3. engagement and motivation for cep workshop (nxpowerlite)

8/13/2019 3. Engagement and Motivation for CEP Workshop (NXPowerLite)

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CEP Workshop Series 2013

Module 3: Engagement & Motivation

Fraser Todd and Michelle Fowler

2013


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Workshop Introduction


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Workshop Agenda

Mihi, Introductions, Housekeeping & Workshop overview

Introduction to the Workshop & Exercise 1

Strategies to enhance engagement

Exercise 2

Motivation

Models of Motivation

Motivation Tools

Session Structure and the Motivational Framework

The Spirit of MI

Change Talk

Exercise 3

Implementation Intention and Mental Contrasting

Exercise 4

Action Planning Take Home

Homework


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Three Dimensions of CEP Practice

Spirit Principles - Techniques:

Spiri"

7 Key Principles

Techniques

1. Cultural Considerations

2. Recovery & Well-being

3. Engagement

4. Motivation

5. Assessment

6. Management

7. Integrated Care

Person-focused care

Well-being orientated care Integrated care

Walk the Talk


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Engagement


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Principle 3: Engagement

The Importance of Engagement:

35 - 50% of all CEP patients drop out of treatment 50% of MH patients do not comply with treatment Factors Associated wit Poor Engagement

o Lack of belief that treatment is effectiveo Low sense of psychological safety in treatment

(stigma, MH environment)

o Single mode treatment (psychotherapy ORpharmacotherapy

o Young ageo Lack of social pro-treatment supporto

Male gendero Drug dependenceo High levels of daily stress


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What is Engagement? :

!"#$#%&%"'

#$"% &'$($&$)( #$"% *+,-$&+ #$"% .)()/+.+(" 0')(

12 3+ )&4-+'5 $(-2'-+6 7,+*+(&+

1

88

1 1


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Exercise 1: Presence

9++ 7)/+ : 2; "%+ #2,


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A Structure for Thinking About Engagement :

!"#$#%&%"'

=>"+,()'

7%5*$&)' ? ",)(*02,"@ &%$'6

&),+

9A002," ;2, ",+)".+("

+B/B ;).$'5@ 0++,*82+,&$2( +B/B &2A,"*

7,2/,)..+ &2(*$*"+(&5

92&$)' (2,.*

7,+C",+)".+(" D

=(",5 $("2 1,+)".+("

95.0"2.* *+-+,$"5

E24-)42( ;2, &%)(/+

F+)6$(+** ;2, ",+)".+("7)*" ",+)".+(" +>0+,$+(&+

G(>$+"5 D %2*4'$"5

=.242( 65*,+/A')42(

1 1

#$"%$( 1,+)".+(" D

F+"+(42(

1%+,)0+A4& ,+')42(*%$0

G**+,4-+ ;2''2HCA0

82/($4-+ ;A(&42($2(/IA"&2.+ +>0+&")(&$+*

9",A&"A,+6 *+**$2(*

82/($4-+ ;A(&42($(/

1


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Factors Influencing Engagement:


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Strategies to Enhance Engagement 1:

Values, vision of well-being

Cognitive mapping

MI Engagement Interview

Autonomy-supportive environment

(3-5 choices)

Treat hostility, emotional dysregn early

Clearly structured sessions

Adapt to coping style

Remove barriers

Consistency of approach

Peer Support to engageAssertive follow-up

Adapt for cultural needs


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Cognitive Mapping:

82/($4-+ E)00$(/J(&,+)*+* +(/)/+.+("35 KBL>

7,+*+(" $(;2,.)42(

)* ) 6$)/,).

8'$+(" 2, &'$($&$)(

.)5 &2.0'+"+ $"

1H2 6$*4(&" &%)((+'* ;2,

")


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Cognitive Mapping:

82/($4-+ E)00$(/J(&,+)*+* +(/)/+.+("35 KBL>

7,+*+(" $(;2,.)42(

)* ) 6$)/,).

8'$+(" 2, &'$($&$)(

.)5 &2.0'+"+ $"

1H2 6$*4(&" &%)((+'* ;2,

")


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Cognitive Mapping:

82/($4-+ E)00$(/J(&,+)*+* +(/)/+.+("35 KBL>

7,+*+(" $(;2,.)42(

)* ) 6$)/,).

8'$+(" 2, &'$($&$)(

.)5 &2.0'+"+ $"

1H2 6$*4(&" &%)((+'* ;2,

")


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Cognitive Mapping:

82/($4-+ E)00$(/J(&,+)*+* +(/)/+.+("35 KBL>

7,+*+(" $(;2,.)42(

)* ) 6$)/,).

