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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. What us MI? Why MI? Before considering… - PowerPoint PPT Presentation
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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 CouncilRegional Conference
July 12-13, 2012
Overview What us MI? Why MI? Before considering…
Post-Training blues: What now? Why coaching and supervision is necessary What we know works best for integrating MI into agency practice Examples Hands on tools for on-site practice
Definitions of Motivational Interviewing (MI) from MI-3
MI is… a collaborative, goal-oriented style of communication
with particular attention to the language of change. 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
Engaging our clients helps focus on what is important to them
Focusing on what is important to them may evoke a discussion about their own reasons for change
Evocative discussions about their own reasons for change may lead to them planning change
Planning change leads to potential change
Yet what seems simple requires practice, patience and persistence!
Sballasiotes, MC., 2012Adapted by Miller & Rllnick, 2011
Why MI?
Programs often require or desire “evidence-based” programs—funding based
Evidence-based: Research shows better client outcomes. If done right, it is effective
Used in any setting/around the world
Not just for work!
Why MI?Training participants say….
o “I don’t have to work as hard to “fix” anyoneo “I am enjoying my job for the first time in a long timeo “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. ChampionSupervisor/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 ProcessEngage : 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., 2012Adapted by Miller & Rllnick, 2011
It’s All Related!
Staff Satisfaction
Client Satisfaction
Continued Training
Supportive Agency Culture
Agency-Wide Involvement
On-Site Activities Examples Viewing video or Reading transcripts and
“coding” Peer Observation (or listening) with coding
and/or feedback Group Coaching Series: Phone or live Work Book Activities (Rosengren, D.B) Group Practice: Real Play to Client Practice
Coding Used for research, but also have clinical utility
Way to identify and improve skills & provide feedback
Simple to begin Skills OARS-O Transcripts Videos Peer recordings 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
Open-ended Questions Affirmations Reflections Summaries Offering Information
Fundamental, but not easy
Providing Feedback: Pre-Observation
Providing feedback should be a two-way process
Clarify WHY you are doing it. Clarify how the process will go ahead of
time Share any forms you will be using while
observing mentees
Providing Feedback1. Allow enough time for observation and/or feedback
2. Set the stageo Create a safe and confidential spaceo Discuss the processo Ask permission to go forwardo Answer any questions
3. Be immediate-Give feedback as close to the time of observation/performance
as possible
Providing Feedback4. 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 exampleo “I liked the reflection where you said…”o “You did a great job the other day when you..”
Providing Feedback6. Focus on behavior, not the person
o Quantity, qualityo Careful of assumptions and judgments
7. Avoid giving too much feedbacko no more than 2-3 areas of focus
8. Take a strength-based approacho Encourage the increases of positive
behavior rather than decreasing less-positive behavior
Providing Feedback9. 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 adviceo “You should try…” o “The best approach for me is…”o “You really need to…
Offering Feedback
11. End with themo 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: www.motivationalinterview.org
Debrief One thing you learned (or relearned) One thing that surprised you One thing you will do differently
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