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Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. 60318 Frankfurt a.M.Tel.:(0 69) 1533 Nibelungenplatz.

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Presentation on theme: "Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. 60318 Frankfurt a.M.Tel.:(0 69) 1533 Nibelungenplatz."— Presentation transcript:

1 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. 60318 Frankfurt a.M.Tel.:(0 69) 1533 2819mschmid@fh-frankfurt.de Nibelungenplatz 1 Fax:(0 69) 1533 2809 http://www.fh-frankfurt.de Case Management and Motivational Interviewing in the German Heroin Trial Irmgard Vogt, Martina Schu, Martin Schmid, Wilfried Görgen, Hans Oliva Fachhochschule Frankfurt am Main/ FOGS, Köln

2 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management and Motivational Interviewing in the Heroin Trial Case Management and Motivational Interviewing is introduced into the Heroin Trial as one variation of psychosocial support of clients Case Management emphasises structure and an organisational framework, networking and cooperation with other agencies; Motivational Interviewing embraces motivational factors, style of interaction, collaboration with clients The two concepts blend well as both of them have a long history in individual counselling and are related to each other To facilitate comparison of results in a multicenter setting, implementation and documentation are standardised, and coaching of counsellors during trial is part of the standard procedure

3 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management: Background CM has a long history in individual counselling CM is a variation of a client-centred approach in a well structured setting, designed specifically for the care of people with complex problems CM is target-orientated CM is designed for long term interventions and geared to solutions and sustained support in a continuum of care Case Managers work "in the field making use of clients resources as well as organisational networks; in cooperation with clients they plan, organise and coordinate a needs-based, comprehensive and efficient package of care, crossing institutional and professional boundaries.

4 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management: Techniques CM is well structured and organised along stages or steps of the helping process CM asks for networking and cooperation of (welfare) agencies and organisations CM includes re-assessment and evaluation of the helping process and of its outcome CM blends well with MI. However, CM underlines structure, MI counselling style and techniques. Mixing both requires a delicate balancing of form and content, structure and style of interaction

5 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Model of Case Management and Motivational Interviewing

6 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management CM has been evaluated in the USA, within the framework of a control study of drug addicts with complex problems (cf.: Ball & Ross 1991, Mejta et al. 1997) Result: CM is more successful than "treatment as usual CM has been implemented in Germany as well (cf. Oliva et al. 2002), but not yet in comparative studies

7 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Motivational Interviewing MI has developed out of a client-centred counselling approach, integrating elements of motivational psychology and cognitive behaviour therapy MI is based on the stages-of-change model MI stresses the style of interaction between counsellor and client. Counselling techniques are tailored to facilitate the exploration of motivational conflicts of client and to support motivation to change

8 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Stages of Change

9 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Motivational Interviewing, Stages of Change

10 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Motivational Interviewing: Basic Skills Unconditional Acceptance - the counsellor accepts the client as a person regardless of his or her values, life-style or actual problems; he is respectful towards the client Empathy - understanding another persons emotions and feelings from that persons frame of reference; the counsellor is warm, caring and interested in the client Enhancing Self-efficacy in clients - the counsellor fosters hope and optimism in the clients capacities to change

11 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Motivational Interviewing: Techniques Showing interest in client via reflective listening and open- ended questions Developing discrepancies between clients current situation and hi/her hopes for the future Avoiding to argue, moralise, blame and label Avoiding interpretations - clients statements are taken as such and not analysed for hidden meanings Roll with resistance - instead of confrontation shift perspectives and reframe statements Supporting self-efficacy - strengthen clients belief in change

12 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Motivational Interviewing MI was used and analysed in the USA in several efficacy studies, eg. in project MATCH (1998) In the study, alcohol dependent clients were randomly assigned to 3 groups of intervention methods, one of it was MI. Results were monitored and treatment outcomes evaluated. Result: MI is an effective intervention method MI is widely used in Germany, especially in counselling persons with alcohol problems (John et al. 1996, Kremer et al. 1999) and in short interventions