8'$+(" 2, &'$($&$)(

.)5 &2.0'+"+ $"

1H2 6$*4(&" &%)((+'* ;2,

")


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Rachel Cognitive Map of Formulation:

U$)/(2*+* 7,23'+.*

G+42'2/$&)' V)&"2,*

9",+(/"%*N)'A+*#+''C3+$(/

F)0+

9+>A)' G3A*+

EA'40'+ 0,$.),5 *&%22'*

9SU

=>"+,()'$*$(/

3+%)-$2A,*

G-2$6)(" &20$(/


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Autonomy-Supportive Environment:

GA"2(2.5C9A002,4-+ =(-$,2(.+("

I04.)''5 WCX &%2$&+*

9%)0+ 6$,+&42( 35 2Y+,$(/ &%2$&+

8'$+(" +(&2A,)/+6 "2 .)


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The Engagement Intervention:


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Exercise 2: Rachel Engagement

9++ 7)/+ KO 2; "%+ #2,


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Motivation


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Model of Motivated Behaviour:

Principle 4: Motivation

)%*+,"

-

./'0$1,"

/"'%*$21,"

321," 40'2,&% 5,"+%60%"2%+

J("+(42(

V2,.)42(

J("+(42(

J($4)42(

J("+(42(

U+)&4-)42(

U+'$3+,)42( 7')(($(/ G&42( =-)'A)42(

7+,*2(M(++6*.24-+*/2)'*

9$"A)42(M2002,"A($4+*

$(&+(4-+*


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Key Principles of General Motivation:

KB G&&+**$3$'$"5 7,$(&$0'+ E24-)42()' &2(*",A&"* ),+ )&4-)"+6 ;,2. .+.2,5 #2,


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Implications of the Key Principles of General Motivation:

S$.$" "%+ (A.3+, 2; /2)'* 3+$(/ )&4-+'5 H2,


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Stages of Change (Prochaska & DiClemente):

7,+C&2("+.0')42(

82("+.0')42(

7,+0),)42(G&42(

E)$("+()(&+


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Non-autonomous Autonomous

Amotivation Extrinsic Motivation Internal

Motivation

External

Regulation

Introjected

Regulation

Indentified

Regulation

Integrated

Regulation

Intrinsic

Regulation

!82.0+"+(&+@ )A"2(2.5 D ,+')"+6(+**

b/,+)"+, .24-)42( ;2, ",+)".+("b",+)".+(" 3+$(/ .2,+ -)'A+6b '+** ).3$-)'+(&+ )32A" ",+)".+("b%$/%+, '+-+'* 2; *+';C+c&)&5 D *+';C+*"++.b3+\+, +(/)/+.+(" $( ",+)".+("b3+\+, ",+)".+(" 2A"&2.+*b $(&,+)*+6 )3$'$"5 "2 2-+,&2.+ 3),,$+,* "2 &%)(/+


Self-determination Theory (Ryan &Deci):


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Theory of Planned Behaviour Change (Azjen):

7%8$9/,0*J("+(42( "2 G&"

Gd"A6+ "2H),6* 3+%)-$2A,

9A3`+&4-+ T2,.*

e;+'" *2&$)' 0,+**A,+ "2 )&"f

7+,&+$-+6 g+%)-$2A,)' 82(",2'

g+%)-$2A,)' 3+'$+;*

IA"&2.+ +-)'A)42(

T2,.)4-+ 3+'$+;*

E24-)42( "2 &2.0'5

82(",2' 3+'$+;*

7+,&+$-+6 02H+,


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Internal

Motivation

MI

7,+C&2("+.0')42(

82("+.0')42(

7,+0),)42(

G&42(E)$("+()(&+

F+')0*+

5,&:%'%"2%

30',",&;


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Crucial Transitions:

V)&"2,* "%)" $(%$3$" "%+ $($4)42( 2; )&42(S2H *+';C+c&)&5S2H 3+%)-$2A,)' &2(",2' 2-+, "%+ )&4-$"5P(H$''$(/(+** "2 *AY+, *%2," "+,. &2*"* ;2, '2(/ "+,. /)$(*h$/% $.0A'*$-$"5 e6$*",)&42(fS)&< 2; -)'A+ )\)&%+6 "2 "%+ /2)' e2A"&2.+ +>0+&")(&5fEA'40'+ /2)'*9",+** J(&2(/,A+(&+ 3+"H++( J.0'$&$"_+>0'$&$" .24-+*

9",)"+/$+* "2 +(%)(&+ "%+ $($4)42( 2; )&42(

=(%)(&+ "%+ -)'A+ 2; ) /2)' 35 )\)&%$(/ $" "2 '$;+ -)'A+* )(6 H+''C3+$(/ J(&,+)*+ *+';C+c&)&5 J(&,+)*+ 3+%)-$2A,)' &2(",2' "%,2A/% &,+)4(/ )( )A"2(2.5 *A002," +(-$,2(.+("82(",2' $.0A'*$-$"5 H$"% .$(6;A'(+**S$.$" "%+ (A.3+, 2; 02*$4-+ /2)'* 3+$(/ )&4-+'5 H2,


