极速赛车168最新开奖号码 motivational interviewing Archives - Community Care

极速赛车168最新开奖号码 Using motivational interviewing in social work: four key techniques

Gillian MacFarlane — Tue, 09 Jul 2024 15:33:47 +0000

This article presents a few key pieces of advice from Community Care Inform Children’s guide on motivational interviewing. The full guide sets out how practitioners can adapt this approach to social work practice, including explanations and examples of the key processes involved, and questions to consider when promoting behaviour change. It also provides examples of questions to ask in line with the core counselling skills that underpin motivational interviewing. Community Care Inform Children subscribers can access the full guide here.

The guide was written by Karen Evans, a motivational interviewing trainer, counsellor and supervisor.

What is motivational interviewing?

Motivational interviewing can be defined as a particular way of talking with people about change and growth to strengthen their own motivation and commitment. It was first developed by William Miller (1983) while working in the field of substance misuse, but very quickly its relevance to a wide variety of fields resulted in its application in many countries across the world and in diverse settings and cultures.

Motivational interviewing focuses on the here and now; practitioners look at how the person is feeling and behaving at that moment and notice the difference between this and how the person would like to feel and behave.

Social work practitioners in many scenarios, from safeguarding children to working with older adults with acute and chronic illness, have used the approach. Motivational interviewing has been used with young people in schools and can be applied to direct work with children and families, such as in addressing concerns about domestic abuse, substance misuse and general behaviour change.

Four tasks of motivational interviewing

1. Engaging: This process focuses on building a relationship between the practitioner and the individual. The counselling skills of open questioning, affirming, reflective listening and summarising (known as OARS) begin in the engaging process and continue throughout the whole approach. The person needs to be engaged with the practitioner and their approach before the other tasks can occur. First impressions are important and appropriate body language and eye contact are essential. There are some key ‘traps’ to avoid so that engagement can happen. For example, the ‘assessment trap’ describes the possibility that during the practitioners’ process of gathering information at the initial meeting, the practitioner may ask too many questions and take on an ‘assessor’ role. The practitioner should avoid making the conversation feel like an interrogation. Other ‘traps’ to avoid are explained in the full guide.

2. Focusing: While it is important for practitioners to have an aim and agenda for what they want to address, it is equally important to include issues that the person would like to focus on. This creates a collaborative partnership rather than a hierarchical exchange. It also helps in creating a more relaxed setting and can reduce the level of defensiveness, because the person has a sense of empowerment and control. It is likely that during motivational interviewing you will need to provide information and advice; a helpful structure is to ask, offer, ask. For example:

Ask

“What things have you tried in the past?”
“What options have other people tried that you are aware of?”

Offer

“Is it okay with you if I run through a couple of ideas?”
“Evidence suggests…” “Research shows….”.

Ask

“Which one will you think about/try/do?”

More examples are included in the full guide.

Practice point

Practitioners should encourage individuals to explore their thoughts around their behaviour before offering advice. Often practitioners may be limited by time constraints and the pressure to get results, which can result in giving advice too soon. This may mean the person doesn’t have chance to consider their own thoughts and options.

3. Evoking: Practitioners should use an interviewing style in their dialogues, which enables the person to share their thoughts, feelings and opinions. There are several skills the practitioner can use to attempt to draw out more ‘change talk’ (see below for the definition).

Sustain talk: the things that are said that keep a person stuck in their behaviour. Typical statements might focus on the function of the behaviour or why it’s enjoyable.
Change talk: involves statements that might lead the individual to consider a behaviour change, often related to its harmful consequences or problems.

Evocative questions

These are direct, often challenging questions. For example: “What worries you about your drinking?”

Looking back

It can be helpful for people to identify factors that have helped them make changes in the past, either related to the current or previous behaviour. This may help them with current change. For example: “Can you look back to a time when you drank less? What helped?”

Looking forward

If the practitioner provides time and space to consider a future focus, it can help the person identify a clear idea of where they want to be and the goals towards achieving that. For example: “If I were to see you in a year, realistically what would you like to be telling me about your drinking?”

If the practitioner hears an intention to change, it is important to reflect on this, provide affirmation and explore it further.

