iuc training academy interview module adults

Colleen Friend, Ph.D., LCSWCalifornia State University, Los Angeles

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Welcome!Content Outline for Adult Clients

A. Multiculturalism and Cultural CompetenceB. Principles of Ethnographic InterviewingC. Interview Practice is Guided by ASFA Core ValuesD. Shift into Using a Strengths-Based ApproachE. Motivational and Solution-Focused Interviewing

SummarizedF. Sample Questions, Review of Interview Techniques, Suicide

Assessment, Preparing for an Interview, and Neglect Red Flags

G. Role Play Directions, Role Play, Video Selections, and Video Worksheet

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Multiculturalism & Cultural Competence

What is Culture?

The way of life of a people. The sum of their learned behavior, patterns, attitude, etc.; it includes beliefs, preferences, verbal and nonverbal communication styles and relationship patterns. We see the world via our own cultural filters. What each person like you already “knows.”

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What is cultural competence?Knowing how to negotiate cultural differences

and being willing to conduct human interactions in a respectfully responsible and responsive manner … that protects / preserves the dignity of individuals. It is more than knowledge; it is a state of mind and way of life.

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Five Elements of Cultural CompetenceAs an Individual: Awareness and acceptance of difference Awareness of own cultural values Understanding dynamics of difference Development of cultural knowledge Ability to adapt practice to the cultural context

of the client

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As an Organization: Valuing diversity Participating in cultural self-assessment Managing the dynamics of difference Institutionalizes cultural knowledge Adapts to diversity

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What are the “isms”?

racism

sexism

classism

ageism

disable-ism

heterosexism

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Principles of Ethnographic Interviewing

Disproportionality in Child Welfare

Los Angeles County Children receiving DCFS servicesCaucasian 3,829 11.9%Hispanic 17,724 55.2%African American 9,596 29.9%Asian Pacific Islander 595 1.9%American Indian 127 0.4%Filipino 186 0.6%Other 71 0.2%

Note: Data from June 2009 LA County DCFS Fact Sheet.

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How we Bridge the Gap

As a cultural anthropologist:

Worker is a guest, client is cultural guide

Expert is a person from that culture

Guide becomes the teacher and

interviewer is the student

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What is ethnographic interviewing?

It is a method of inquiry in which the interviewer controls the structure but not the content of the interview.

Two Assumptions

Language and words are windows into the interviewee’s world

The narrative produced encourages healing through a process of self-discovery, valuing, and moving out of the victim role.

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Principles of Ethnographic Interviewing Parts of the interview

Rapport buildingAsking “Global Questions” that focus on perceptions of self,

norms, what feels like help, etc?Use of “Cover Terms” and descriptive questions specific to the

guide’s culture, convey important symbolism“Descriptors Questions” are characteristic of the guide’s cover

termsUse of “Summary” reflects interviewer’s listening; should show

the client’s perspective, allow for collaborative decision-making and identify culturally appropriate services.

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Interviews are Guided by ASFA Core Values

Shortened timelines to permanencySafety for children,

especially for those in foster careStability and well being for children,

especially for those in foster care

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Public Child Welfare has Shifted into Strengths-Based Approach

PCW and the Strengths-Based ApproachRecognize a shift into building on strengthsModel empathy and offering supportFocus on “good” and use that to build a positive chainTreat family as expert on themselves and extended

family affiliates as helpersConduct problem-solving in partnership Create an atmosphere that is open to feedback;

and model it first

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Public Child Welfare has Shifted into Strengths-Based Approach

Look for opportunities to reinforce positive changeTest whether or not you are communicating in a

respectful manner; would you want someone from DCFS to treat your family member this way?

See yourself in a partnership with your supervisorKeep track of what you are learning and where you

get stuckInterviewer’s job is to maintain the focus and

direction of the interview

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Consider Three Interviewing Approaches

Narrative

Motivational

Solution-Focused

Evidence to support these approaches differs

We will examine each, then summarize their different uses, and apply each in an exercise

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Narrative Interviewing for Adults

What is it? A style of interviewing; uses prompts such as “tell me about it..” That encourages the client to narrate about their own experience. The interviewer listens attentively and compassionately.

BenefitsEstablishes the client as the expert in his/her own experience, from

his/her own cultural vantage point Potentially draws out material your way not be able to reach through

traditional interviewingMay be useful in rapport buildingHas the power to illuminate issues when there are large cultural

differences between the client and interviewer

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Narrative Interviewing for Adults

Benefits (continued)Can reveal a range of attitudes and beliefs about

receiving “help” which affects your relationship Once elicited, you can analyze, identifying complex

motives, themes and constraints.Considerations

Clients vary in their abilities to organize their storiesInterviewer minimizes interruptions.Requires a commitment of time do well.

