Ensuring Fidelity to Motivational Interviewing among Frontline Service Providers

Ensuring Fidelity to Motivational Interviewing among Frontline Service Providers Presented by Benjamin Callaway, LMSW & Nicole S. Chisolm, MPH May 23, 2018

Thomas Durham, PhD Director of Training NAADAC, the Association for Addiction Professionals www.naadac.org tdurham@naadac.org

Produced By NAADAC, the Association for Addiction Professionals www.naadac.org/webinars

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Using GoToWebinar (Live Participants Only) Control Panel Asking Questions Audio (phone preferred) Polling Questions

Webinar Presenters Benjamin Callaway, LMSW Case Management Supervisor II Benjamin.Callaway@prismntx.org Nicole S. Chisolm, MPH Program Evaluation Director Nicole.Chisolm@prismntx.org

Prism Health North Texas- Dallas, TX Our Mission Advancing the health of North Texas through education, research, prevention, and personalized integrated HIV care. Our Services Our dedicated staff provides medical care, testing, prevention, research, outreach, education, and case management. Our Population Since 1986, we have been helping those living with HIV and AIDS in the community, as well as those at risk for infection.

Webinar Learning Objectives 1 2 3 Identify practical applications of MI techniques when working with persons diagnosed with substance use disorders. Understand the process supervisors used to assess fidelity to MI among front line service providers. Identify methods used to increase fidelity to MI among frontline service providers.

Polling Question #1 What agencies/ organizations are represented in the audience today? a. Residential treatment b. Outpatient facility c. Social support services d. Consumer advocate e. Other

Polling Question #2 What job roles are in the audience today? a. Case manager or peer counselor b. licensed clinician c. Program administrator d. Researcher or evaluator e. Other

Motivational Interviewing - Miller and Rollnick define Motivational Interviewing (MI) as: a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence (2000) - MI is used to promote behavior change in a directive, but nonjudgmental and collaborative way - MI originated in the treatment of substance use disorders, specifically alcohol misuse disorders (Miller & Rose, 2009)

Influences on the Development of MI -MI draws from a number of other psychological approaches including Diclemente s transtheoretical stages of change -Other influences include Carl Rogers empathic, client-centered therapy (Miller & Rose, 2009)

MI is evidence based - Over 200 clinical trials of MI have been published over three decades - MI has been shown to be effective for a range of issues from cardiovascular disease to problem gambling - Not all trials have been positive - One trial found larger effect sizes with minority populations (Miller & Rose, 2009)

Motivational Interviewing Application Use for Engagement in HIV care Harm reduction of substance misuse and high risk sexual behaviors Maintaining employment Engagement in housing programs Maintaining housing Substance misuse treatment

Use by Motivational Interviewing Application at Prism Health North Texas Case Managers- utilize MI intensively with clients to engage in HIV treatment, to conduct harm reduction, and to engage with housing and other social services Behavioral Health Counselors- utilize MI in the context a course of behavioral health treatment in conjunction with HIV and psychiatric providers

Polling Question #3 How do you apply MI? a. Assessment and screening b. Residential care c. Outpatient care d. Detoxification e. Aftercare

Polling Question #4 Does your agency engage in monitoring fidelity to MI principles? a. Yes b. No c. I m not sure

Plan-Do-Study-Act (PDSA) Cycle

PDSA Cycle: PLAN Structured Elements - Supervisor conducted observations using a rubric - Conduct a peer review using checklist - Document use of motivational interviewing Unstructured Elements - Supervisor debriefs - Team debriefs - Peer-to-peer knowledge exchange

Supervisor Observation (Quarterly) Peer Review (Quarterly) Documentation of MI in Encounter Documentation (Ongoing) Team Debriefs (Monthly) PDSA Cycle: DO Peer-to-peer knowledge exchange (Ongoing)

Supervisor Observation Tools Motivational Interview Rating Worksheet Motivational Interviewing Adherence and Competence Feedback Form Motivational Interviewing Skills Development Plan

Supervisor Observation Tools

Peer Review Sample text from peer review documents: The findings from this process evaluation will be used to develop recommendations for improvement and to highlight best practices of the Health, Hope and Recovery team. This is not a punitive process and evaluation activities are in no way linked to performance evaluations. The ultimate goal of the evaluation is to improve the quality of service provided to Health, Hope and Recovery clients.

Peer Review Checklist

Planning Tools

Supervisor Debriefs (One-on-one) o o o Provide a copy of the MI Adherence and Competence Feedback Form and MI Skills Development Plan Discuss observations- include specific examples and quotes Role play Team Debriefs (Group) o o o o o Present aggregate report of peer review findings Discuss common observations - challenges, successes and lost opportunities Reinforce successful application of techniques and troubleshoot as a group Case conference PDSA Cycle: STUDY Identify training and resource needs

PDSA Cycle: ACT Use commonly cited strengths to establish program-wide best practices. Use peer review results and supervisor observation findings to identify training priorities. Update tools (checklist, support tools, encounter note templates)

Motivational interviewing is a way of being with a client, not just a set of techniques for doing counseling. Miller and Rollnick, 1991

Observations at PHNTX Positive Observations Potential Challenges Increase professional support Burnout prevention Knowledge transfer Process streamlining Meaningful staff education Consistent documentation Staff buy-in Increased accountability Time commitment System-level changes

Trainees need more than a onetime workshop to improve skillfulness in this complex method. - Miller (2009) Don t just encourage conversations, facilitate them Move away from static trainings Develop tools, and keep them current Change culture, so that MI is used both philosophically and technically

References Miller, W. R., & Rollnick, S. (2000). Motivational interviewing: Preparing people for change. New York: Guilford Press. Miller, W. R., & Rose, G. S. (2009). Toward a Theory of Motivational Interviewing. The American Psychologist, 64(6), 527 537. http://doi.org/10.1037/a0016830 National Institute on Drug Abuse (NIDA) & Substance Abuse and Mental Health Services Administration (SAMSHA). Motivational Interviewing Rating Guide: A Manual for Rating Clinician Adherence and Competence. NIDA/ SAMHSA Blending Initiative.

Thank You! Benjamin Callaway, LMSW Case Management Supervisor II Benjamin.Callaway@prismntx.org Nicole S. Chisolm, MPH Program Evaluation Director Nicole.Chisolm@prismntx.org

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