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Motivational Interviewing

MI Introduction.

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Motivational Interviewing

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    1. The Divison of Mental Health and Substance Abuse Motivational Interviewing An Evidence-based Practice By Jean Henry, LCSW Suzanne Carrier, LCSW

    2. MI Introduction “ Motivation is a state of readiness or eagerness to change which may fluctuate from one time or situation to the another” Ray Gingerich

    3. MI Introduction Motivational Interviewing is a set of principles, philosophies and techniques that assist the helper in engaging the client in the process of change. MI is client-centered, integrates well with other methods, effective with a diverse array of problems and increases understanding about the client’s perception and willingness to enter the treatment process.

    4. The Spirit of Motivational Interviewing Autonomy Collaboration Evocation Empathy

    5. The Spirit of MI A way of being with people.

    6. The Principles of MI Roll with Resistance Enhance Empathy Develop Discrepancy Support Self-Efficacy

    7. Key Techniques of MI Open-Ended Questions Affirmations Reflections Summaries

    8. How to implement MI Support from Leadership Assess readiness of staff Investment of training Practice, Practice, Practice Supervision Practice based evidence

    9. Miller, Sorensen, Selzer & Brigham (2006) Support from Leadership MI Works Clinicians respond more favorably to guidelines based on principles and procedures rather than session-by session prescription of content.

    10. NIDA & SAMHSA blending initiative (2006) Support From Leadership “One session of MI improved retention: Clients who received one MI session were more likely to continue to engage in treatment one month later and to have attended more session than clients who received treatment as usual.”

    11. Effects of Brief Motivational Intervention with College Student Drinkers Borsari & Carey, 2000; Journal of Consulting & Clinical Psychology, 68:728-733 Design Randomized clinical trial Population Binge drinkers Nation US (Syracuse, NY) N 60 college students MI 1 session MET Comparison Assessment only Follow-up 6 weeks Effects of a brief motivational intervention with college student drinkers.Author(s):Borsari, Brian, Syracuse U, Dept of Psychology, Syracuse, NY, US Carey, Kate B.Source:Journal of Consulting and Clinical Psychology, Vol 68(4), Aug 2000. pp. 728-733. Journal URL: http://www.apa.org/journals/ccp.html Publisher:US: American Psychological Assn Publisher URL: http://www.apa.org ISSN:0022-006X (Print)Digital Object Identifier:10.1037/0022-006X.68.4.728 Language:EnglishKeywords:brief motivational feedback intervention, treatment outcomes, college student binge drinkers, 6 wk followupAbstract:This study consisted of a randomized controlled trial of a 1-session motivational intervention for college student binge drinkers. Sixty students who reported binge drinking 2 or more times in the past 30 days were randomly assigned to either a no-treatment control or a brief intervention group. The intervention provided students with feedback regarding personal consumption, perceived drinking norms, alcohol-related problems, situations associated with heavy drinking, and alcohol expectancies. At 6-week follow-up, the brief intervention group exhibited significant reductions on number of drinks consumed per week, number of times drinking alcohol in the past month, and frequency of binge drinking in the past month. Estimates of typical student drinking mediated these reductions. This study replicates earlier research on the efficacy of brief interventions with college students and extends previous work regarding potential mechanisms of change. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)Effects of a brief motivational intervention with college student drinkers.Author(s):Borsari, Brian, Syracuse U, Dept of Psychology, Syracuse, NY, USCarey, Kate B.Source:Journal of Consulting and Clinical Psychology, Vol 68(4), Aug 2000. pp. 728-733.Journal URL: http://www.apa.org/journals/ccp.html Publisher:US: American Psychological AssnPublisher URL: http://www.apa.org ISSN:0022-006X (Print)Digital Object Identifier:10.1037/0022-006X.68.4.728 Language:EnglishKeywords:brief motivational feedback intervention, treatment outcomes, college student binge drinkers, 6 wk followupAbstract:This study consisted of a randomized controlled trial of a 1-session motivational intervention for college student binge drinkers. Sixty students who reported binge drinking 2 or more times in the past 30 days were randomly assigned to either a no-treatment control or a brief intervention group. The intervention provided students with feedback regarding personal consumption, perceived drinking norms, alcohol-related problems, situations associated with heavy drinking, and alcohol expectancies. At 6-week follow-up, the brief intervention group exhibited significant reductions on number of drinks consumed per week, number of times drinking alcohol in the past month, and frequency of binge drinking in the past month. Estimates of typical student drinking mediated these reductions. This study replicates earlier research on the efficacy of brief interventions with college students and extends previous work regarding potential mechanisms of change. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)

