Implementing MI agency wide (and a fun MI app!)

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bwierman
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Joined: 06/09/2014 - 10:03
Implementing MI agency wide (and a fun MI app!)

At our agency we have had an MI group meeting on an ongoing basis for several years, led by a staff member who is part of MINT. Many interesting ideas, including a commitment to implementing the use of MI throughout the agency, have come up through this group. Recently we have been looking at this Change Talk app and thinking about ways to use it to spur clinician interest in learning more about MI. Any ideas about how to use the app, or other platforms, to advance implementation of MI?

http://www.kognito.com/changetalk/

outreach1
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Joined: 06/06/2014 - 10:45

At my facility we had a "Motivational Enhancement" group for a while. Administration could not decide if it was better to have the pre-contemplative clients in a group by themselves or integrate them into a group with more motivated clients and hopefully they will catch up. The unmotivated, court ordered clients became so disruptive and unfocused we stopped putting them in a regular IOP group and created the ME group. After a few months we switched back again. Unmotivated, court ordered clients with a personality disorders are very difficult. I feel they may benefit from feed-back from the more Contemplative clients.

mjellison
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Joined: 06/06/2014 - 16:39

My feeling is that I would rather have a varied group of clients that are also at different stages of readiness, what a wonderful therapeutic tool to have available. For myself when it comes to MI in a group setting, a cultural component is always in place, and part of this could be what I like to call "cultural readiness." Which means that across the group spectrum those members that are at different stages may have the opportunity to learn from each other, enhancing that member to member therapeutic relationship. What better way for those members at a beginning stage to witness, hear, and see success from a peer supported view of those that are further along in their group process of recovery. One thing I have learned in group process is if the group is not going well or is getting out of control, I have to wonder at how the group is being facilitated. From my experience in group process I am not only a relationship mediator but also responsible for the emotional tone of the group, those clients that attempt to act out, provide us with a wonderful opportunity to use those MI skills in real time. If my organization were to try and separate individuals in a group process based on readiness to change, I would also ask if they would like to separate individuals on race, gender, age, socio economic background etc... "you get my point." Just my two cents!

Michael

outreach1
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Joined: 06/06/2014 - 10:45

I do get your point and i agree with However when you include clients forced to attend treatment, living at work release in the county jail and are included with clients that are sincere and motivated toward change the magic of. MI does not always work. In public health health settings the clinician has little say regarding the make up of the 12-13 clients in the group for 3 hours daily They go because probation and the judge says go. They spend group time stating they have no plans of even considering change. Sometimes the client chooses jail to avoid treatment. We usually see them again a couple years later. But they do leave an impact on the group and valuable group time is spent rolling with resistance.

mjellison
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Joined: 06/06/2014 - 16:39

You are absolutely right, mandated treatment can be a very tough group to work with, especially if it is mixed with those that are more self-motivated. I'm not sure there is a tried and true approach in that situation. I guess the best one can hope for is that a seed is planted.

marajbrandon
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Joined: 01/28/2015 - 19:17

In my experience working in a chemical dependency outpatient program with a large percentage of mandated clients: quite a few of them started out in the precontemplative stage and by the end of their mandate, were not only in the action stage, many were asking to be enrolled as volunteers. I wish I could remember the research study I read that stated that mandated clients had the same likelihood of obtaining and maintaining sobriety over 3 months, than non-mandated clients. At the time of study, (mid-2000s?); those stats were something like 50% of all outpatient clients were obtaining sobriety after 3 months. If anyone can has read this study or knows of similar studies with similar results, it would be great to post on this forum.

Aleverett
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Joined: 06/07/2014 - 08:02

I agree having clients at various stages of change in a group is an asset as well as a challenge. I have found that having a group of mandated resistant clients in a group does not work so well. They seem to have better outcomes when they are in a group with other motivated clients. If not they tend to breed consistent negativity thus reinforcing the resistance to change. When MI is implemented appropriately the client feels more in control of their lives which promotes change with this population. Sometimes starting with the bare basics such as group attendance is a milestone for a mandated client. Start at the bottom and build up is my slogan for mandated clients.

kim johnson
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Joined: 03/05/2012 - 17:35

Oooh, I love this app. We should be building more apps like this for our field. What is the reaction of the staff? Have you pilot tested it with them to see if they can get over the fact that it is about obesity and focus on the skill development aspect?

Levinemk
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Joined: 08/04/2014 - 14:36

I just watched the preview of this app and plan to explore it further. What a great idea. I would love to see something like this to use at our clinical team meetings. Just installed the app to see how we could at least adapt the techniques. It's all about change, just a different subject. Would never have heard of it without this forum. Thanks

tw_telehealth
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Joined: 06/06/2014 - 09:34

Speaking of Apps, when is A-CHESS available for clinicians?

http://www.spectrum.niaaa.nih.gov/newsfromthefield/smartphone.aspx

kim johnson
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Joined: 03/05/2012 - 17:35

Hopefully we will have some news about a commercially available product next month. Programs can still join our research consortium to gain access for their patients now. It costs $10,000 per year for 100 patients. If people have more patients than that, then we negotiate the cost for additional patients. The research consortium has two studies running. The first is an implementation study where we interview providers about their experience and the second is an outcome study for patients that are involved in A-CHESS. People can contact me: kimberly.johnson@chess.wisc.edu or susan.dinauer@chess.wisc.edu.

Maureen Fitzgerald
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Joined: 06/04/2014 - 10:33

Telehealth Tuesday #6
Motivational Interviewing and Telehealth: Special Considerations, Part I – 6/10/14

Check out this webinar offered by the National Rural and Frontier ATTC about how to adapt Motivational Interviewing for interventions provided through telehealth technologies.

http://us5.campaign-archive1.com/?u=a9fcccbf973d79e9758a82536&id=b3e29b0...

MentalBlueprints
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Joined: 06/07/2014 - 16:07

The main goal of intervention, prevention, and treatment is based on the needs of the individual not the program. I think its important to remind ourselves that each individual is not the same even though they may share the same level of change, motivation, acceptance or denial. Ultimately, yes we know that a lack of motivation can affect the individual and service professional successful outcome. What I found by using an integrated approach and less of lecture format along with the population required interaction with self and others helps to decrease the persona of avoidance and non-participation. Its important to remember that at some point the individual shuts down and begins to look at life through a narrow view. The challenge is not the program but the therapeutic relationship even if just a short-while.

mafinn3
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Joined: 08/05/2014 - 07:06

In mandated groups at CPS we use a mixture of education and motivational interviewing tools. Our groups are to get people ready for therapy not provide therapy.

Maureen Fitzgerald
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Joined: 06/04/2014 - 10:33

And here's a new free training option on MI from the PCSS-MAT: http://pcssmat.org/education-training/modules/pcss-mat-online-module-mot...

kim johnson
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Joined: 03/05/2012 - 17:35

There are a lot of different studies with different outcomes. One that looked at "coerced" treatment across studies was: Farabee, D., Prendergast, M., & Anglin, M. D. (1998). Effectiveness of Coerced Treatment for Drug-Abusing Offenders, The. Fed. Probation, 62, 3.

Probably the one that you are referring to is: Kelly JF, Finney JW, Moos RH: Substance use disorder patients who are mandated to treatment: Characteristics, treatment process, and 1- and 5-year outcomes. Journal of Substance Abuse Treatment 2005, 28:213-223.

I can't post the actual articles, but if you want, you can probably request them from your local library or try the CTN library: http://ctndisseminationlibrary.org/
They have a great librarian!

marajbrandon
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Joined: 01/28/2015 - 19:17

Thank you!