13 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management and Motivational Interviewing Steps to Standardization Development of guidelines to Case Management and Motivational Interviewing - Manual for counsellors Development of questionnaires and fact sheets to facilitate assessment, treatment planning, minutes etc. Trainings of Case Managers in the trial in methods, techniques and use of questionnaires Re-trainings of Case Managers 3 and 6 months after start of the trial Coaching of Case Managers at work place

14 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management and Motivational Interviewing Steps to Standardization Development of questionnaires and fact sheets General information sheet for clients regarding Case Management and Motivational Interviewing contract to collaboration while in trial Client files and documents Documentation of daily work schedule of Case Managers Questionnaire of Generalised Competence Expectation Final evaluation assessment sheet

15 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management und Motivational Interviewing Steps to Standardization Client files and documents Structured assessment forms regarding: patterns of drug use and abuse, general aspects of health, relationship to family members and friends, education and employment, actual income and debts, problems with the police and the judicial system, self-reported problems Checklist of regional support system (e.g. counselling organisations and welfare agencies) and establishing a network according to the needs of the client Forms for treatment plans and for conferences to discuss treatment plans Re-assessment forms Final evaluation form

16 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management und Motivational Interviewing Summary The blending of CM and MI is suitable and offers a wide range of methods and techniques to psychosocial care for substance dependents The combination of CM and MI is tailored to care for people with longstanding and complex problems including clients with dual diagnosis Steps to standardise the helping process allow for a control of the number and type of interventions in multicenter settings

17 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management and Motivational Interviewing ContentMotivational stage Techniques Admission and first session, explanation of the concept, establishing collaboration and agreement to work together Precontem- plation Reflective listening, open-ended questions, explore and support clients needs, provide information of study, regional support system etc. Assessment, start to network with counselling and other related agencies in the region and with personal resources of client ContemplationReflective listening, open-ended questions, evoke and work with discrepancies, affirm, give feedback, summarise. First assessment of clients motivational stage in different areas of interest; mapping of counselling and welfare agencies in the region; if appropriate, introduce diagnostic results (triangulation); visit client at home.

18 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management and Motivational Interviewing ContentMotivational stage Techniques Assessment and definition of target problems. Outlining a treatment plan Contemplation Preparation Reflective listening, open-ended questions, evoke and work with discrepancies, elicit self-motivational statements, affirm, give feedback, summarise, planning of next step, reframe, explore alternatives and choices, support self-efficacy. If appropriate, organise conference on treatment plan with colleges of related agencies Working along treatment planPreparation Action Reflective listening, open-ended questions, affirm, elicit self-motivational statements, reframe, advocacy, feedback, summarise. Introduce relapse prevention

19 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management and Motivational Interviewing ContentMotivational stage Techniques First preliminary evaluation of results.If necessary, Re- Assessment and re- arrangement of treatment plan. Strengthening collaboration with colleges of related agencies, networking with new actors Contemplation, Praparation, Action Reflective listening, open-ended questions, affirm, elicit self-motivational statements, give feedback, reframe, explore alternatives and choices, support self- efficacy, intensify cooperation with other institutions Working along treatment plan. Process evaluation Action Maintenance Reflective listening, open-ended questions, affirm, elicit self-motivational statements, give feedback, explore alternatives and choices, support self-efficacy, increase level of clients self management

20 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management and Motivational Interviewing ContentMotivational stage Techniques Outcome evaluation and termination of counselling Maintenance Termination Reflective listening, open-ended questions, affirm, feedback, summarise, support self- efficacy, increase level of clients self management, prepare to finish counselling

21 Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M. Case Management and Motivational Interviewing ContentMotivational stage Techniques Relapse preventionRelapseRelapse prevention package, crisis intervention, reflective listening, open- ended questions, provide information, planning of next step


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