    12. Brief MI with College Students

    13. Brief Intervention for Alcohol Positive Older Adolescents  in an Emergency Room Monti, et al.,1999; Journal of Consulting and Clinical Psychology, 67:989–994. Design Randomized clinical trial Population Emergency room Nation US (Providence, RI) N 94 adolescents (18-19) MI 1 session (35-40 min) Comparison Standard care Follow-up 6 months

    14. Brief Intervention in  Emergency Room

    15. Brief Intervention for High-Risk College Student Drinkers: 2-year Follow-Up Results Marlatt et al., 1998; Journal of Consulting and Clinical Psychology, 66:604-615 Design Randomized clinical trial Population College students Nation US (Seattle, WA) N 348 heavy drinkers MI 1 individual session Comparison Assessment only Follow-up 2 years Screening and brief intervention for high-risk college student drinkers: Results from a 2-year follow-up assessment.Author(s):Marlatt, G. Alan, U Washington, Dept of Psychology, Seattle, WA, US Baer, John S. Kivlahan, Daniel R. Dimeff, Linda A. Larimer, Mary E. Quigley, Lori A. Somers, Julian M. Williams, EllenSource:Journal of Consulting and Clinical Psychology, Vol 66(4), Aug 1998. pp. 604-615. Journal URL: http://www.apa.org/journals/ccp.html Publisher:US: American Psychological Assn Publisher URL: http://www.apa.org ISSN:0022-006X (Print)Digital Object Identifier:10.1037/0022-006X.66.4.604 Language:EnglishKeywords:brief intervention for harmful consequences of heavy drinking, high-risk college student drinkers, 2 yr followupAbstract:This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)Screening and brief intervention for high-risk college student drinkers: Results from a 2-year follow-up assessment.Author(s):Marlatt, G. Alan, U Washington, Dept of Psychology, Seattle, WA, USBaer, John S.Kivlahan, Daniel R.Dimeff, Linda A.Larimer, Mary E.Quigley, Lori A.Somers, Julian M.Williams, EllenSource:Journal of Consulting and Clinical Psychology, Vol 66(4), Aug 1998. pp. 604-615.Journal URL: http://www.apa.org/journals/ccp.html Publisher:US: American Psychological AssnPublisher URL: http://www.apa.org ISSN:0022-006X (Print)Digital Object Identifier:10.1037/0022-006X.66.4.604 Language:EnglishKeywords:brief intervention for harmful consequences of heavy drinking, high-risk college student drinkers, 2 yr followupAbstract:This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)

    16. Brief MI for College Students: 2-year Follow Up

    17. Motivational Interviewing and HIV Prevention Two trials of an motivational interview based intervention for HIV risk reduction in a high-risk population, conducted through community-based organizations.

