The Institute for learning and Development

1. Motivational Interviewing (MI) Assessment “Sandwich” Presented by The Institute for learning and Development A New York State Office of Alcoholism and Substance Abuse (OASAS) certified education and training provider.

2. Introduction • This presentation will explain the concept of the • Motivational Interviewing (MI) Assessment “Sandwich”. • As a precursor the Motivational Interviewing style will be briefly defined. • Participants will increase their knowledge of intake, assessment and evaluation strategies incorporating Motivational Interviewing Assessments techniques and in particular the MI Assessment “Sandwich”.

3. History The NIDA/SAMHSA Blending Initiative clinical trials have proven the Motivational Interviewing Assessment protocol to be more successful with client retention rates. • In 2001 the National Institute on Drug Abuse (NIDA) launched the Blending Initiative in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA), the Center for Substance Abuse and Treatment’s (CSAT) Addiction Treatment Transfer Center (ATTC).

4. Motivational Interviewing Defined: Motivational interviewing is a treatment intervention designed to enhance a client’s intrinsic motivation and capacity for change. It is: • Client- Centered • Directive • MI seeks to increase internal motivation for change through resolution of ambivalence and an increase in perceived self-efficacy.

5. “Spirit” of Motivational Interviewing Motivational Interviewing is an intervention style that is used as a “way of being” with a client. The “spirit” of MI is characterized by a warm, genuine, respectful and egalitarian stance that is supportive of client self-determination and autonomy.

6. Motivational Interviewing Skills O.A.R.S • Open-ended Questions • Affirmations • Reflections • Summaries The goal is to help the client resolve ambivalence about change and make a commitment to a plan of action. MIA-STEP NIDA-SAMHSA Blending Initiative

7. What is a MI Assessment? • Use of client-centered MI style to identify the capacity for change • MI strategies that can be integrated into the agency’s existing intake assessment process via the MIA “Sandwich” • Methods that can be used with diverse substance use problems • Skills for assisting clients in assessing their own substance use • Understanding the client’s perception and willingness to enter into a treatment process MIA-STEP NIDA-SAMHSA Blending Initiative

8. The Goal • The goal of a MI Assessment is to understand the motives clients have for addressing their problems and to build and strengthen their motivation for change in these areas. • The goal of a MI Assessment is to create an accepting and non-judgmental therapeutic alliance. Once ready for change the client begins to identify personal goals and methods to achieve them in collaboration with the treatment program clinicians. MIA-STEP NIDA-SAMHSA Blending Initiative

9. What is the MIA “Sandwich” ? The Motivational Interviewing Assessment “Sandwich” is an initial interview protocol in which a more structured standard assessment process is sandwiched between two client-centered MI interventions of 10-15 minutes each. The clinician incorporates gentle shifts of style to form an assessment sandwich. MIA-STEP NIDA-SAMHSA Blending Initiative

10. MI strategies during 1st 10-15 min Agency’s Standard Intake/Assessment MI strategies during last 10-15 min MI Assessment “Sandwich” MIA-STEP NIDA-SAMHSA Blending Initiative

11. Step 1Building a bond • During this step of the assessment the clinician uses MI skills to build rapport and elicit a discussion of the client’s perception of his/her problems. It is an excellent time to use open-ended questions to explore what the client wants from the agency’s treatment program and affirming the client’s decision and potential for change. • During this initial stage the counselor or social worker gets an idea of where the client is in their perception of them self and the their readiness for change. MIA-STEP NIDA-SAMHSA Blending Initiative

12. Step 2Gathering the intake information • Conduct your agency’s standard psychosocial history and assessment gaining knowledge of the client’s perceived problems and treatment objectives. • It is recommended not to try to artificially integrate an MI style into what typically are semi-structured methods of history, data, and information collection. • Upon completion the clinician can summarize their findings as a method of transitioning back to the MI style discussion. MIA-STEP NIDA-SAMHSA Blending Initiative

13. Step 3Summarizing & reconnecting to the client At this point the clinician shifts back to a more open-ended MIA format with the purpose being to better understand what the client wants to achieve during treatment. The material obtained during the standard assessment provides the counselor with ideas about questions that might be asked to establish discrepancies and enhance motivation for change. MIA-STEP NIDA-SAMHSA Blending Initiative

14. For more information … http://www.drugabuse.gov/blending/MIASTEP.html http://www.attcnetwork.org/explore/priorityareas/science/blendinginitiative/miastep/product_materials.asp