An Introduction to Motivational Interviewing with Native American Adaptations

Transcription

1 An Introduction to Motivational Interviewing with Native American Adaptations Kamilla Venner, PhD, Athabascan Assistant Professor, Department of Psychology; Research Assistant Professor, Center on Alcoholism, Substance Abuse, and Addictions (CASAA) at the University of New Mexico Behavioral Health is Essential to Health Prevention Works Treatment is Effective People Recover American Indian & Alaska Native Behavioral Health Webinar Series This webinar is provided by the National American Indian & Alaska Native ATTC, a program funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Substance Abuse Treatment (CSAT). For more information on the ATTC Network, visit: attcnetwork.org To find your regional center, visit: attcnetwork.org/findregcenter.asp For more information on the National American Indian & Alaska Native ATTC, visit: attcnetwork.org/americanindian, or call

2 Upcoming webinars from the National American Indian & Alaska Native ATTC Combining Traditional Healing and Motivational Interviewing for Alcohol and Drug Prevention Among American Indian & Alaska Native Urban Adolescents presented by: Dan Dickerson, DO, MPH, Inupiaq To Be Announced presented by: David Burggraff, PhD, Psychologist; and Harrison Jim Professional Readiness: Attitudes and Values presented by: Matt Ignacio, Tohono O odham, MSSW Group Counseling presented by: Matt Ignacio, Tohono O odham, MSSW For more information about our webinar series, contact Kate Thrams at kate-thrams@uiowa.edu or Continuing Education Hours (CEH) Webinar Follow-Up CEHs are available upon request for $15 per session. This session has been approved for 1.0 CEH s by: NAADAC: The National American Indian & Alaska Native ATTC is a NAADAC (The Association for Addiction Professionals) certified educational provider, and this webinar has been pre-approved for 1.0 CEH. To obtain CEHs for this session, submit a CEH Request Form and payment to the National AI & AN ATTC. A request form is available for download in the Files pod in the webinar screen. If you choose to download a file, a new tab will be opened in your browser, and you will have to click on the webinar window to return to view the webinar. Participants are responsible for submitting state specific requests under the guidelines of their individual state. Presentation handouts: A handout of this slideshow presentation is also available by download. If you are unable to download the documents from the webinar, please contact Kate Thrams at kate-thrams@uiowa.edu or

3 Webinar Follow-Up Evaluation: SAMHSA s GPRA This webinar is provided by the National American Indian & Alaska Native ATTC, a program funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Substance Abuse Treatment (CSAT). Participation in our evaluation lets SAMHSA know: How many people attended our webinar How satisfied you are with our webinar How useful our webinars are to you Immediately following this webinar, you will be redirected to a customer satisfaction survey. Please take a few minutes to give us your feedback on this webinar.. You can skip any questions that you do not want to answer, and your participation in this survey is voluntary. Through the use of a coding system, your responses will be kept confidential and it will not be possible to link your responses to you. We appreciate your response and look forward to hearing from you. Participation instructions: To alternate between full screen mode, please click on the full screen button on the top right of the presentation pod. (It looks like 4 arrows pointing out) To ask questions or share comments, please type them into the Q&A pod and hit Enter. Adobe Connect Overview 3

4 Adobe Connect Overview Please note: The webinar system records participant attention time. If you have other windows open and active, or have the webinar minimized, the system will deem you as inattentive, which may be reflected in the number of CEHs received. Disclaimer Please note: The National American Indian & Alaska Native Addiction Technology Transfer Center is supported by a grant from SAMHSA The content of this publication does not necessarily reflect the views or policies of SAMHSA or the Department of Health and Human Services (HHS). 4

5 Today s Speaker Kamilla Venner, PhD, Athabascan Dr. Venner is an Assistant Professor in the Department of Psychology, and a Research Assistant Professor for the Center on Alcoholism, Substance Abuse, and Addictions at the University of New Mexico. Her research focuses on improving the alarming substance use related health disparities for American Indian/Alaska Natives while balancing the focus on cultural strengths and high rates of abstinence from substances. One avenue to improved outcomes has been to culturally adapt evidence-based treatments in partnership with AI and AN communities. Another line of research has been elucidating the path to resolving alcohol dependence. Kamilla L Venner, PhD Assistant Professor UNM/CASAA 5

