ensuring fidelity to motivational interviewing among ... · 5/23/2018  · ensuring fidelity to...

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 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

Nicole.Chisolm@prismntx.org

Webinar

Presenters

Benjamin Callaway, LMSW

Case Management Supervisor II

Benjamin.Callaway@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

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

Nicole.Chisolm@prismntx.org

Thank You!

Benjamin Callaway, LMSW

Case Management Supervisor II

Benjamin.Callaway@prismntx.org

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

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