Because i said so how to support adult clients through change
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“Because I Said So”: How to Support Adult Clients through Change. Louisiana Association of Drug Court Professionals April 11-13, 2012 Jane E. Pfeifer, MPA. First Question:. Q.: What agency/organization provides primary case management services for your Drug Court?.

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Because i said so how to support adult clients through change

“Because I Said So”:How to Support Adult Clients through Change

Louisiana Association of Drug Court Professionals

April 11-13, 2012

Jane E. Pfeifer, MPA


First question
First Question:

Q.: What agency/organization provides primary case management services for your Drug Court?


Eight evidence based principles for effective interventions
Eight Evidence-Based Principles for Effective Interventions

1. Assess Actuarial Risk/Needs.

2. Enhance Intrinsic Motivation.

3. Target Interventions.

4. Skill Train with Directed Practice

5. Increase Positive Reinforcement.

6. Engage Ongoing Support in Natural Communities.

7. Measure Relevant Processes/Practices.

8. Provide Measurement Feedback

NIC, 2004


2 enhance intrinsic motivation
2. Enhance Intrinsic Motivation

  • Use motivational techniques

  • Get training

  • Develop rapport with the participant

  • Avoid arguing!


Engagement
Engagement

Whose job is it to engage the client?


Engagement1
Engagement

Engagement activities are intended to identify and fulfill the client's immediate needs, often with something as tangible as a pair of socks or a ride to the doctor.

Center for Substance Abuse Treatment. Comprehensive Case Management for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration; 1998 (Treatment improvement protocol; no. 27).


Increasing motivation
Increasing Motivation

Whose job is it to assist the client in increasing his or her motivation?


Increasing motivation1
Increasing Motivation

  • Stages of Change

  • Motivational Strategies

    In a recent study, clients assigned to receive motivational interviewing techniques at intake had significantly better retention rates at the 28-day follow-up than clients who received the standard intake evaluation. (Carroll, et al., 2006.)


Stages of change readiness prochaska and diclemente 1992
Stages of Change Readiness (Prochaska and DiClemente, 1992)

Precontemplation

Maintenance

Contemplation

Action

Preparation


Stages of change
Stages of Change

Pre-contemplation

Contemplation

Preparation

Relapse-Lapse-Change

Action

Maintenance


Stages of change1
Stages of Change

Pre-contemplation

  • Not thinking about changing

  • Happy user

  • Learned helplessness

  • Has no intention to take action within the next 6 months


Stages of change2
Stages of Change

Contemplation

  • Thinking about changing

  • Ambivalence

  • Chronic contemplators

  • Intends to take action within the next 6 months.


Stages of change3
Stages of Change

Preparation

  • Decision made

  • Firm plans

  • Possibly recent attempts at change

  • Intends to take action within the next 30 days.

  • Has taken some behavioral steps in this direction.


Stages of change4
Stages of Change

Action

  • Overt behavioral change

  • ‘Stopping’ main issue

  • Grief issues

  • Counter-conditioning

  • Stimulus control

  • Contingency management

  • Has changed overt behavior for less than 6 months


Stages of change5
Stages of Change

Maintenance

  • Sustained behavior over time

  • Alternatives established

  • Later, becomes a non-issue

  • Has changed overt behavior for more than 6 months.


What is motivational interviewing
What is MOTIVATIONAL INTERVIEWING?

  • Intervention designed to mobilize client’s internal resources for change by enhancing intrinsic motivation.

  • A style of being with people, not just a set of techniques

  • An important goal is to clarify values and amplify discrepancies

  • Purpose is to move person through the stages of change

    from Morgenstern-”Motivational Interviewing”


Philosophy of motivational interviewing
Philosophy of Motivational Interviewing

  • MI is a technique in which you become a helper – not a dictator – in the change process for your client.

  • In criminal justice we are used to telling people what to do.

  • This is a different style of interview and counseling.


Goal of motivational interviewing
Goal Of Motivational Interviewing

The goal of MI is to create a safe and supportive rapport with a person, in order to facilitate their thinking about their behavior and whether/how they might go about making changes.


Confrontation a goal not a style
Confrontation: A Goal Not a Style


Ambivalence
AMBIVALENCE

“I want to but I don’t want to”


Important assumptions in motivational interviewing
Important Assumptions in Motivational Interviewing

  • Clients are AMBIVALENT about changing.

  • There are BOTH pros AND cons to getting off of drugs vs. continuing to use.


Ambivalence about quitting
Ambivalence about quitting

  • We in criminal justice don’t typically see that for the client there are at least some good reasons to continue to use.

  • MI recognizes that ambivalence about quitting is NORMAL.



Exercise
Exercise

Share an example with your team of how you, in your role, can assist with increasing motivation.


Developing discrepancy
DEVELOPING DISCREPANCY

  • Motivation for change is enhanced when clients perceive the discrepancies between their current situations and behaviors, and their hopes and goals for the future.

  • Let the client present the argument for change.


  • “Tell me the good parts about using.”

  • “Tell me the negatives.”

    You will often hear about damaged family relationships, especially with the client’s children.

  • “How do these weigh out to you?”

  • “Where do you think you go from here?”


Have the client state the solution of what he must do to achieve his stated goals, desires, wants, and wishes.


Take home message
Take Home Message: achieve his stated goals, desires, wants, and wishes.

  • Motivation to change is elicited from the client, and not imposed from without.

  • It is the client's task, not the interviewer’s, to articulate and resolve his or her ambivalence.


Exercise1
Exercise achieve his stated goals, desires, wants, and wishes.

  • Pair up

  • Pick a real-life behavior change you want to make (be sure it’s one you want to share!)

  • One is the case manager and one is the drug court participant—then switch.

  • As the case manager, help your partner develop discrepancy. By the end, and without asking directly, see if you can determine if your partner is low importance/low ability; low importance/high ability; high importance/low ability; high importance/high ability.


3 target interventions
3. Target Interventions achieve his stated goals, desires, wants, and wishes.

a. Risk Principle: Prioritize supervision and treatment resources for higher risk offenders.

b. Need Principle: Target interventions to criminogenic needs.

c. Responsivity Principle: Be responsive to temperament, learning style, motivation, culture, and gender when assigning programs.


Meeting client s needs
Meeting Client’s Needs achieve his stated goals, desires, wants, and wishes.

  • “client’s” not “clients’”

  • What does this client need?

  • How do we know?

    • Assessment

    • Interviewing-ASK HER!

  • Comprehensive case management

    • Realistic case planning

    • Incremental objectives

  • Treatment matching

    • Gender appropriate

    • Culturally relevant


What do drug court participants need
What do Drug Court Participants need? achieve his stated goals, desires, wants, and wishes.


What goals are set for clients
What Goals Are Set For Clients? achieve his stated goals, desires, wants, and wishes.

  • Are there target behaviors that all clients must achieve?

  • Are they different in the beginning of the program?

  • Does your department/agency have differing goals for clients than the drug court, or are they consistent?

  • How individualized can goals be for each client?


Exercise2
Exercise achieve his stated goals, desires, wants, and wishes.

  • As a team:

    • identify two strengths of your case management services.

    • identify two challenges with your case management process, and discuss possible solutions.


Resources
Resources achieve his stated goals, desires, wants, and wishes.

  • Motivationalinterview.org

  • TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment.

  • Motivational Interviewing, Second Edition, by William Miller

  • Miller and Rollnick, Motivational Interviewing: Preparing People for Change, (New York: Guilford Press 2002)


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