Prevention Planning: Whats Up? FILE: WHATSUP CH SBT 7-24-12
Wayne Munchel - [email protected] 2011 Wayne Munchel &
Hewitt B. Clark
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Whats Up? Prevention Planning Method TIP Model Practices for
Improving Outcomes with Youth & Young Adults with EBD Wayne
Munchel, LCSW Hewitt B. Rusty Clark, Ph.D., BCBA National Network
on Youth Transition
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Types of Risk Behavior/Risk Situations (RB/RS)
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WHATS UP?: Objectives To elicit reasons for change from the YP
To promote YPs involvement & investment in their own treatment
& support plans To create a safe place for YP to explore making
changes without feeling pressure from TF to do the right thing To
(begin) instilling a sense of self-efficacy, self-advocacy and
self-evaluation.
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Prevention Planning Method WHATS UP? WHATS UP? ~ A Motivational
Interviewing (MI) approach to reducing & eliminating risk
behaviors & risky situations among youth & young adults
(YA) with emotional & behavioral difficulties.
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Why MI for Youth & Young Adults? Powerful process for
enhancing YAs engagement, empowerment & for eliciting change
Respects autonomy & utilizes value explorations/future focus
Brief, informal, flexible applications Many TAY are classic
pre-contemplators/ contemplators Consistent w/ TIP Guidelines &
Core Competencies
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Transition & Risk Behavior Transition is a time of
developmentally normative risk Transition is a time of
developmentally normative risk What does this mean?
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What is your concern? How does RB fit in with future
plan/values? Ask about good, not so good aspects of RB. Talk about
options. See the stage of change. Understand ambivalence. Plan for
next steps.
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WHATS UP? Considerations Distinguish between Safety Planning
& Prevention Planning To write plan or not if YP wants to, yes
When YP refuses? STAY ENGAGED The Prevention PLAN ~ is a fluid
ongoing process Learning WHATS UP? requires practice, coaching
& feedback Dont stress on the letters ~ keep listening &
reflecting
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SODAS YP more clearly in action stage For coaching in more
rational/ cognitive process Decision-making re: lower risk
behaviors WHATS UP? YP more ambivalent, contemplative For coaching
in more emotionally driven behaviors Decision making higher risk
behaviors vs.
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The TFs First Task Distinguish yourself from adults w/ more
traditional messages WHY? ~ hx of controlling interactions ~
previous exposure to exaggerated drug ed ~ sense of invulnerability
~ coercion by justice system ~ need to establish identity/autonomy
Ingersoll, Wagner, Gharib (2000)
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What is your concern? Builds upon foundation of
engagement/trust Many ways to start this conversation w/ young
people what are yours? Focus on informative details of situations
& function of RB Acknowledge common doubts/feelings Use OARS
& LISTEN!!!
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Open-ended Questions Affirmations Reflections Summary
Statements OARS Miller and Rollnick, (1991)
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Role Play: What is the concern? Training Manual p.12 &
13
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How does concern (RB/RS) fit in w/ Futures
Planning/Goals/Values? TIP Guideline: Acknowledge & develop
personal choice & responsibility MI principle: Gently develop
discrepancies between goals, hopes, values (Dont confront) This
step can often inform medical necessity Avoid argumentation and be
mindful of righting reflex. Stop, Drop & Roll with
Resistance!
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Ask about pros/cons of YPs concern (RB/RS) Express empathy
-acknowledge how RB/RS makes sense (Acceptance is not approval)
What function does RB/RS serve? Use SODAS format of
advantages/disadvantages Normalize ambivalence
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Talk About Options/Elicit Change Talk Include/affirm option of
continuing RB What are advantages of change/disadvantages of status
quo? Explore incremental/harm reduction changes Only when people
feel free to stay the way they are do they feel free to
change-Rogers
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Role Play Juan/Juanita: W H A T What is the concern? How does
the RB fit with future plan? Ask about pros/cons of RB Talk about
options Training Manual p.12 & 13 Juan USE WHATS UP? FORM
DURING ROLE-PLAY
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See the Stage of Change? This is an assessment not a question
for YP Pre-Contemplation ~ What problem? You/they have the problem!
Contemplation ~ Sometimes I think Ill do something about it, but
other times, I just go with the flow. Preparation ~ Im starting to
think about how I could change, what are the options? How hard
would it be? Action ~ Im want this, where do I get started, Ill
need help, lets do this thing Maintenance ~ Ive made changes and Im
doing OK (man, its hard!) Im worried about screwing up,
though.
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Pre-contemplater Educate w/ permission focus on building trust
& encouraging self-exploration Strengths Discovery & Needs
Assessment
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Contemplater NORMALIZE AMBIVALENCE Help tip the decisional
balance scales toward change Encourage evaluation of pros &
cons of change (SODAS/Futures Planning)
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Preparer Assist w/ prob solving (SODAS/SCORA), encourage
initial small steps, clarify goals (Futures Planning) Identify and
explore possible actions, visualize what change would look like,
what would be hard? Use Internet & field visits
Maintainer Discuss coping w/relapse (Prev. Planning) Practice
new skills (In-vivo) Review long-term goals (Futures Planning) Plan
for follow up Reframe relapse as part of recovery
Discussion: See the Stage of Change Training Manual p.13
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Understand Ambivalence Summarize options &
advantages/disadvantages of change Reframe past unsuccessful
attempts at Involve supportive key players as appropriate Express
encouragement & hope
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Plan next steps Match step to Stage of Change
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Now you try it! Participant Manual Pg. 12 Form groups of 2 or 3
Designate TF, young person, scribe/observer Ask for help/input from
observers Dont stress over which letters youre on Pause at end of
WHAT- & ask which stage is portrayed Have fun! Discuss whats
difficult/whats easy?
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Valuable Resources on MI MI Website:
www.motivationalinterview.org Naar-King, S. & Suarez, M.
Motivational Interviewing with Adolescents and Young Adults 2011
John S. Baer and Peggy L Peterson. (Chapter 21). Motivational
Interviewing with Adolescents and Young Adults. In Miller, W.R.
& Rollnick, S. Motivational Interviewing: Preparing People for
Change (2 nd Edition).
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More TIPS for using WhatsUp? Make specific plans when hearing
increasing levels of change talk>>>>>commitment talk
(Ill try ~ I will) Test the waters: What do you think youll do
next? Avoid asking for specific action steps in earlier stages
Anticipate changes: How might you go about making changes when you
feel ready? What might get in the way? Share experiences: If youd
like, I can tell you about some things other YP have tried and has
worked for them. What, if anything, would you like to work on next
time? Consider: Are you more enthusiastic about change than
YP?