MOTIVATIONAL INTERVIEWING Person-Centered Techniques to Motivate Behavior Change

Michael McManus MSW, LICSW

Martha J. Henry, PhD

• Key assumptions and considerations

• What is motivational interviewing?

• CANS Framework

• Person-centered practice

• Development, culture, and trauma

• What does it all mean for practice?

HIGHLIGHTS

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KEY ASSUMPTIONS

Providers want to do what is best for children, youth, and families. This can sometimes be challenging given the constraints of daily work.

Understanding development is crucial to good clinical work.

It is important to recognize the inevitable subjectivity of the individual professional’s personally held views (Harris and Lindsey, 2010).

Self-reflective practice is critical to good work.

• Which practices and policies protect the safety and well-being of service-involved youth?

• Research supports that community supervision and non-residential, evidence-based programs are more effective and vastly more cost-efficient.

• Research has demonstrated that boot camps do not produce better outcomes, and Scared Straight was shown to be harmful and actually worse than no intervention.

Petrosino, Turpin-Petrosino, & Finckenauer, 2000

CONSIDER THIS . . .

• Develop understanding of the principles of MI.

• Consider the intersection of CANS and MI

• Discuss how to support youth and families through this framework.

OBJECTIVES

• Establishing a working client-practitioner relationship

• Having good interpersonal skills

• Respect for client dignity

• Respectful engagement strategies

• Personal characteristics and beliefs

GOOD PRACTICE AND PROFESSIONAL ETHICS

WHO ARE OUR YOUTH?

Poverty

Mental Illness

Substance Abuse

Combo

Domestic/ Family

Violence

CANS: SIX GUIDING PRINCIPLES

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6 5

Items are included because each one may impact service planning.

Item rating levels translate immediately into action.

Focus on the child’s needs not interventions that could mask a need.

Consider development and culture before translating into action levels.

It is about the ‘what’ not about the ‘why.’

The 30-day window reminds us to keep

assessments relevant and ‘fresh.’

• Supports youth and family centered practice.

• It focuses on what is happening and not why. – This is important so that everyone keeps a focus on what is happening because

we can’t always know why it is happening.

– Focusing on the why can create feelings of embarrassment or blame for youth and families, which is not helpful to anyone.

• It always takes into account a youth’s development and his or her culture to provide the most accurate information for planning.

KEY FEATURES OF THE CANS

• CANS is a youth and family friendly tool that makes youth and family the center of the work.

• It is a comprehensive tool that captures a youth’s current needs and strengths with simple, straightforward language.

• It gives youth and families an opportunity to be full partners in the work.

BENEFITS OF CANS PRACTICE?

• It is purposefully direct and clear. It has simple ratings per item so that all important people in the youth’s life can understand and communicate about his or her needs and strengths.

• It helps youth and families understand the recommendations that providers make for treatment.

BENEFITS OF CANS PRACTICE?

MOTIVATIONAL INTERVIEWING The Basics

Motivational interviewing is “a client-centered, directive

method for enhancing intrinsic motivation to change by exploring and resolving

ambivalence.” — Miller and Rollnick, 2002

Helping people make the changes

that they for themselves

IN OTHER WORDS . . .

• Collaboration vs. confrontation

• Drawing out vs. imposing ideas

• Autonomy vs. authority

MOTIVATIONAL INTERVIEWING

• Express empathy

• Develop discrepancy

• Avoid argumentation

• Roll with resistance

• Support self-efficacy

GUIDING PRINCIPLES

• OARS

• Change talk

DARN

CAT

KEY STRATEGIES

OARS

• O pen-ended questions

• A ffirmations

• R eflections

• S ummaries

OARS IN PRACTICE

“Its like picking flowers one at a time and giving them back

to the person in a bouquet.”

CHANGE TALK: DARN

• D esire

• A bility

• R eason

• N eed

CHANGE TALK: DARN

• D esire – “I want to change.”

• A bility – “I can change.”

• R eason – “It’s important to change.”

• N eed – “I should change.”

CHANGE TALK: CAT

• C ommitment

• A ctivation

• T aking steps

CHANGE TALK: CAT

• C ommitment – “I will make changes.”

• A ctivation – “I am ready, prepared, willing to change.”

• T aking steps – “I am taking specific actions to change.”

WHAT DOES RESEARCH TELL US?

