motivational interviewing 30k feet
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ENGAGEMENT TRAINING FOR CASE MANAGEMENT: MOTIVATIONAL INTERVIEWING
Mary M. Cain, MPH
July 8, 2011
Mary
I am a part of all that I have met – Tennyson Institute for the Future > role of
consumers & technology LifeMasters > application of activation and
motivational interviewing in disease management call centers decreased HC utilization by 11%
StayWell > health coaches have an advantage in engaging members
Improving Member Engagement
From Case Management Team: We need to improve engagement with members Case Managers don’t like “selling” themselves We want to improve member’s health by
ensuring access to the services available The value of case management not clear to the
member or to case managers Current results:
Short interactions Missed opportunities No connection made with the member
How to improve CM results
Revisit the value of case management from the case manager’s perspective
Introduce Motivational Interviewing Meet the member where they are Learn how to listen, collaborate and
connect with the member
Objectives for training
Describe the core skills of motivational interviewing and the concept of engagement as they apply it to the case management process
Demonstrate basic motivational interviewing techniques and an understanding of how to engage members in assessment, goal setting and achieving plan of care
Practice specific techniques to increase member engagement to facilitate assessment, goal setting and achieving plan of care
Demonstrate skills to utilize effective responses designed to reduce member resistance, allowing facilitation of goal setting and continued member engagement with the plan of care
Process for developing and conducting training
Learn about the context for case management How are staff trained? What are they measured on? What do they think works and why?
Develop customized training Provide training
Train-the-trainer Clinical: 3 modules trained in August
2 virtual 2-hour trainings over 2 weeks, 1 onsite 4-hour training
Non-clinical: 2 modules trained in September 2 virtual 2-hour trainings over 2 weeks
Post-training evaluation
Success Metrics
CM staff’s ability to articulate an understanding of the case management program
CM staff’s comfort with ability to engage members as measured by pre- and post-training assessments
Effective communication with members as measured by member surveys
Efficient process for staff that doesn’t increase perception of workload burden as measured by pre- and post-training assessments (i.e. revisiting the process, not just piling more on top)
Long-term measures of success Fewer “one and done” cases, fewer incidences of “lost contact” Greater member satisfaction with case management services
Context of Case Management
Why do people choose to be case managers?
What helps them connect with their members?
What are the barriers to connecting?
Motivational Interviewing
Collaborative, person-centered form of guiding to elicit and strengthen a person’s motivation for change – Bill Miller
Goal: give the staff tools to draw the member out and support the member’s own motivation for change in the context of an appropriate care plan
Spirit of MI
Collaborative > a partnership, not top down
Evocative > the member has the resources within herself to make a change
Honors autonomy > Case Manager can’t make choices for the member
Principles of MI
Support self-efficacy Express empathy Roll with resistance Develop discrepancy
MI Techniques
OARS Open-ended questions Affirmative statements Reflective statements Summary statements
Listening for change talk Desire: Why would you want to make this change? Ability: How would you do it if you decided? Reason: What are the three best reasons? Need: How important is it? and why? Commitment: What do you think you’ll do?
MI works
Keys to success
Training is the first step in a journey Evidence supports ongoing coaching and
management support will make or break the sustainability of the change
Supporting infrastructure is key Performance evaluation and measurement
must adjust to continue staff growth in skills
MI is a big change
Change is hard Congratulations on taking this first step This is a marathon, not a sprint
Value
To member: greater self-efficacy, help when they need it and ultimately better quality of life
To staff: job satisfaction, more efficient process and time well spent
To Corporation: more appropriate use of services, improvement in the health of the member population
