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The Efficacy of Motivational Interviewing with Offenders
The New Zealand Psychological Society Annual Conference 2009
Kevin Austin and Dr. Mei Wah Williams
Introduction
I will:
• briefly outline relevant motivational interviewing (MI) and correctional rehabilitation literature
• introduce and describe the current study
• describe the results, discuss the findings and recommend further research
Literature• Motivation was historically (pre 1970s) viewed
as a stable personality trait
• In the late 1970s research demonstrated that therapist variables better predicted motivation
• As such, attention shifted to how therapists could foster motivation
• MI emerged as a “promising approach”
Literature
• Applications of MI proliferated
• However, MI’s popularity out-stripped the evidence
• Unlike MI, the efficacy of correctional rehabilitation was rigorously refuted (Martinson, 1974)
• Scholars counter argued for the efficacy of correctional rehabilitation based on empirical studies
• The “what works” approach emerged
Literature
• Risk, need and responsivity (RNR)
• Motivation as a component of responsivity
• MI was adapted for use with offenders
• Like other fields, MI was used with offenders despite little empirical support
Research questions
• Can MI foster motivation to change among a high risk of recidivism offender sample?
• How well is MI delivered to offenders?
Participants• A power analysis to calculate sample sizes (26 for t-tests; 21 for ANOVA)
• 38 male offenders from Waikeria and Tongariro-Rangipo prisons (Roc*RoI M = .78, SD = 0.09)
• 18 - 42 years, M = 27.24, SD = 6.7 (younger than the general prison pop)
• 76.3% identifying as Māori (disproportionate number of Māori)
• High criminal versatility
• Fairly typical high risk offender profile (Wilson, 2004)
• 12 offenders consented to a follow-up assessment of motivation to change and programme integrity.
• Five registered clinical psychologists
The Short Motivational Programme (SMP)
• Delivered over five sessions by psychologists (manualised)
• Focuses on rehabilitative needs
• Reflects MI and correctional rehabilitation principles
• High risk offenders – serving short sentences
Principles
Skills
Change Talk
Commitment Talk
Behaviour Change
Spirit
Courtesy of:Dr J. Porter, PsyD
Hypotheses
1. Offenders will demonstrate a sustained increase in motivation to change.
2. Psychologists will demonstrate MI skills.
3. Offenders will experience MI principles.
MethodOutcome: repeated measures - within group • Shift in motivation: pre- to post-intervention.
• A sub-group consented to a third time period: follow-up• University of Rhode Island Change Assessment Questionnaire – adapted for the
SMP (SMP URICA)
• Balanced inventory of desirable responding (BIDR)
Process comprised two parts:• Psychologists’ use of MI skills
• Motivational interviewing treatment integrity code 3.0 (MITI)
• Offenders’ experiences of MI principles• Assessment of the five principles of MI (A5PMI)
Results - outcome• A statistically significant increase in SMP URICA scores from
pre-SMP to post-SMP for the total sample
Mean SMP URICA Total Scores at Pre and Post SMP
Time period N M SD
Time 1 (pre-SMP) 38 129.61 13.23
Time 2 (post-SMP) 38 133.89 14.51
P < .05 (two tailed)
Results - outcome• For the sub-group, there was a significant and large effect for
time (pre - post SMP - follow-up)
• Pairwise comparison showed the significant effect was from pre - post-SMP; not from post-SMP to follow-up
Mean SMP URICA Total Scores across the SMP at Pre, Post and Follow-up
Time period N M SD
Time 1 (pre-SMP) 12 126.42 19.21
Time 2 (post-SMP) 12 133.50 21.71
Time 3 (follow-up) 12 134.92 15.83
P < .15
Results - processPsychologists’ MI skills
• Psychologists demonstrated full competency in using direction
• Psychologists closely approached competence for global clinician ratings, percent open questions, evocation, collaboration, autonomy and empathy.
• Psychologists did not achieve competency for reflection to question ratio, complex reflections and MI adherent behaviours (skills specific to MI).
• The hypothesis that psychologists would demonstrate competence in the use of MI skills was not fully supported.
N = 5
Results - processA score of 4 or above indicated an offender strongly experienced the MI principle
Mean A5PMI scores for the Offender Sub-group
Scale M SD
Developing discrepancy 4.64 .67
Avoiding argumentation 4.78 .39
Rolling with resistance 3.55 1.1
Expressing empathy 4.69 .45
Supporting self-efficacy 4.64 .49
(N = 12)
Discussion
• MI, a brief intervention, can effect a shift in motivation to change with high risk offenders
• Somewhat contradicts the risk principle
• Together, this study and Anstiss’ 2005 study, support the use of MI across the risk spectrum
Discussion
• Offenders strongly experienced MI principles
• MI principles tend to reflect general clinical competencies, such as expressing empathy
• Psychologists’ strengths may reflect general clinical training rather than specific training in MI
• The principles have better predicted shifts in motivation to change than MI skills
• But, greater outcomes are likely if MI skills are also used, such as reinforcing change talk
Limitations• The omission of a control group
• The use of self report measures
• Increased risk of Type one error for follow-up group
• Demand characteristics may have affected psychologists’ audio-taping
• Difficult to generalise across risk profiles
Future studies
• Does the SMP alone (with high risk offenders) reduce re-offending and therefore contradict the risk principle
• Norms and cut-off scores for the SMP URICA
• How are the principles of MI and correctional rehabilitation effectively combined
• There is a paucity of internal validity studies
• Research on the use of MI with offenders remains in its infancy - a robust replication (addressing limitations)
Thanks to:
• The study participants (offenders and psychologists)
• Dr. Mei Wah Williams; Massey
• The Department of Corrections• Glen Kilgour (Principal Psychologist)
• Dr. Llewelyn Richards-Ward