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W-2 Case Management: Participant Motivation for

Change

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Case Management and Change

Case management provides “…an organized, structured process for moving participants through the process of change…”

-Dr. Beverly Ford, Making Case Management Work, page 4

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Motivation

Motivation: “…those forces that can push us to leave the comfort of what we know to venture out into the unknown.”

-Dr. Beverly Ford, Making Case Management Work, page 14

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Trying to Motivate

•“Insight”

•“Knowledge”

•“Skills”

•“Suffering/Fear”

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Motivation Hierarchy

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An Example

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Motivational Interviewing

A collaborative conversation to strengthen a person’s own motivation for and commitment to change.

A goal-oriented conversation, focusing on a target behavior with special attention paid to the language of change.

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• Quicker and more cost effective in the long term

• Applicable across a range of problems

• Culturally relevant

• Useable by non-specialists

Motivational Interviewing is:

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Key Elements

• Collaboration

• Evocation

• Autonomy

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Listening

“A practitioner who is listening, even if it is for just a minute, has no other immediate agenda than to understand the other person’s perspective and experience.” - Miller, Rollnick and Butler (MI Researchers), 2008

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OARS

• Open Questions

• Affirmations

• Reflections

• Summarizing

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Open Questions•“What do you…”

•“What have you…”

•“What are the…”

•“How might you…”

•“Tell me about…”

•“Describe your…”

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Affirmations

• Commenting positively on an attribute or strength

• A statement of appreciation

• “Catching” them doing something right

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Reflections

1. Hear what the person is saying.

2. Make a guess about the underlying meaning or emotion.

3. Choose what you will respond to.

4. Make your reflection as a statement.

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Summaries• A recap

• Highlights participant motivation

•Demonstrates attentiveness

•Consolidation of information

•Useful for concluding or shifting direction of the conversation

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Change Talk• D

• A

• R

• N

• C

• A

• T

esire

bility

easons

eed

ommitment

ctivating

aking steps

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• Ask evocative questions• Explore decisional

balance• Try looking

forward/looking back• Query extremes• Use readiness or

confidence rulers• Explore goals and values

Evoking Change Talk

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Responding to Change Talk

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Sustain TalkDon’t:

• Push back• Argue• Judge or confront• Overwhelm with reasons• Cheerlead• Jump ahead of readiness• Discount or ignore feelings or thoughts

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MI Skill Practice

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Important Points to Remember

MI is about:–Empathy–Collaboration–Respect–Evocation–Accepting–Autonomy

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www.motivationalinterview.org