Presentation on theme: "People not Problems: Motivational Interviewing in Practice."— Presentation transcript:
1People not Problems: Motivational Interviewing in Practice. Rhoda Emlyn-Jones
2Where it began 1970’s Community based counselling services In the 80’s working within the local authority.CounsellingSocial workhomelessness
3The early context Building accessible community services Emphasising personal choiceAcknowledging the expertise of the individualChoosing their own pathMI built on the observations of best practise and provided the framework for best practise ,
4What helped Understanding ambivalence ! Exploring helpful aspects of current behaviour first !Knowing what you were doing if you weren’t asking questions or giving advice.Reflect , reflect , reflect.Not to pathologise normal behaviourNot challenging behaviour head on
5principles Express empathy: best relationship Develop Discrepancy: most difficult conversationAvoid argumentation: its not about what we thinkRoll with resistance: It’s a normal response but if raised will get in the way of changeSupport self-efficacy :Its peoples belief in their own strategies and skills that leads to sustained change.
6Effective services Skills Methodology Design MI consistent Consistently scrutinise and support all three
7New service areas Early 90’s Criminal justice servicesChild protection servicesFear of riskFear of perceived collusion“doing good with a vengeance”
8The contextPeople noticed more for the problems they cause than the problems they facedDominated increasingly by assessmentCare planning and monitoring.Deficit modelsPoor engagementLittle focus on outcomes
9Spirit Assess Engage listen /Evoke Plan Collaborate, with . not do to MonitorEngage listen /EvokeCollaborate, with . not do toFirm platform not scaffolding.Autonomy : focus on sustainable outcomes
10MI concepts that helped Judges and family courtsImportance and confidence !The wider system not just the support serviceChild protection social workers“If we have no models to work with ambivalence we end up being too nice or too nasty “!Listen engage :lower resistance increase disclosure
11Family focussed work Homebuilders and MI MI and Option 2 Evaluation and research what works in high risk/complex familiesBeing MI consistent !
12Support the skills OARS Open questions Affirmations Reflective listeningsummary
13Focus on outcomes 4 to 6 week intervention 5.5 year follow up small sampleParents considerably reduced or stopped their substance use 98% to 58%Parental stress and risk of psychological problems 44% to 85%Families had significantly more cohesionOnly 8% of option 2 children entered care compared to 44%None in care permanently compared to 38%
14IFSS Underpinned by the spirit the principles and the skills Supported by legislation: Child and family measure (Wales)2010Building a platform for integration:A centre for workforce development:A catalyst for transformational change:Real commitment from Ministers and Officers.
15Family Adult Services Children’s Service Case Management Primary Care SupportWorkerSupportWorkerAdminSubstanceMis-useWorkerAdultSocial WorkerSupportWorkerMental HealthWorkerChildren'ssocial workerDesignatedIFSSPracHealthVisitorFamilyAdult ServicesChildren’s ServiceCase ManagementPrimary Care
16Community Safety Partnerships The Wider WorkforceHealthIndependentSectorLocal AuthoritiesEducationCommunity Safety PartnershipsIFSS Team: Core skills, Models& ApproachesOrganisational Development: TheSkilled WorkforceWider Workforce Training
17Training in the IFSS Model of Family Intervention: 4-days Principles:All team membersShared ideologiesSkill setUnderstanding
18The IFSS Model of Family Intervention: 4-Day Training Introduction to the Model: Overview of Model & TrainingKey Components of the Model: The Process of Behaviour ChangeKey Components of the Model: Outcome Focussed WorkDay 2:Core Skills: Motivational Interviewing, Engagement, Collaboration & OutcomesBeginning the Intervention: Reducing Resistance & Increasing SafetyDay 3:Working through the Intervention: Enhancing Motivation to ChangeBuilding Action Plans: Consolidating Change Behaviour & Inviting in SupportDay 4:Beyond the Intensive Intervention: Maintaining ChangeThe Working Context: Our Team, Clarity of Role & Function
19Training for other MI Congruent IFSS Team Roles Consultation in the IFSSSupervising in the IFSSIFSS TrainersIFSS services and wider workforce development
20Integrated Family Support Service: Workforce Development Modules Module 1: Enhancing MotivationTV Game, Stages of change, 4 statements, Good teacher/bad, Principles of MI, OARS practiceModule 2: Lowering ResistancePersuasion exercise, Resistant behaviour, Road blocks & traps, 3-in-a-row, Palm push/shameful secret, Batting practice, Hot seat reflections OARSModule 3: Goal Centred InterventionsWhy Goals? Case study focus SMART goals, Knowing when you’ve got there, Negotiating goals with families & professionalsModule 4: Promoting Family ChangeProcess of change, Engagement, Motivational tasks at each stage, Miracle Question, Values, Strengths & GoalsModule 5: Care Pathways: Maximizing Multi-agency PlanningCase study, Brainstorm what’s available, Identify goals, High, medium & low importance, Short, medium, long term, Engaging services around the familyModule 6: Substance MisuseWhat you know quiz, Knowledge, Attitudes, Impact on family life, Risk and resilience, Lifestyle impact
21Feedback from training I will listen rather than tellI will reflect meanings and feelingsI will resist rescuing or fixingI will empathise and work with the person not the presenting behaviourI will affirm rather than praiseI will not rob them of their own internal argument for changeI will try and help my agency to change
22Feedback regarding the impact of training Found myself offering to take a mother to her counselling appointment. Thank GOODNESS she knows the model builds autonomy & said "Thanks but no thanks, I can get a bus for my kids. I'll text you later"…!O2 worker in NW EnglandMy new best friends are content, meaning and feeling reflections. Been rolling with resistance all morning. Saw it happen though, the moment the thought was provoked. Dad made a great argument for his change. So brave.SW in Wales
23The focus of my work behaviour feelings Avoiding appointments Blaming othersHostilityComplianceRefusal to engageMinimising problemsDiverting the focusShameFear of judgementFear of consequencesLack of trustLack of confidenceLack of hopeAvoiding pain.
24Accreditation: Assessing consolidating Learning; IFSS Model of Family Interventions: Underpinning Knowledge & Skills for IFSS (Level 2), Implementing IFSS (Level 3), Managing the Delivery of Family Focussed Interventions (Level 6)Consultation Skills in the IFSSSupervising in the IFSSTraining the IFSS TrainersAll 6 of the wider workforce modulesHundreds of staff across Wales describing MI practise
25The current context and beyond A real opportunity !!Maximizing potential to changeBuilding on strengths competency modelsGreater integrationReclaiming social workWorkforce developmentRisksIncreased blame and punishmentLess hope and opportunityLess provision supporting the core conditions for change.
26Create Shared Platform Across All Disciplines There is a government vision LegitimacyAdequacySupportIFFS ,Family first :Adult services: Criminal justiceCommunities first.Shared ValuesShared SkillsShared Language
272012 transformational change imbued with MI spirit, principles and skills Remain purposeful and intentionalBe clear about what needs to changeSee things through to the desired outcomesBring clarity to the systemNotice what's working and build on itIts high challenge it needs high support it needs commitmentSkilled conversations, working together, release potential for autonomy.
28And then there’s the future, the next 21 years Top StoriesAnd then there’s the future, the next 21 years