment. • Address the client’s readiness for change. • Work with people where they are at.

8. Project Background Research Priorities: • Explore new and creative untested approaches. • Maximize the labour market participation of the currently underemployed or under-represented groups through the removal of barriers.

9. Project Background Opportunities for Employment Inc. (OFE) has conducted 22 months of research within a three-year study (Feb 2007 – Jan 2010) using Stages of Change Model and Motivational Interviewing Funding for the Stages of Change Research Study is provided by: The Government of Canada The Manitoba Government

10. Project Background This study uses a previously untested approach to increase the labour market participation of those currently underemployed or unemployed by addressing motivation and readiness to change. This research project also focuses on addressing and removing barriers to employment faced by individuals receiving income assistance and other under-represented labour market groups.

11. Project Background Test Question: “As compared to a control group, how does the application of Transtheoretical Model of Change and Motivational Interviewing to employment development, impact participants’ (study group) movement within the Stages of Change; will it result in… • decreased program attrition, • increased employment rates, and • increased employment retention rates?”

12. Project Background Primary Participant Demographic: • Chronically unemployed • Clients of First Nation, Métis, Inuit, or non-status descent (58%) • Single Parents (mostly women) • Clients with significant and multiple barriers to employment • Persons with disabilities • Ex-offenders • Newcomers to Canada • Youth (18-29 years of age)

13. Project Background Participant Assignment: Participants volunteering to take part in the research study were randomly assigned to either a study group or control group. During the course of the research project, over 2,400 individuals will take part in this exciting opportunity.

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22. Recycling • An important concept that underlies this understanding of change is the acceptance that people rarely start at one point and progress through the Stages of Change without interruption. • Such interruptions or setbacks are referred to as Recycling… • And viewed as normal and not viewed as failure.

23. Recycling • Individuals may be identified as Recycling by behaviours such as: • Poor attendance • Missed appointments • or perhaps a change in the level of job search activity

24. Activity • Let’s get moving… It’s your turn!

25. “You know, I’ve lost two uncles to lung cancer, and now I’ve lost my dad. I have got to quit. I’ve been reading some information on the Patch. This pack of cigarettes is my last pack, them I’m done.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

26. “I can’t believe how much weight I have lost! I’ve been on this diet for almost a month and I’m up to three days a week at this gym. I’m really getting into this!” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

27. “Jumping through hoops is not going to make any difference in my life. I know what I need to do, and I’ll do it when I’m good and ready.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

28. “I guess those are some things I haven’t thought about before. I’m not saying I agree with you, or that I am going to enter treatment, but I’ll think about what you said.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

29. “There is no way I am taking that medication. I know what kind of crap that does to your head. There is nothing you can do to help me or fix me.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

30. “Are you kidding me? It’s been a year since I’ve started counseling? I guess I have been leading my AA group for over a year, too. I’ve felt so good and life has been going so well that I haven’t seriously even considered drinking for a long time.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

31. “Well, I was discharged 10 days ago. I have been taking my meds ever since, and I have made it to both of my counseling appointments.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

32. “I am going to do it. I am going to start working out if it kills me. I’ve called 24-Hour fitness, I’ve figured out the times of the week I can workout, and now I’m just looking for a workout partner.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

33. “I’ve dropped those twenty pounds I wanted to! I’m still walking every night after dinner, I’m great at counting calories, and I let myself cheat two meals a week. This has been a great year.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

34. “Will this really help me get my kids back? I really can’t take the time off work for inpatient treatment, but I’ll consider it if it will help me get my kids. Are there any other options that would help?” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

35. “Our foster daughter gets discharged next Thursday. We have met with her teachers, put an alarm on her door, and we have respite set up on weekends. I think we are ready to try this foster parenting thing with her again.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

36. “All I hear about are those horrible side effects. I will quit taking that medication if I have those crazy things happen to me. Do you really think it will help?” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

37. “Marijuana should be legal anyway. Everybody smokes it and I just sell enough to make a little spending money. It’s not like I’m some addict or some major drug dealer.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

38. “My son has been home for six months now, and I feel really good. Those Motivational Interviewing classes really helped my parenting. I just got my one year coin in AA and I’m co-leading a meeting with my sponsor. It’s hard to believe, but I actually like going to work now.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

39. “I hate it, but I’m not talking with my old friends. I don’t like those AA meetings either. I haven’t smoked weed or drank in almost two months. At least some of my memory is coming back.” • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

40. Assessment Tool During a one-on-one intake process, an assessment is done with the participant. The tool we use is a modified version of the University of Rhode Island Change Assessment scale (URICA), there are 12 questions asked using a 5pt Likert scale. Participants are then referred to an intervention based on the readiness to change score.

41. SOC Model Stage Indicators: Each stage has identifiable indicators based on behaviours or attitudes.

42. Stage 1 Pre-Contemplation: • Not thinking about getting a job • Doesn’t see a benefit to working in relation to earning an income • Working isn’t relevant • Feeling defensive towards those that intervene • Uninformed or under informed about consequences of not working • Usually referred by others • See others as having a problem • May feel demoralized

43. Stage 2 Contemplation: • Thinking about working (but feel ambivalent) • Working may be relevant • May see some benefit from obtaining employment • Needs help to figure out what having a job would mean for them • May experience a feeling of being “stuck” • Experiences fear of failure and fear of the unknown • May begin to speak of perceived barriers to employment

44. Stage 2 Contemplation: • May be eager to talk in order to explore and fully understand their present state • High levels of anxiety • Low self-efficacy • Willing to weigh the pros and cons of change in order to make a decision • May start to think more of the future than the past

45. Orientation Pre-Contemplation and Contemplation: Workshop One • This three-hour workshop is designed for participants who are identified, as not be being “ready, willing and able” to obtain and sustain employment. • Participants will be introduced to the concept of the six Stages of Change. • Using a decisional balance exercise, participants will explore, as part of a group, the advantages and disadvantages of being employed and unemployed.

46. Orientation Pre-Contemplation and Contemplation: Work Readiness Orientation One • Other activities used is emotional arousal (videos), consciousness raising (to increase one awareness of self and the need to change), and self revaluation (to examine one’s own attitudes and behaviours) • The workshop focuses on feelings of ambivalence and what it feels like to feel two ways about working. • Assessment is done at the end of the workshop, the result of the assessment will determine what intervention the participant will go to next.

47. Orientation Pre-Contemplation and Contemplation: Workshop Two • Participants will engage in this three-hour workshop based on referral according to their self-assessment score obtained at the end of Workshop One. • This workshop further explores feelings of ambivalence that are common in the Stages of Change cycle.

48. Orientation Pre-Contemplation and Contemplation: Workshop Two • This session expands on the concepts of emotions, stress, self-efficacy, and the importance of self-confidence as related to change and to employment. • It also includes a SOC self-assessment.

49. Orientation Preparation: Workshop Three • This three-hour workshop reviews and builds on the SOC concepts introduced previously, for those that attended Workshops 1 & 2, and introduces them for the first time for those that come to intake in Preparation • Focuses on reinforcing the decision made to move towards engagement in the labour force. • SOC concepts utilized in this workshop include helping relationships, countering, and commitment.

50. Psycho-Therapy Pre-Contemplation and Contemplation: Motivational Interviews • Motivational Interviewing (MI), developed by Miller and Rollnick (1991), is defined as a client-centered, directive counselling method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. • It focuses on the person’s current interests and concerns and it is consciously directive in that the interviewer elicits and selectively reinforces change talk and also responds to resistance in a manner intended to extinguish it.