People not Problems:
Motivational Interviewing in
Practice.
Rhoda Emlyn-Jones
Where it began
• 1970’s
• Community based
counselling services
• In the 80’s working within
the local authority.
• Counselling
• Social work
• homelessness
The early context
• Building accessible community services
• Emphasising personal choice
• Acknowledging the expertise of the
individual
• Choosing their own path
• MI built on the observations of best
practise and provided the framework for
best practise ,
What helped
• Understanding ambivalence !
• Exploring helpful aspects of current
behaviour first !
• Knowing what you were doing if you
weren’t asking questions or giving advice.
• Reflect , reflect , reflect.
• Not to pathologise normal behaviour
• Not challenging behaviour head on
principles
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Express empathy: best relationship
Develop Discrepancy: most difficult conversation
Avoid argumentation: its not about what we think
Roll with resistance: It’s a normal response but if
raised will get in the way of change
•
Support self-efficacy :Its peoples belief in their own
strategies and skills that leads to sustained change.
Effective services
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Skills
Methodology
Design
MI consistent
Consistently scrutinise and support all
three
New service areas
Early 90’s
• Criminal justice services
• Child protection services
• Fear of risk
• Fear of perceived collusion
• “doing good with a vengeance”
The context
• People noticed more for the problems they
cause than the problems they faced
• Dominated increasingly by assessment
• Care planning and monitoring.
• Deficit models
• Poor engagement
• Little focus on outcomes
Spirit
• Assess
• Engage listen /Evoke
• Plan
• Collaborate, with . not do to
•
• Monitor
Firm platform not scaffolding.
• Autonomy : focus on
sustainable outcomes
MI concepts that helped
• Judges and family courts
• Importance and confidence !
• The wider system not just the support service
• Child protection social workers
• “If we have no models to work with ambivalence we
end up being too nice or too nasty “!
• Listen engage :lower resistance increase disclosure
Family focussed work
• Homebuilders and MI
• MI and Option 2
• Evaluation and research what works in
high risk/complex families
• Being MI consistent !
Support the skills
• OARS
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Open questions
Affirmations
Reflective listening
summary
Focus on outcomes
• 4 to 6 week intervention
• 5.5 year follow up small sample
• Parents considerably reduced or stopped their
substance use 98% to 58%
• Parental stress and risk of psychological problems 44%
to 85%
• Families had significantly more cohesion
• Only 8% of option 2 children entered care compared to
44%
• None in care permanently compared to 38%
IFSS
• Underpinned by the spirit the principles
and the skills
• Supported by legislation: Child and family
measure (Wales)2010
• Building a platform for integration:
• A centre for workforce development:
• A catalyst for transformational change:
• Real commitment from Ministers and
Officers.
Support
Worker
Support
Worker
Admin
Support
Adult
Worker Social Worker
Children's
social worker
Substance
Mis-use
Worker
Mental Health
Worker
Designated
IFSS
Prac
Health
Visitor
Family
Adult Services
Children’s Service
Case Management
Primary Care
The Wider Workforce
Independent
Sector
Education
Health
Local
Authorities
Community
Safety
Partnerships
IFSS Team: Core skills, Models
& Approaches
Organisational Development: The
Skilled Workforce
Wider Workforce Training
Training in the IFSS Model of
Family Intervention: 4-days
Principles:
All team members
Shared ideologies
Skill set
Understanding
The IFSS Model of Family
Intervention: 4-Day Training
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Day 1:
Introduction to the Model: Overview of Model & Training
Key Components of the Model: The Process of Behaviour Change
Key Components of the Model: Outcome Focussed Work
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Day 2:
Core Skills: Motivational Interviewing, Engagement, Collaboration & Outcomes
Beginning the Intervention: Reducing Resistance & Increasing Safety
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Day 3:
Working through the Intervention: Enhancing Motivation to Change
Building Action Plans: Consolidating Change Behaviour & Inviting in Support
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Day 4:
Beyond the Intensive Intervention: Maintaining Change
The Working Context: Our Team, Clarity of Role & Function
Training for other MI Congruent
IFSS Team Roles
• Consultation in the IFSS
• Supervising in the IFSS
• IFSS Trainers
– IFSS services and wider workforce
development
Integrated Family Support Service:
Workforce Development Modules
Module 1: Enhancing Motivation
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TV Game, Stages of change, 4 statements, Good teacher/bad, Principles of MI, OARS practice
Module 2: Lowering Resistance
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Persuasion exercise, Resistant behaviour, Road blocks & traps, 3-in-a-row, Palm push/shameful secret, Batting practice, Hot seat
reflections OARS
Module 3: Goal Centred Interventions
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Why Goals? Case study focus SMART goals, Knowing when you’ve got there, Negotiating goals with families & professionals
Module 4: Promoting Family Change
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Process of change, Engagement, Motivational tasks at each stage, Miracle Question, Values, Strengths & Goals
Module 5: Care Pathways: Maximizing Multi-agency Planning
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Case study, Brainstorm what’s available, Identify goals, High, medium & low importance, Short, medium, long term, Engaging services
around the family
Module 6: Substance Misuse
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What you know quiz, Knowledge, Attitudes, Impact on family life, Risk and resilience, Lifestyle impact
Feedback from training
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I will listen rather than tell
I will reflect meanings and feelings
I will resist rescuing or fixing
I will empathise and work with the person not the
presenting behaviour
• I will affirm rather than praise
• I will not rob them of their own internal argument
for change
• I will try and help my agency to change
Feedback regarding the
impact of training
• Found myself offering to take a mother to her counselling
appointment. Thank GOODNESS she knows the model
builds autonomy & said "Thanks but no thanks, I can get
a bus for my kids. I'll text you later"…!
O2 worker in NW England
• My new best friends are content, meaning and feeling
reflections. Been rolling with resistance all morning. Saw
it happen though, the moment the thought was
provoked. Dad made a great argument for his change.
So brave.
SW in Wales
The focus of my work
behaviour
• Avoiding appointments
• Blaming others
• Hostility
• Compliance
• Refusal to engage
• Minimising problems
• Diverting the focus
feelings
• Shame
• Fear of judgement
• Fear of consequences
• Lack of trust
• Lack of confidence
• Lack of hope
• Avoiding pain.
Accreditation: Assessing
consolidating Learning;
• IFSS Model of Family Interventions: Underpinning
Knowledge & Skills for IFSS (Level 2), Implementing IFSS (Level 3),
Managing the Delivery of Family Focussed Interventions (Level 6)
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Consultation Skills in the IFSS
Supervising in the IFSS
Training the IFSS Trainers
All 6 of the wider workforce modules
Hundreds of staff across Wales describing MI
practise
The current context and beyond
• A real opportunity !!
• Risks
• Maximizing potential to
change
• Building on strengths
competency models
• Greater integration
• Reclaiming social work
• Workforce development
• Increased blame and
punishment
• Less hope and
opportunity
• Less provision supporting
the core conditions for
change.
Create Shared Platform
Across All Disciplines
There is a government vision
• Legitimacy
• Adequacy
• Support
• IFFS ,Family first :Adult services: Criminal justice
• Communities first.
 Shared Values
 Shared Skills
 Shared Language
2012 transformational change imbued with
MI spirit, principles and skills
• Remain purposeful and
intentional
• Be clear about what needs to
change
• See things through to the
desired outcomes
• Bring clarity to the system
• Notice what's working and
build on it
• Its high challenge it needs high
support it needs commitment
• Skilled conversations, working
together, release potential for
autonomy.
And then there’s the future,
the next 21 years