    18. Motivational Interviewing and HIV Prevention Immediate effects that were observed: Increased knowledge of HIV risk Stronger intentions to adopt safer sex practices Intentions communicated to sexual partners Fewer acts of unprotected sex Effects were mostly sustained at a three-month follow up. Effects were partially replicated in a second field trial by a 4 time increase in condom use. Women were also more likely to: Discuss HIV and condom use with partners Refuse unprotected sex Get an HIV test

    19. Thevos et al, 2000 Health Promotion International, 15:207-214 Design Comparison zones Population Households Nation Zambia, Africa N 332 households MI Health visitor consults Comparison Health education Follow-up 6 months

    20. Thevos et al., 2000

    21. Meta-analysis motivationalinterviewing.org

    22. Assess Readiness of Staff Stages of Change – the people we serve go through a natural change process and so do we

    25. MI/Assess for Readiness 5 factors – perception of the new practice by staff Relative advantage: better than current practice, more effective, cost effective Compatibility: fits with the provider’s experience, values, and goals Simplicity: perception that the new practice is easy to understand and use

    26. MI/Assess for Readiness Trialability: extent it can be sampled or tried out before a decision is made Observability: how readily the benefits of the practice can be observed by others

    27. Assessing readiness Incentives to change Barriers to change At what stage of change is the target audience How will the practice of those involved be affected by change Can we identify the opinion leaders The Change Book

    28. NIDA & SAMHSA blending initiative (2006) MI/Investment of Training The cost of staff time to learn MI skills The cost of ongoing Supervision, including reviewing taped interviews and giving feedback The cost of a tape recorder and tapes

    29. Miller, Sorensen, Seizer & Brigham (2006) MI/Practice, Practice, Practice 3 General Learning Aids Preparatory knowledge: Interactive workshop (results in moderately large changes in professional practice where didactic alone is not enough to change) John Corbett

    30. MI/Practice, Practice, Practice Monitored Practice with Feedback Audio tapes: coded with written feedback Supervision and Coaching Supervisor needs strong MI skills Include at least one role play with focus on issue that needs work Supervise in the MI spirit

    31. EMEE STUDY 50% proficiency after workshop 75% proficiency with 6 half hour individual coaching consults Train to CRITERION Miller, 2004

    32. NIDA & SAMHSA Blending Initiative (2006) 32 MI/Supervision MI skills can be taught and implemented at a high fidelity level when agencies utilize: Focused clinical supervision Audio taped MI assessment sessions Tape coding Feedback and instruction for improving skills

    33. Learning MI Eight stages Overall spirit of MI OARS Recognizing change talk and resistance Eliciting and strengthening change talk Rolling with resistance Developing a change plan Consolidating commitment Transition and blending

    34. Orlinsky, Grawe, & Parks (1994) Practice-based evidence “Research makes clear that regardless of type or intensity of approach, client engagement is the single best predictor of outcome.”

    35. Dr David Mee-Lee (2006) Practice-based evidence Move away from diagnosis and program driven treatment towards individualized assessment-driven treatment.

    36. Miller, Mee-Lee, Plum and Hubble (2005) Practice-based evidence Instead of trying to “fit” clients into “fixed” treatment approaches via “evidenced-based practices”, work with individuals, by gathering ongoing feedback with regard to the process and outcome of care they receive and use this data to construct and guide services.

    37. MI & ME Tools MI Assessment (MI Sandwich) MI strategies during the 1st 20 min (building a bond with the client) Agency intake or assessment (gathering essential information) MI strategies during the last 20 min (summarizing and reconnecting with the client)

    38. Experience Required training of outside program staff No choice – where is that MI spirit? Minimal influence with upper level staff on “how to do this” Resistance

    39. Experience Requiring a program to utilize MI as part of a package change That’s not my role I am not a counselor I already know how to do reflective listening

    40. KIDS NOW Plus Incentives to change: continued funding, reach higher risk pregnant women Barriers to change: existing program good, minimal funds, adding a stronger tx focus, changes happened quickly At what stage of change is the target audience: pre-contemplation to action

    41. How will the practice of those involved be affected by change: more involved in transfer to case manager, fewer Prevention activities Can we identify the opinion leaders: two CMHC’s took lead in making changes, recognized the possibilities of reaching high risk women, flexible

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