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Traditional vs. Motivational/solution-focused

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TraditionalMotivational and Solution-Focused

Interviewer does most of the talking

Questions are designed to elicit client’s talk

Interviewer as expert, all “knowing”

Client as expert/competent; interviewer takes not-knowing posture

Interviewer conducts assessment Co-construction of assessment, goal path; solution is client’s

Interviewer may proscribe/advise after understanding the problem

Emphasis on listening, empathetic responses, incorporating client’s words/perceptions in responses; limits on advice-giving

Sees resistance as a client trait Sees resistance as a creation of the interview interaction

May take a deficit approach Operates from strengths

One size fits all? Sees ambivalence as normal

Training and practice may or may not be required or inconsistent

Requires training, practice, and supervision with consistent approach

Summary: Motivational and Solution-Focused Interviewing

Motivational Interviewing:Is a directive, client centered approach (or counseling style) for

eliciting behavior change by helping clients to engage in change talk when exploring and resolving ambivalence

Is based on an understanding of change stages, the particular stage

of change your client is in and what triggers changeAssumes that readiness to change is not a client trait, but a

fluctuating product/process of interpersonal relationshipsDEARS: Develop the discrepancy, Express Empathy, Avoid

argumentation, Roll with resistance, Support self efficiencyResearch: Well supported and effective ; rated “level 1” by the

California Evidence Based Clearing House (CEBC)

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Summary: Solution-Focused Interviewing

Solution Focused Interviewing

Is a system of intervening that emphasizes: Client as competent co-constructor of goals and an expert in

making them happen Interviewer operates as a not knowing discoverer Generating “solution talk” with an appreciation for client’s

strengths and resources Resistance is not a client trait, but can be generated in the

interview interaction Construct interview “moves” based on solution-focused techniques

which do influence outcomes by uncovering the client’s own solution

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Stages of Change

StageSample Statement

Typifies StageInterview Techniques

Pre-contemplation “What? I don’t have a problem!”Build rapport, use open-ended questions, personalize risk, roll with resistance, raise doubt

Contemplation “I have been worried about x.”Double-sided reflections, make observations, summarize ambivalence, offer interpretations, highlight concerns, reevaluate

Preparation“I am going to go to x, I have called several times.”

Assist in developing a concrete plan for follow through, support what has been done so far, acknowledge difficulty, encourage commitment

Action“I am getting the help I need and I see a difference.”

Support self-efficacy, elicit barriers to long term change, help problem solve, verbally reinforce, substantiating alternatives

Maintenance“I did not drive by the x on my way home from work.”

Identify high risk situations, plan for relapse prevention, identify safety plans, anticipate recycling/expand alternatives, encourage self-reward, provide feedback

Termination“I used to do x, but that’s a part of my past.”

Support self-efficacy, acknowledge accomplishment, invite check-ins

*Anticipate/recycling before lasting maintenance is achieved.Note: Some earlier works from DiClemente and Prochaska identify “Relapse” as a separate stage, and an integral part of change.

Sumamry: Motivational terviewing

5 GENERAL BASIC SKILLS: AROSE

1. Affirmation

2. Reflective Listening

3. Open Ended Questions

4. Summarization

5. Eliciting Change Talk

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Review: Reflective Listening and Statements

Simple Reflection Paraphrase Reflection of Feeding Double Side Reflection

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.Review

Summarization:

• Pulls together reflective listening and prepares the client to move on.

• Check with client for accuracy and perspective.

Change Talk:• Assesses desire, ability, reason, need or commitment to

change Asks evocative questions, explore pros and cons, ask for

narrative.

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TECHNIQUES:

Use questions to draw out the client’s position: “What needs to happen for our talk to be useful?”

Treat your client as an expert to diminish defensiveness: “How is not signing the contract useful to you?”

Use normalizing, brief statements: “Of course, sure, yes, that’s understandable.”

Use Partializing: “What part of ‘x’ did you agree with?”

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TECHNIQUES:

Affirm your client’s perceptions: “What would it take for them to know what a good mother you are?”

Develop goals: elicit his/her description of what will be different when solved; work with small increments

Explore for exceptions: what was happening when situation was less severe (“wh” questions) using scaling and miracle questions.

Co-construct goals: Use scaling questions to establish a baseline and what the client thinks it would take to get to the next level.

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TECHNIQUES:

Co-construct hope: Use “miracle” questions to facilitate making a concrete plan from a wish or dream.

End of session feedback: Construct messages that acknowledge strengths based on goals and what needs to happen on co-constructed goals (give homework).

Evaluate client progress: done together; use scaling questions to assess baseline and change

RESEARCH: Probably a promising practice; not rated by California Evidence Based Clearing House (CEBC)

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Motivational interviewing:Sample Questions, Review of Interview Techniques

Pick one question from this list that you can see having immediate utility in your future interviewing. Explain your choice.