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The Spirit of MI MI3:

)),"(+,*%$0

3c,.)42(

52.0)**$2(

!-2&)42(


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MI Process:

KB =(/)/+OB

J6+(4;5 7,23'+.*

WB =-)'A)"+ *")/+ 2; &%)(/+^B =-)'A)"+ ,+)6$(+** )(6 &2(j6+(&+ e*+';C+c&)&5fXB 9",)"+/$+* "2 $(&,+)*+ ,+)6$(+** )(6 &2(j6+(&+ e$(&,+)*+ &%)(/+ ")'


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Readiness Rulers:

T2" F+)65 P(*A,+ F+)65


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Readiness Rulers:

T2" 82(j6+(" P(*A,+ 82(j6+("


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Use of the Rulers:

P*+ 2; "%+ ,A'+, H$"%$( EJM

G*< "%+ 0+,*2( "2 ,)"+ 2( "%+ ,A'+, H%+,+ "%+5 ),+ (2H $( "+,.* 2; 3+$(/ ,+)65"2 &%)(/+m

82..+(6 "%+ ,+*02(*+G*< H%5 "%+ 0+,*2( 6$6 (2" 0$&< ) '2H+, (A.3+,G*< H%)" $" H2A'6 ")


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Readiness + Confidence:

F+)6$(+**

82(j6+(&+

Kn

Kn

n

V,A*",)42(

S)&< 2; o(2H'+6/+

9A&&+**

9


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Readiness + Confidence:

F+)6$(+**

82(j6+(&+

e9+';C+c&)&5f

Kn

Kn

n

7,+0),)42(

82("+.0')42(

7,+C

&2("+.0')42(

35GB4H E)$("+()(&+


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J("+/,)"+


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J("+/,)"+


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Change Talk:

I+*$,+

33$'$"5

%"1?;/"# 58$"#% G$=EJ


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Exercise 3: Identifying Change Talk3


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Exercise 4: Reflective Listening3


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Self-Efficacy:


1%+ &2(-$&42( "%)" 2(+ &)( *A&&+**;A''5 &),,5 2A" "%+ 3+%)-$2A,*

(++6+6 "2 0,26A&+ ) &+,")$( 2A"&2.+

h$/% *+';C+c&)&5 $* )**2&$)"+6 H$"%M

$(&,+)*+6 '$


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Self-Efficacy:


9",)"+/$+* "2 $.0,2-+ *+';C+c&)&5M

=>0+,$+(&+* 2; .)*"+,582/($4-+ ,+*",A&"A,$(/N$&),$2A* +>0+,$+(&+F+6A&+ *",+**@ )(>$+"5@ ;)4/A+ )(6 ')&< 2; *'++090+&$j& ;++63)&< ? )&&A,)"+ 3A" +(&2A,)/$(/92&$)' *A002,"820$(/ *$+"5 )(6 *",+**9%2,"C"+,. )&%$+-)3'+ /2)'*G-2$6 &2.0),$*2( H$"% 2"%+,*9A002," )A"2(2.5


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Mental Contrasting and Implementation Intentions (MCII):

KB E+(")' 82(",)*4(/ 8%22*+ ) *0+&$j& ",+)".+(" /2)' =(-$*$2( "%$* /2)' H%+( *A&&+**;A''5 &2.0'+"+6 *2.+4.+ $( "%+ ;A"A,+ =(-$*$2( H%+,+ "%$(/* ),+ )" &A,,+("'5 $( ,+')42( "2 "%+ /2)' J6+(4;5 3),,$+,* $( )&%$+-$(/ "%+ /2)'OB J.0'+.+(")42( J("+(42(*

1%$(< 2; "%+ 3),,$+,* "2 "%+ /2)' 1%$(< 2; *"+0* "2 )&%$+-+ "%+ /2)'7')( *0+&$j& 6+")$'* )32A" H%+( "%+ *"+0* H$'' 3+ A(6+,")


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Exercise 5: Mental Contrasting and

Implementation Intentions

4%% #(2% 56 0& 7*819**1


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Implicit Motivation:


!-:=/2/' B&:=/2/'

82(*&$2A* T2(C&2(*&$2A* C A()H),+

N+,3)' T2(C-+,3)'

]A$6+* &2(*&$2A* /2)' *+d(/ J("A$4-+ /2)' 0A,*A$"

Z"%2A/%"[ S$


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