4. Planning: In this process, the practitioner provides support to move towards a change plan, where they explore how realistic plans are and continue to explore ambivalence. The practitioner uses skills to strengthen the person’s commitment to change and supports them through the process. Practitioners need to recognise readiness for change in the person they are supporting, which in turn moves the dialogue into a plan. Signs of readiness include:

Increased change talk: the person offers more preparatory change talk (which express a desire to change) in their dialogue and possibly also some mobilising language, which shows they are taking steps to change.
Taking steps: the person takes some small steps towards change. For example, they may find out the details of a support group in the area. The practitioner should affirm these small steps.
Diminished sustain talk: the person gives less sustain talk at the same time as making more change talk statements.
Resolve: the person exhibits a quiet resolve towards change.
Envisioning: the person starts to look at the future situation or self.
Questions about change: the person starts asking questions about change, demonstrating greater openness towards it.

The practitioner will also assess how the person feels about their behaviour and how close they are to making a change. This assessment of their readiness to change informs the practitioner of the focus of the work and the appropriate skills to use.

The full guide on motivational interviewing includes more information on the core counselling skills that underpin the approach, as well as how to assess readiness to change and integrate motivational interviewing into practice. If you have a Community Care Inform Children licence, log on to read the full guide.

极速赛车168最新开奖号码 Motivational interviewing: “Now I listen more before jumping in with a possible solution”

xmlrpcuser — Tue, 09 Feb 2016 13:30:40 +0000

“You are the first person to really listen and not criticise me”

This is a comment a social worker halfway through a motivational interviewing programme received from a young person in Merton.

Motivational interviewing (MI) is a structured approach to direct work that can help individuals to want to change behaviour. It is shaped by an understanding of what triggers change and is designed to be a non-confrontational way of helping someone to recognise and do something about their present or potential behaviour concerns.

Behaviour change can feel ‘hit and miss’ at times…a young person can seem to be doing really well and all of a sudden revert back to unwanted behaviour. Motivational interviewing addresses the factors that frequently underlie this – ambivalence about wanting to change, resistance and the idea of ‘learned helplessness’.

Building resilience and autonomy

It can be particularly effective when working with young people as the focus on their personal motivation and commitment to specific goals helps develop a stronger sense of identity and decision-making capacity. The confidence gained from making small steps towards change builds resilience which supports young people move towards greater autonomy.

Merton, a south London borough, is training 70 practitioners on a programme which links evidence-based motivational interviewing techniques to an understanding of adolescent brain development and attachment theory.

Staff from the 14+ team, youth justice, Transforming Families (Merton’s troubled families service) and education, training and employment team who all work with young people who are at a risk and/or present as a risk to others are taking part in the programme.

Embedding learning into practice

Many social workers will recognise the feeling that training courses do not always translate to changes in their practice. We are combatting this with a programme of clinical group supervision and action learning discussions alongside learning the techniques, as well as ensuring individual supervision reviews the MI-based work.

The approach is becoming embedded in practitioners’ whole approach to work and their workflow. Reflective learning logs enable reflection on using the approach and planning ahead.

The spirit of working in partnership is brought to all assessments and case recording as well as direct contact, ensuring the young person’s voice and perceptions are kept central.

I am able to better record and evidence professional judgements in my case notes when using MI with young people

Analytical skills can also be underpinned by the principles we use to look at change, for example identifying and affirming strengths, seeking exceptions to problems, reframing problems, deconstructing problems, setting goals and incremental small steps towards goals which use the young person or family’s skills.

Impact on practitioners

Motivational interviewing also encourages self awareness (sometimes referred to as reflexivity) – looking at how the social worker is perceived by young people and how this impacts on the way they engage. Practitioners then develop strategies to work with this.

A full evaluation of the Merton programme will be carried out on completion but the impact of the techniques and how they link together is already valued by staff for how it has improved relationships with people using services. So far staff have said things like:

“Allowing more time to identify young people’s views on their situation gives me a greater understanding of how they see their situation.”

and

“Using some of the skills around empathy building and reflective listening seem to build up a better connection with the young person.”

One practitioner felt that using some of the motivational interviewing skills had led to safeguarding disclosures by a young person which had never been mentioned to other professionals.

Looking ahead

A key part of the programme is training a small cohort of social workers to be motivational interviewing ‘champions’; they will develop further specialist skills and knowledge in order to support other practitioners and deliver training for more groups in future.

Merton were keen to implement motivational interviewing for a number of reasons, including Munro and government recommendations to increase focus on relationships and direct work with service users and Ofsted feedback to local authorities to use more evidence-based practice.

Practitioners in some of the teams have identified how the techniques can be useful in other scenarios – for example, one said the skills means she is able to teach parents to better communicate with their children. The aim is that the champions will make the programme self-sustaining and enable it to spread to other parts of children’s services.

T Daszkiewicz Associates incorporates the Centre for Training, Education and Development which focuses on skills-based learning for children & families workforce development.