• Roots in substance abuse treatment and works very well

• A reaction to confrontational approach

• More recent use in the adult correctional system

• Little research on adolescent populations

• Fidelity of implementation of all components critical to effectiveness

PERSON-CENTERED FRAMEWORK Benefits and Considerations

• Person gains a greater sense of control

• Acknowledges and appreciates individual and family differences

• Shared goal development and planning – Appreciating a youth’s perspective

• Builds skills and knowledge to anticipate and prepare for future challenges

BENEFITS OF PERSON-CENTERED PRACTICE

Prizant, 2008

• Development

• Culture

• Trauma experiences

• Gender

THINGS TO CONSIDER

• Complex trauma impacts attachment, affective and behavioral regulation, cognition, biology, and self concept².

o Changes the physiological and psychological functioning of the brain and nervous system

• Caregiver-induced trauma is more potentially damaging psychologically than any other social or physical stressor³.

COMPLEX TRAUMA

² Denise Lacher, Family Attachment and Counseling Center of Minnesota

³ Bruce Perry, The Child Trauma Academy

• Culture affects so many aspects of self-perception, social perception, and behavior.

• Culturally-informed practice extends beyond individual interactions and impacts sense of self.

CULTURE AND SELF

WHAT DO YOU KNOW? Game Time

• It is about the ‘what’, not the ‘why’.

• First, establish what is the behavior, skill, knowledge, attitude that needs to be addressed.

• In collaboration with the youth, develop specific measurable goals.

LISTENING…

• How do you engage youth in goal-setting?

• What kind of questions do you ask?

• How much do you share about yourself?

– What is appropriate?

• How do you review the articulated goal(s) with youth?

– What language is used both verbally and written?

• During a crisis, how do you help youth connect to the goals?

– After the crisis?

PRACTICE: GOAL-SETTING WITH YOUTH

• Involving the youth in the goal-setting positively influences a youth’s satisfaction with services and enhances outcomes.

• Clear goals enhance motivation and lead to more positive outcomes (Locke & Latham, 1990).

• Specific, functional goals lead to the best outcomes (Ponte-Allan & Giles, 1999).

WHAT DOES RESEARCH TELL US?

• Self-efficacy is key: Does the individual believe he/she has the ability to achieve the goal?

• Feedback about performance is necessary.

• Personal satisfaction comes with successful performance.

WHAT DOES RESEARCH TELL US?

Theodorakis, et al., (1996)

• Consider appropriate boundaries

• Take development and culture into account

• Ask open ended questions

• Utilize reflective listening

– Ask for examples

– Reflect back; what was the outcome?

– Hypothesize future

PRACTICE POINTS

• What are the pros and cons of decisions?

• Worst/best case scenarios

• Think about family involvement

• Readiness for change

• Expect and manage conflict well

PRACTICE POINTS

• Harris, R., & Lindsey, C. (2010). How professionals think about contact between children and their birth parents. Clinical Child Psychology and Psychiatry , 7 (2), 147-161.

• Jackman, K. (2012), Motivational Interviewing with Adolescents: An Advanced Practice Nursing Intervention for Psychiatric Settings. Journal of Child and Adolescent Psychiatric Nursing, 25: 4–8. doi: 10.1111/j.1744-6171.2011.00304.

• Miller,W.R.,& Rollnick,S.( 2002).Motivational Interviewing: Preparing People for Change. 2ndEdition. NewYork:Guilford Press.

• Petrosino, A., Turpin-Petrosino, C., & Finckenauer, J. O. (2000). Well-meaning programs can have harmful effects! Lessons from experiments of programs such as Scared Straight. Crime and Delinquency, 46, 354 – 379.

• Prizant, B. M. (2008). Treatment options and parent choice: An individualized approach to intervention. Winter, 34-37. http://www.barryprizant.com/resources.php

• hwww.motivationalinterview.org retrieved May 18, 2012

• http://www.nova.edu/gsc/forms/mi_rationale_techniques.pdf retrieved May 18, 2012

• http://www.motivationalinterview.org/Documents/1%20A%20MI%20Definition%20Principles%20&%20Approach%20V4%20012911.pdf retrieved May 18, 2012

• ttp://www.thenationalcampaign.org/resources/pdf/BRAIN.pdf

• http://www.aecf.org/KnowledgeCenter/JuvenileJustice.aspx retrieved May 18, 2012

SELECTED REFERENCES AND RESOURCES

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