6 11:00 Introductions MI Definitions & Ambivalence Persuasion exercise MI Spirit Cultural considerations Resist the Righting Reflex Change Talk Open questions/reflections Snatching Change Talk Taste of MI Adjourn 6

7 Bill Miller Steve Rollnick 3 Essential Elements 1. A Conversation about Change 2. MI is Collaborative 3. MI is Evocative 7

8 Motivational Interviewing is a collaborative conversation style for strengthening a person s own motivation and commitment to change Miller & Rollnick 2013 Motivational interviewing is a personcentered counseling style for addressing the common problem of ambivalence about change 8

9 Motivational interviewing is a collaborative, goaloriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by drawing out and exploring a person s own reasons for change within an atmosphere of acceptance and compassion 9

10 They like what they are doing AND they don t like some things about it If you push for change, the client pushes back against change People commit to what they say or argue for and then are less likely to change I d like to talk with you about vegetables How many vegetables do you eat a day? You should be eating 4 5 servings each day if you expect to be healthy. All you have to do is add veggies to each meal. Have you tried those little bags of carrots? Why don t you add one serving each day? Well, there s nothing I can do for you unless you are ready to get healthy. 10

11 Angry, agitated Oppositional Discounting Defensive Justifying Not understood Not heard Procrastination Helpless Overwhelmed Ashamed Trapped Disengaged Not coming back Uncomfortable Afraid Not a technique for tricking people into doing what they do not want to do If you don t capture the spirit of MI, using the techniques will not be considered MI 11

12 Partnership Acceptance Compassion Evocation Active Collaboration Share Power Exploration more than persuasion See the world through the client s eyes rather than pushing one s view onto the client 12

13 Absolute worth Accurate empathy Autonomy support Affirmation Acceptance frees people to change Judgment can paralyze Overt recognition of the client s right and capacity for self-direction. 13

14 Differentiates MI from sales Heart in the right place Priority to actively promoting client s welfare People already have within them much of what is needed Focus on & understand person s strengths They already have motivations and resources within Understanding the client s perspective and wisdom 14

15 Cultural identity Acculturation (stress) Traditional behavior Traditional ceremonies Traditional spirituality Religion Colonization and Historical Trauma Every Person is: Like All Other People (Universal) Biological, Common Experiences Like Some Other People (Group/Cultural) Culture, ethnicity, race, gender, social class Belonging to a group can be major part of identity Like No Other Person (Individual) Individuals are unique Do not stereotype, more differences within group 15

16 How salient is the person s identity with the special population? If group identity is important, explicit attention to the cultural identity may be instrumental for engagement, retention and outcome Cultural Identity How important to person, to working together Acculturation Stress, Strength Spirituality Religion Discrimination Collectivism Any need for referral(s)? 16

17 The setting may not seem welcoming Maybe no signs of AI/AN culture Maybe no AI/AN providers The person may not feel comfortable talking about AI/AN culture Person not sure if anyone will understand them Adaptations may help make MI make more sense, more culturally relevant Help person connect motivations to culture, spirituality, family, etc. Aspects of the setting Décor, AI/AN staff, questionnaires, resources Asking Open-ended questions about culture Reflections including culture Understandings of the problem Motivations to change the problem Ideas for how to change the problem Cultural supports for the change Explore interest in traditional healing 17

18 I don t want to rush in and provide solutions We often want to fix problems and help people Problem is the effect: natural to resist persuasion Especially if one is ambivalent about change, if you argue for change, Client argues against In MI, the client voices reasons for change 36 18

19 MI Desire Ability Reasons Need Commitment Change 19

20 Desire Ability Reasons Need Commitment Activating Taking steps I want to change I can change I have good reasons to change I need to change I will change I see this as a problem I am wondering how to make a change I am taking steps toward change 20

