ensuring fidelity to motivational interviewing among ... · 5/23/2018 · ensuring fidelity to...
TRANSCRIPT
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
Produced By
NAADAC, the Association for Addiction Professionalswww.naadac.org/webinars
www.naadac.org/webinars
www.naadac.org/fidelity-to-MI-webinar
Cost to Watch:
Free
CE Hours
Available:
1.5 CEs
CE Certificate for
NAADAC
Members:
Free
CE Certificate for
Non-members:
$20
To obtain a CE Certificate for the time you spent watching this
webinar:
1. Watch and listen to this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/fidelity-to-MI-webinar
3. If applicable, submit payment for CE certificate or join
NAADAC.
4. A CE certificate will be emailed to you within 21 days of
submitting the quiz.
CE Certificate
Using GoToWebinar – (Live Participants Only)
Control Panel
Asking Questions
Audio (phone preferred)
Polling Questions
Nicole S. Chisolm, MPH
Program Evaluation Director
Webinar
Presenters
Benjamin Callaway, LMSW
Case Management Supervisor II
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
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.
1 32
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
- 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)
Motivational Interviewing
-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)
Influences on the Development of MI
- 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)
MI is evidence based
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
Motivational Interviewing Application
Use by
• 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
Motivational Interviewing Application at
Prism Health North Texas
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
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
PDSA Cycle: PLAN
• Supervisor Observation (Quarterly)
• Peer Review (Quarterly)
• Documentation of MI in Encounter Documentation (Ongoing)
• Team Debriefs (Monthly)
• Peer-to-peer knowledge exchange (Ongoing)
PDSA Cycle: DO
• Motivational Interview Rating Worksheet
• Motivational Interviewing Adherence and
Competence Feedback Form
• Motivational Interviewing Skills Development
Plan
Supervisor Observation Tools
Supervisor Observation Tools
Supervisor Observation Tools
Supervisor Observation Tools
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
Peer Review Checklist
Planning Tools
Planning Tools
Supervisor Debriefs (One-on-one)
o Provide a copy of the MI Adherence and Competence Feedback Form and MI
Skills Development Plan
o Discuss observations- include specific examples and quotes
o Role play
Team Debriefs (Group)
o Present aggregate report of peer review findings
o Discuss common observations - challenges, successes and lost opportunities
o Reinforce successful application of techniques and troubleshoot as a group
o Case conference
o Identify training and resource needs
PDSA Cycle: STUDY
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)
PDSA Cycle: ACT
Motivational interviewing is a way
of being with a client, not just a set
of techniques for doing
counseling. Miller and Rollnick, 1991
Positive Observations
• Increase professional
support
• Burnout prevention
• Knowledge transfer
• Process streamlining
• Meaningful staff education
• Consistent documentation
Potential Challenges
• Staff buy-in
• Increased
accountability
• Time commitment
• System-level changes
Observations at PHNTX
“Trainees need
more than a one-
time 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.
Nicole S. Chisolm, MPH
Program Evaluation Director
Thank You!
Benjamin Callaway, LMSW
Case Management Supervisor II
www.naadac.org/fidelity-to-MI-webinar
Cost to Watch:
Free
CE Hours
Available:
1.5 CEs
CE Certificate for
NAADAC
Members:
Free
CE Certificate for
Non-members:
$20
To obtain a CE Certificate for the time you spent watching this
webinar:
1. Watch and listen to this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/fidelity-to-MI-webinar
3. If applicable, submit payment for CE certificate or join
NAADAC.
4. A CE certificate will be emailed to you within 21 days of
submitting the quiz.
CE Certificate
July 25, 2018June 27, 2018
June 13, 2018 July 11, 2018
Upcoming Webinars
www.naadac.org/webinars
Early Recovery Nutrition Education
By Jeffrey Lang, PhD, LCADC, CCS
Therapeutic Considerations of
Psychopharmacology for Opiate Use Disorder
By Linda Shaffer, MA, EDS, LCAS
Picking up the Pieces for Wholeness and Recovery
By Dana DeDolf, MA, LPC, CADCIII, MAC
Cognitive Therapy and Compulsive Sexual
Behavior
By William Brock, PhD
www.naadac.org/webinars
Over 145 CEs of free educational
webinars are available. Education
credits are FREE for NAADAC
members.
WEBINAR SERIES
In each issue of Advances in
Addiction & Recovery, NAADAC's
magazine, one article is eligible for
CEs.
MAGAZINE ARTICLES
NAADAC offers face-to-face
seminars of varying lengths in the
U.S. and abroad.
FACE-TO-FACE SEMINARS
Earn CEs at home and at your own
pace (includes study guide and
online examination).
INDEPENDENT STUDY COURSES
NAADAC Annual Conference, October 6-8
2018, Houston, TX
www.naadac.org/2018annualconference
CONFERENCES
Demonstrate advanced education in diverse
topics with the NAADAC Certificate Programs:
• Recovery to Practice
• Conflict Resolution in Recovery
• National Certificate in Tobacco Treatment
Practice
CERTIFICATE PROGRAMS
www.naadac.org/education
Thank you for joining!
NAADAC
44 Canal Center Plaza, Suite 301
Alexandria, VA 22314
phone: 703.741.7686 / 800.548.0497
fax: 703.741.7698 / 800.377.1136
www.naadac.org
NAADACorg
Naadac
NAADAC