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Motivational Interviewing in Child Welfare
Transcript of Motivational Interviewing in Child Welfare
in Child Welfare What is Motivational Interviewing? Four Key Principles of MI
from Miller & Rollnick (2002): Developed by William Miller in the early 80s as response to frustrations by drug and alcohol practitioners whose clients seemed to lack motivation to change or insight about seriousness of their problems. Up to this time, approaches were primarily confrontational. (Walsh, 2010)
William Miller found that confrontation doesn't help clients; in fact, it actually increases denial and resistance. (Hohman, 1998)
Influenced by Miller's own therapeutic approach, Rogerian therapy, cognitive dissonance theory, and the Transtheoretical Stages of Change model (Walsh, 2010)
William Miller and Stephen Rollnick (2002) define MI as a:
"Client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence." (Wahab, 2005)
Interventions are often short-term The Spirit of MI Rollnick and Miller (1995) outline seven key elements: 1) Motivation to change is elicited from the client, not imposed from without.
2) It is the client's task, not the counselor's, to articulate and resolve his/her own ambivalence.
3) Direct persuasion is not an effective method for resolving ambivalence.
4) The counseling style if generally a quiet and eliciting one.
5) The counselor is directive in helping the client to examine and resolve ambivalence.
6) Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction.
7) The therapeutic relationship is more like a partnership or companionship than expert/recipient roles. 1) Express empathy (build rapport and trust, use active listening techniques)
2) Develop discrepancy (suggest client look at benefits and drawbacks of their behavior)
THE DISCREPANCY CAN MOVE A CLIENT FROM PRECONTEMPLATION TO CONTEMPLATION STAGE
3) Roll with the resistance (avoid labeling of or arguing with client)
4) Support self-efficacy (Express optimism that change IS possible!) Over 73 international clinical trials have evaluated MI in various settings
MI practice occurs on 5 continents
Used and tested with adolescents and adults in several areas
A systematic review in 2001 found there was substantial evidence of MI's effectiveness as a substance abuse intervention method
(Wahab, 2009) MI: A Good Fit with Social Work Values Relationship is central
Partner with client
Client owns change process
Respect for diversity
Client is expert
(Hohman, 1998, and Barbee, et al 2011) Putting MI into Practice:
University of Maryland 2-year MI traineeship of CW Partnership students in Baltimore City Challenges for case workers using MI:
Families are often addressing multiple problems (e.g. housing and substance dependence)
There are times when workers must assume authority role
MI requires a paradigm shift for both worker and client
Workers struggle with their own impatience with client
Benefits seen by workers using MI:
Sense clients are engaged in sustainable change
Services are client-centered and client steers services
Clients are empowered
Relieves pressure on worker for outcomes! Challenges of MI in Social Work Practice Social workers must have access to training and supervision, and alot of it. MI requires training, and then practice with feedback and coaching. (Miller & Rollnick, 2009)
Teaching and practicing MI may pose a challenge for those who "do not embrace epistomologies that regard human beings as experts on their own lives, entitled to self-determination, respect and acceptance." (Wahab, 2005)
MI counselors engage in little actual problem-solving action planning, or giving advice - - a significant contrast to the activities of most social workers. (Wahab, 2005) Challenges of MI in Child Welfare This article evaluated the effective of a two-day workshop in MI for forty social workers who work with alcohol misuse.
Focus of worker always needs to remain on the child while engaging the parent(s). This requires a high level of skill in MI. (However study found that training workers in MI did not result in a loss of focus on child)
Increasing emphasis on timelines and pressure to complete assessments may make using any person-centered work difficult.
Eight workers said it impacted their experience as a social worker they enjoyed their work and felt less stressed. They felt less pressure to resolve their clients' problems.
Higher skilled workers felt MI reduced resistance and increased parental engagement.
Many workers increased their listening skills even if their MI skills did not improve. From "Child Risk & Parental Resistance: Can Motivational Interviewing Improve the Practice of Child and Family Social Workers in Working with Parental Misuse?" Donald Forrester, et al. "At the core of this difficult work lies a worker's capacity to engage those clients who feel least like developing a working relationship, and an agency's ability to develop conditions that promote that capacity. ..Dawson and Berry (2002) agree and report that worker and agency behaviors appear to be most significant in engaging families in child welfare services. Highlighted in all this work work is the primacy of the client-worker relationships."
- Julie Cooper Altman, 2008
"Engaging Families in Child Welfare:
Worker Versus Client Perspectives" Is MI Effective? Let's Look for the O.A.R.S.
in this Role Play
(I need 2 volunteers) Transtheoretical Stages of Change O.A.R.S.
4 Strategies of motivational interviewing in the early stages of treatment Open-ended questions
Summarize Miller & Rollnick, 2002 MI in Oregon Child Welfare:
Some considerations MI is an intervention that would fit well with Oregon's trend toward client-centered services, family assessment and engagement, prevention, reunification,
and moving families toward sustainable change.
MI practitioners requires extensive, ongoing training, as well as coaching and feedback from trained supervisors.
Unless used as a very short-term intervention, MI takes time (clients move through the change process at different rates, and progress can be slow - workers must stay within time frames)
Transtheoretical Stages of Change Precontemplation- Person does not believe they have problem and is unwilling to change
Contemplation - Person is contemplating change, is seeing benefits to stopping the behavior even as he/she engages in it.
Preparation - Person is poised to change within next month and is working on a strategy
Action - Person begins to take action
Maintenance - Sustained change has occurred for 6 months
Relapse - If person relapses, the steps are revisited. Most substance-abusing clients
seen by social workers are
precontemplators or contemplators.