21 (Pre) Contemplative Preparatory Action 41 Do you promise to love and honor each other for the rest of your lives, through good times and bad, in sickness and in health? I want to make this commitment I am sure I can make this commitment I have good reasons to make this commitment I really need to make this commitment I promise to love and honor him/her! 21

22 Four Fundamental Processes* of MI Planning Bridge to Change Evoking Transition to MI Focusing Strategic Centering Engaging Relational Foundation *Replaces prior Phase 1 & Phase 2 Introduce Self If Native, may share tribe, clans, connections Invite the client to introduce self Open ended question Meant to get to know client and get talking about mental health Sets the stage for active participation of client Share limits of confidentiality Develop rapport 22

23 Answer to closed question? Answer to open-ended question? Why use open-ended questions? Questions When did you last drink/use? What do you like about alcohol? Have you quit drinking before? How were you able to quit before? What was your longest period of sobriety? What would you like to do stop completely, cut down, or sample sobriety? How would you like me to help? Tell me about the last time you felt really good without drugs or beer? Open or Closed? 23

24 What do you think caused this problem? What is the best way to improve/heal? How might stressors such as poverty or discrimination affect your health? How important is spirituality to you? How might spirituality affect your health? How might spirituality help you with this problem? How is this problem affecting your family? How might your family support you? Fundamental skill for MI 24

25 Simple Repeat You are angry with your mom Synonym You are upset with your mom Complex Paraphrase You wish your mom would believe in you Add meaning Seems like your mom is being unfair Add feeling Part of you is also hurt Metaphor Feels like a volcano exploding Change talk often comes intertwined with sustain talk That s the nature of ambivalence 25

26 I really don t want to stop smoking, but I know that I should. I ve tried before and it s really hard. 1. You really don t want to quit. 2. It s pretty clear to you that you ought to quit. 3. You don t think you can quit. See, the thing is, all my friends drink. Some of them probably drink way too much, too, but if I quit drinking, I don t have any friends. I just stay home. That would be pretty lonely. Quitting would cause a new problem. And at the same time you recognize that you, and probably some of your friends, are drinking way too much. 26

27 I know you re worried that I m getting addicted, and I guess I can see what you mean, but I really need more pain medicine. I don t know how I would get through the day without it. If you won t prescribe it, then I ll find someone else who will. You understand my worry about dependence. It s hard to imagine how you would get along without more medicine. One way or another, you re going to get more medicine. Why would you want to make this change? What are the 3 best reasons for you to do it? How important is it for you to make this change? How might you go about it in order to succeed? Give short summary of what you have heard. What will you do? Just listen with interest 27

28 Decrease in resistance/status quo talk Increase in change talk Express confidence that change is possible Support efforts to change Clients/Patients are your best teacher Patient is talking more than you are You reflect more than you ask questions When you ask questions, use open questions Avoid getting ahead of patient s readiness level 28

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30 Questions and Discussion Please type your questions or comments for the presenter in the Q&A pod at this time Follow-up Within the next 24 hours, you will receive an from the National AI & AN ATTC which will include: Link to the recording of this webinar We appreciate your participation in our survey, it should take you no more than 10 minutes to complete, and lets SAMHSA know: How many people attended our webinar How satisfied you are with our webinar How useful our webinars are to you 30

31 Upcoming webinars from the National American Indian & Alaska Native ATTC Combining Traditional Healing and Motivational Interviewing for Alcohol and Drug Prevention Among American Indian & Alaska Native Urban Adolescents presented by: Dan Dickerson, DO, MPH, Inupiaq To Be Announced presented by: David Burggraff, PhD, Psychologist; and Harrison Jim Professional Readiness: Attitudes and Values presented by: Matt Ignacio, Tohono O odham, MSSW Group Counseling presented by: Matt Ignacio, Tohono O odham, MSSW For more information about our webinar series, contact Kate Thrams at kate-thrams@uiowa.edu or Thank you for taking time out of your very important work to ensure quality service through education in collaboration with the persons you serve Behavioral Health is Essential to Health Prevention Works Treatment is Effective People Recover 31