Motivational Interviewing

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Motivational Interviewing

• An Integrated Approach
• to
• Brief Intervention
• in
• Primary Prenatal Care Settings

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Questions to Be Answered

• Is there research to support the brief
  intervention of which MI is a part?
• How will I know when to employ the brief
  intervention?
• What does the flow of events look like
  screening to MI?
• What is MI and how do I learn to be effective?

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Webinar Process

• Dr. McGourty - Input on research brief
  intervention and screening with the 4Ps Plus.
• Dr. McGourty How motivational interviewing is
  linked to screening and the use of I am
  Concerned.
• Video showing the 4Ps Plus and I am Concerned
• Questions
• Dr. McGourty Motivational Interviewing
• Dr. McGourty MI transcripts
• Questions

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Key Research

• A study on the effectiveness of brief
  intervention in the prenatal care setting was
  conducted at Kaiser Permanente (Armstrong et al.,
  J of Perinatology, 2003.)
• Women who were negative for drug-use (controls)
• Women who were positive for drug use
• Screened
• Screened and Assessed
• Screened, Assessed and Treated

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The Kaiser Permanente Data

• For all the outcome measures the basic pattern
  held true
• The group that received brief intervention had
  birth outcomes that were similar to the controls
  and better than those who did not receive a brief
  intervention.

5382
262
348
782
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Rate of NeonatalAssisted Ventilation
Armstrong, et al, 2002
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Rate of Low Birth Weight (lt2500 grams)
Armstrong, et al, 2002
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Rate of Delivery Before 37 Weeks Gestational Age
Armstrong, et al, 2002
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Rate of Neonatal Intensive Care Unit Admission
Armstrong, et al, 2002
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Summary

• Women who were screened, assessed and treated in
  the primary prenatal care setting had improved
  birth outcomes as measured by
• days on assisted ventilation
• incidence of low birth weight
• pre-term deliveries
• intensive care admissions
• The group who showed this improvement included
  women some of whom had only one treatment
  session.

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Some pregnant substance-using women abstain
once they learn they are pregnant.
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Screening Results (N 26,805)
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Substance Use in Pregnancy
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Combining MI with Screening and I am Concerned

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Motivational Interviewing Defined

• Motivational Interviewing (MI) is a
  client-centered, directive approach to enhance
  intrinsic motivation for behavior change by
  working with and resolving ambivalence (Miller
  and Rollick, 2002 Rollick and Miller, 1995).
• The roots of MI are with the treatment of problem
  drinkers (Miller, 1983) but MI has been used and
  tested with a broad range of health behaviors
  (www.motivationalinterview.org).

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Five Aspects to MI

• Express empathy
• Develop discrepancy
• Motivating a woman to change her substance
  use requires that she perceived a discrepancy
  between what she is doing and what she would
  prefer to be doing.
• Avoid argumentation
• Role with resistance
• Support self-efficacy
• Self-efficacy is the belief that one can
  make a change. Help the patient to see that
  change is possible and that she can author the
  change.

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At its core MI is

• A set of communication skills (the skill of
  empathy the use of open-ended questions to
  develop discrepancy)
• Combined with helper self-discipline (avoid
  argumentation, roll with resistance) and,
• An important value (support self-efficacy).

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Which Statement is Inspired Motivational
Interviewing

• Statement AIf you continue your drinking, I can
  almost guarantee you that you will cause your
  baby to have serious problems in life. Doesnt
  that bother you?
• Statement B
• You said a couple of things that drinking
  wine is part of your routine and that you enjoy
  it and it relaxes you. You also said that you
  probably should cut back. Cutting back is the
  right choice and its just a start. Quitting is
  the goal right?

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Inspired by an MI Approach

• Statement B
• You said a couple of things that drinking
  wine is part of your routine and that you enjoy
  it and it relaxes you. You also said that you
  probably should cut back. Cutting back is the
  right choice but its just a start. Quitting is
  the goal right?
• Statement C
• You said a couple of things that drinking
  wine is part of your routine and that you enjoy
  it and it relaxes you. You also said that you
  probably should cut back. What makes you think
  that?

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Create a Discrepancy

• The counselor seeks to develop a discrepancy in
  the client's perceptions between current behavior
  and significant personal values and beliefs.
• Emphasis is placed on eliciting self-motivational
  statements of desire for and commitment to
  change.

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• Moving the Patient from Pre-contemplation to
  Contemplation

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Its the Person (not the technique)

• What makes motivational interviewing effective is
  the skill of the PCP and the PCPs ability to
  communicate concern for the pregnant woman.
• Variations in success rates typically have more
  to do with the therapist than with the type of
  treatment.
• 
  
  Luborsky (1986)

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Three Things to Remember

• Motivational Interviewing is a communication
  technique and a counseling approach but mostly it
  is about your values.
• Elicit change talk from the client.
• Motivational Interviewing is most effective as
  part of an integrated approach to brief
  intervention.

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SART- The Core Intervention
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Training Methods a sample

• Method of contrast to heighten awareness
• Exercise 1 Advice giving, dire predictions,
  personal story vs. MI
• Focus on key communication skills going
  overboard to get on board
• Empathy
• Open-ended questions
• Exercise 2 Only empathy Only open-ended
  questions alternating empathy and open-ended
  questions

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