Presentation on theme: "People not Problems: Motivational Interviewing in Practice. Rhoda Emlyn-Jones."— Presentation transcript:
People not Problems: Motivational Interviewing in Practice. Rhoda Emlyn-Jones
Where it began 1970s Community based counselling services In the 80s working within the local authority. Counselling Social work homelessness
The early context Building accessible community services Emphasising personal choice Acknowledging the expertise of the individual Choosing their own path MI built on the observations of best practise and provided the framework for best practise,
What helped Understanding ambivalence ! Exploring helpful aspects of current behaviour first ! Knowing what you were doing if you werent asking questions or giving advice. Reflect, reflect, reflect. Not to pathologise normal behaviour Not challenging behaviour head on
principles Express empathy: best relationship Develop Discrepancy: most difficult conversation Avoid argumentation: its not about what we think Roll with resistance: Its a normal response but if raised will get in the way of change Support self-efficacy : Its peoples belief in their own strategies and skills that leads to sustained change.
Effective services Skills Methodology Design MI consistent Consistently scrutinise and support all three
New service areas Early 90s Criminal justice services Child protection services Fear of risk Fear of perceived collusion doing good with a vengeance
The context People noticed more for the problems they cause than the problems they faced Dominated increasingly by assessment Care planning and monitoring. Deficit models Poor engagement Little focus on outcomes
Spirit Assess Plan Monitor Engage listen /Evoke Collaborate, with. not do to Firm platform not scaffolding. Autonomy : focus on sustainable outcomes
MI concepts that helped Judges and family courts Importance and confidence ! The wider system not just the support service Child 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
Family focussed work Homebuilders and MI MI and Option 2 Evaluation and research what works in high risk/complex families Being MI consistent !
Support the skills OARS Open questions Affirmations Reflective listening summary
Focus on outcomes 4 to 6 week intervention 5.5 year follow up small sample Parents considerably reduced or stopped their substance use 98% to 58% Parental stress and risk of psychological problems 44% to 85% Families had significantly more cohesion Only 8% of option 2 children entered care compared to 44% None in care permanently compared to 38%
IFSS Underpinned by the spirit the principles and the skills Supported by legislation: Child and family measure (Wales)2010 Building a platform for integration: A centre for workforce development: A catalyst for transformational change: Real commitment from Ministers and Officers.
Family Children's social worker Adult Social Worker Admin Substance Mis-use Worker Mental Health Worker Childrens Service Case Management Adult Services Designated IFSS Prac Health Visitor Support Worker Support Worker Support Worker Primary Care
IFSS Team: Core skills, Models & Approaches Organisational Development: The Skilled Workforce Wider Workforce Training Independent Sector Health Local Authorities Community Safety Partnerships Education The Wider Workforce
Training in the IFSS Model of Family Intervention: 4-days Principles: All team members Shared ideologies Skill set Understanding
The IFSS Model of Family Intervention: 4-Day Training Day 1: Introduction to the Model: Overview of Model & Training Key Components of the Model: The Process of Behaviour Change Key Components of the Model: Outcome Focussed Work Day 2: Core Skills: Motivational Interviewing, Engagement, Collaboration & Outcomes Beginning the Intervention: Reducing Resistance & Increasing Safety Day 3: Working through the Intervention: Enhancing Motivation to Change Building Action Plans: Consolidating Change Behaviour & Inviting in Support Day 4: Beyond the Intensive Intervention: Maintaining Change The Working Context: Our Team, Clarity of Role & Function
Training for other MI Congruent IFSS Team Roles Consultation in the IFSS Supervising in the IFSS IFSS Trainers –IFSS services and wider workforce development
Integrated Family Support Service: Workforce Development Modules Module 1: Enhancing Motivation TV Game, Stages of change, 4 statements, Good teacher/bad, Principles of MI, OARS practice Module 2: Lowering Resistance Persuasion exercise, Resistant behaviour, Road blocks & traps, 3-in-a-row, Palm push/shameful secret, Batting practice, Hot seat reflections OARS Module 3: Goal Centred Interventions Why Goals? Case study focus SMART goals, Knowing when youve got there, Negotiating goals with families & professionals Module 4: Promoting Family Change Process of change, Engagement, Motivational tasks at each stage, Miracle Question, Values, Strengths & Goals Module 5: Care Pathways: Maximizing Multi-agency Planning Case study, Brainstorm whats available, Identify goals, High, medium & low importance, Short, medium, long term, Engaging services around the family Module 6: Substance Misuse What you know quiz, Knowledge, Attitudes, Impact on family life, Risk and resilience, Lifestyle impact
Feedback from training I will listen rather than tell I will reflect meanings and feelings I will resist rescuing or fixing I will empathise and work with the person not the presenting behaviour I will affirm rather than praise I will not rob them of their own internal argument for change I will try and help my agency to change
Feedback 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 England My 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
The focus of my work behaviour Avoiding appointments Blaming others Hostility Compliance Refusal to engage Minimising problems Diverting the focus feelings Shame Fear of judgement Fear of consequences Lack of trust Lack of confidence Lack of hope Avoiding pain.
Accreditation: 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 IFSS Supervising in the IFSS Training the IFSS Trainers All 6 of the wider workforce modules Hundreds of staff across Wales describing MI practise
The current context and beyond A real opportunity !! Maximizing potential to change Building on strengths competency models Greater integration Reclaiming social work Workforce development Risks Increased blame and punishment Less hope and opportunity Less provision supporting the core conditions for change.
Create Shared Platform Across All Disciplines There is a government vision Legitimacy Adequacy Support IFFS,Family first :Adult services: Criminal justice Communities first. Shared Values Shared Skills Shared Language
2012 transformational change imbued with MI spirit, principles and skills Remain purposeful and intentional Be clear about what needs to change See things through to the desired outcomes Bring clarity to the system Notice what's working and build on it Its high challenge it needs high support it needs commitment Skilled conversations, working together, release potential for autonomy.
And then theres the future, the next 21 years Top Stories