How to Keep Motivational Interviewing (MI) Alive! Tools for MI Champions and Supervisors Stephanie Ballasiotes, M.C. 2 Steps Forward Training National Healthcare for the Homeless Council Regional Conference July 12-13, 2012

Overview u What us MI? u Why MI? u Before considering… u Post-Training blues: What now? u Why coaching and supervision is necessary u What we know works best for integrating MI into agency practice u Examples u Hands on tools for on-site practice

Definitions of Motivational Interviewing (MI) from MI-3 MI is… u a collaborative, goal-oriented style of communication with particular attention to the language of change. u designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion. Miller & Rollnick, 2011

Four Fundamental Processes Engaging Focusing Evoking Planning

Four Fundamental Processes u Engaging our clients helps focus on what is important to them u Focusing on what is important to them may evoke a discussion about their own reasons for change u Evocative discussions about their own reasons for change may lead to them planning change u Planning change leads to potential change Yet what seems simple requires practice, patience and persistence! Sballasiotes, MC., 2012 Adapted by Miller & Rllnick, 2011

Why MI? u Programs often require or desire “evidence-based” programs—funding based u Evidence-based: Research shows better client outcomes. If done right, it is effective u Used in any setting/around the world u Not just for work!

Why MI? Training participants say…. o “I don’t have to work as hard to “fix” anyone o “I am enjoying my job for the first time in a long time o “I don’t feel like I’m fighting all of the time with my clients” o “It isn’t rocket science isn’t rocket science: it’s really common sense. o “I realized it is not my responsibly to make them change.” o “It just makes sense—being respectful”

Organizational support Practitioner Competency Leadership What is needed for full implementation ?

Let’s imagine…

Learning

Opportunities to perform

2 to 3 days core training Core training is not enough Coaching and feedback is necessary If none- after 6 months, return to initial skill level Practice does NOT make perfect--- perfect practice does Post-Training: What We Know About Becoming Proficient

Coached/supervised by someone who can demonstrate, knows it Consistent and regular Observation with feedback Identified goals that are challenging, but not too challenging Agency culture that nurtures Some kind of evaluative process Best Practice

Supervisor VS. Champion Supervisor/supervision may involve some kind of authority or influence Performance reviews Evaluation But not always. Yet is most experienced “Champion” is someone who takes on keeping MI alive. Sets up activities, exercises, videos, etc—may change Does NOT have to be the most skilled or experienced.

Your Process Engage : Have a conversation. Get to know them. Tell me about what you do in your position at work? Focus on what is important to them at work: What would you like to see your agency change or do differently regarding how they work/interact with clients? Evoke a discussions about their own reasons for agency change: What would you want your agency to consider changing, modifying or improving how they work with clients Planning change leads to potential change What ideas do you have about how a change can begin? Sballasiotes, MC., 2012 Adapted by Miller & Rllnick, 2011

It’s All Related! Staff Satisfaction Client Satisfaction Continued Training Supportive Agency Culture Agency-Wide Involvement

On-Site Activities Examples u Viewing video or Reading transcripts and “coding” u Peer Observation (or listening) with coding and/or feedback u Group Coaching Series: Phone or live u Work Book Activities (Rosengren, D.B) u Group Practice: Real Play to Client Practice

Coding u Used for research, but also have clinical utility Way to identify and improve skills & provide feedback Simple to begin u Skills OARS-O u Transcripts u Videos u Peer recordings u Live

Rosengren, D.B. (2009). Building Motivational Interviewing Skills: A Practitioner’s Workbook. New York: Guilford Press.

What I did well. What resonated with you/stood out Skills you identified congruent with MI What would you like to see more of? Demo

Coaching & Feedback

Fundamental Skills Necessary When Providing Feedback u O pen-ended Questions u A ffirmations u R eflections u S ummaries u Offering Information Fundamental, but not easy

Providing Feedback: Pre- Observation u Providing feedback should be a two-way process u Clarify WHY you are doing it. u Clarify how the process will go ahead of time u Share any forms you will be using while observing mentees

Providing Feedback 1. Allow enough time for observation and/or feedback 2. Set the stage o Create a safe and confidential space o Discuss the process o Ask permission to go forward o Answer any questions 3. Be immediate-Give feedback as close to the time of observation/performance as possible

Providing Feedback 4. Begin debrief: Person RECEIVING FEEDBACK talks first o “How do you feel it went?” o “What went well?” o “What would you do different next time?” 5. Be specific and provide example o “I liked the reflection where you said…” o “You did a great job the other day when you..”

Providing Feedback 6. Focus on behavior, not the person o Quantity, quality o Careful of assumptions and judgments 7. Avoid giving too much feedback o no more than 2-3 areas of focus 8. Take a strength-based approach o Encourage the increases of positive behavior rather than decreasing less-positive behavior

Providing Feedback 9. Be curious and collaborative o “How would it have be if you….? o “What do you think about…? o “I’m curious about…? 10. Avoid giving direct advice o “You should try…” o “The best approach for me is…” o “You really need to…

Offering Feedback 11.End with them o What questions do you have for me? o How was this process for you? Value is in the relationship more than the content!

You CAN play like this!

Resources Rosengren, D.B. (2009). Building Motivational Interviewing Skills: A Practitioner’s Workbook. New York: Guilford Press. Arkowitz, H. Westra, H. Miller, W.R., & Rollnick, S. (2008). Motivational Interviewing in the Treatment of Psychological Problems. Guilford: New York. Miller, W.R., & Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change. Guilford: New York. Training Tapes: MI Series MI Website:

Debrief u One thing you learned (or relearned) u One thing that surprised you u One thing you will do differently