How is this a concern for you? (Open-ended question) What things could be a problem? (Open-ended

question) What do you think will happen if you don’t make a

change? (Open-ended question, shifting focus) Ok, so you didn’t make it, but each attempt can move

you closer to success. (Reframe) Do you remember a time when things were going well?

What changed? (Open-ended questions) Inquire about the good things i.e. what do you like

about.... (Open-ended question) You are a very resourceful person. (Affirmation)

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Motivational interviewing:Sample Questions, Review of Interview Techniques

You’ve got a point there. (Support) What are your options? What could you do?

(Open ended questions) “This requires commitment/effort, maybe you’re

not motivated/ready yet.” (Complex Reflection) On the one hand, you want Jimmy to come

home, on the other hand, he has special needs that require your constant supervision. (Double Sided Reflection)

On the other hand, you have seen the health risk cigarettes pose, on the other hand, nothing else seems to calm you down. (Double Sided Reflection)

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Solution-focused interviewing:Sample Questions, Review of Interview

Techniques

Pick one question from this list that you can see having immediate utility in your future interviewing. Explain your choice. What have you thought about doing so far? (Open-

ended question) So, that was helpful, what else did you do. (What else

question) Was there ever a time when you were not doing x?

(Exception-seeking question) How would you re create that time? (Exception-

seeking) What needs to happen for our talk to be useful to you?

(Lead-in question) So when you are saying serenity prayer, what will you

be doing differently? (Future-oriented question)31

Solution focused interviewing:Sample Questions, Review of Interview

Techniques

Wow! You’ve been sober for 3 months, how did you do it? (Coping question)

On a scale of 1 – 10 (one being the lowest score and 10 being the highest), how are you doing now? [Note: This question can be modified to be more specific, i.e., doing with your depression? The follow-up question is: Can you describe a (number) for me? And eventually: What would it take to move that to a (one number in a desirable direction)? What would be different?] (Scaling question)

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solution focused interviewing:Sample Questions, Review of Interview

Techniques What part of the issue did you agree with? (Lead-in

question) What would let you know the situation was improving?

(Open-ended question) Does the judge know that you have been making all these

efforts? (Relationship question) How could you get that to happen? (Open-ended question) Suppose there were a miracle cure tomorrow, what would

that look like? (Miracle question) Could it be that you really want to make sure your client is

safe? (Question framed in tentative language)

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Sample Questions, Review of Interview Techniques,

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Differential Use of Interviewing Techniques

You can create your own approach through differential use of these techniques:

Narrative: Use when there is a cultural gap between

interviewer/client. Assure that you have enough time. Employ selectively when there is a part you are not

getting.Motivational:

Use when ambivalence seems to be present and you want to explore the client’s stage of change and willingness to engage in change talk.

Stage of change and willingness to engage in change talk. Can help lower conflict by putting the client in control of

goals, etc.35

Differential Use of Interviewing Techniques (Cont.)

Solution Focused:

Similar to Motivational, use to explore change, your questions are probes for excavating the solution from the client “expert”.

This process also deflects conflict, and relies on the interviewer accepting a role in the creation of resistance.

End of session feed back and complement can move the relationship into a positive realm.

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Practice Example

Consistent use of these approaches requires continued training and supervision.

In the Practice Example we use for Neglect (at the end of this module) prepare to use three techniques / questions from each of these approaches.

Use them differentially, when the need arises.

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PREPARING FOR AN INTERVIEW

Review the record or referral. What do I “know?” As an investigator, is my mind open to new information; am I equally interested in information that may disconfirm my hypothesis?

What is my role and purpose?Did I do my homework from the last home call?Conscious caseworker decisions: where to conduct, who to

interview first?Should the visit be announced or unannounced?

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PREPARING FOR AN INTERVIEW (Cont)

Jurisdiction: Although there been a cross report to LE, do they need to know I am going there now? What will be the plan if I can’t get in?

Should I bring another worker? Should I go with LE?

Assess my safety plan.Anticipate problems (what could happen?);

formulate strategies.Have I filled out an itinerary?Do I need to consult with my supervisor or

lead worker?39

PREPARING FOR AN INTERVIEW (Cont)

Write a short list of reminders.Do I have material to take notes during or

immediately after?Should I bring a car seat?Do I have a map or book of maps, cell

phone, gas, etc.?Plan: Where will I park? What time of day

to conduct? Will I have to do other follow-up immediately?

Am I feeling anxious? 40

High risk for neglect: red flags

Single parent, young motherOwn history of abuse /neglect* in family of originUnrealistic expectations of children (the younger

the child, the higher this concern)DepressionImpulsivityMeets adult needs through childChild’s behavior may exacerbate parental

behavior.

*Research indicates about one-third repeat this.

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Role Play Directions, Role Play,

Video Selections,and Video Worksheet

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iuc training academy interview module adults

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