erin m. espinosa, phd –senior researcherof practitioner-initiated change •provides training...

Erin M. Espinosa, PhD – Senior researcher

• Established in 1907• Over 100 research and

training staff• Supporting over 80

projects across the US and internationally

• Data 4 Equity, Girls & Gangs, LA Model

The What and Why of Motivational Interviewing?

Why MI?

• Evidence- based > 180 clinical trials• Successful in brief interactions• Applies to many problem areas – health behaviors,

substance abuse, mental health, domestic violence, CPS, school counselors, criminal justice, management..

• Complementary to other treatment methods• Non-specialists can learn and use• Verifiable - is it being delivered properly?

Let’s take a minute….

Think about a time someone told you that you had to change something...

Jot down what you felt on page 4 of the hand out.

Let’s take a minute part 2…..

Think about a time you decided to change something, and someone was there to help support you through it…

Jot down what you felt on page 4 of the hand out.

Defensiveness &

Resistance

Action Toward Change

Mot

ivat

ion

Time with Individual

Ambivalence

Empathetic Listening

ChangeDon’t

Change

ShouldI?

CanI? Will

I?

Ambivalence

The Righting Reflex

• Powerful desire to set things right, to heal, to prevent harm, to fix….

• The urge to correct another’s course often becomes automatic, almost “reflexive”

• Natural human tendency to resist persuasion

Muscle Approach

Cheerleader Approach

Reasoning Approach

How Can I Get People To Change?3 Common Efforts

If I can make them feel bad enough

I’ve got to make them see

“You can do it!”

Motivational Interviewing A Definition

Motivational interviewing isa collaborative,

person-centered form of guiding to elicit and strengthen

motivation for change.

The 8 Stages of Learning M.I.Open QuestionsAffirmationREFLECTIVE

ListeningSummarization

1. Overall Spirit• Empathy• Equipoise• Joint decision making

2. Client-centered Interviewing/Communication Skills

The Function of Reflection

What thespeaker means

1

What the listener hears

3What the

speaker says

2

What the listener thinks the speaker means

4

SPEAKER LISTENER

Bridge the gap

R

The 8 Stages of Learning M.I.

3.) Recognizing Change Talk

4.) Eliciting Change Talk (ECT)

5.) Rolling With Resistance

6.) Developing A Change Plan

7.) Consolidating client commitment

8.) Shifting flexibly between MI and other methods.

Open QuestionsAffirmationREFLECTIVE

ListeningSummarization

1. ) Overall Spirit2. ) Client-centered Interviewing/Communication Skills (OARS)

……..But wait there is more!!

1

Four Processes/ Direction: Interviewer exerts influence on the session and generally does not miss opportunities to direct client toward the target behavior or referral question

So…what? How do we do this thing?

Navigating the Implementation Highway

© Fixsen & Blase, 2008

Effective Services with Fidelity High-Quality Practice

Coaching

Training

Selection

Systems Intervention

Facilitative Administration

Decision Support Data System

Com

pete

ncy Organization

Leadership

Adaptive Technical

ImplementationDrivers

Positive Outcomes

Coaching

IndividualEvaluation

CQI

Admin Supports

Selection

Training

(Fixsen et al., 2005)

Core Drivers of Implementation

Typical Hierarchical Models

Top down: Agency administrator decides that specific EBPs will be implemented

Bottom up: Agency is supportive of practitioner-initiated change• Provides training• Provides space for on-going

practice, learning

Leadership Considerations

Intervention Characteristics: Evidence strength and quality,Complexity

Inner Setting: Implementation climate – Tension for change, Compatibility, Relative Advantage, Resources & Access to knowledge and information

Administrative Supports

Identifying an Implementation Team

Executive Level or Highlevel Leadership: Build a team of key leaders to support the innovation within their respective areas of influenceMid Level: Worker “bees” who are influential in the organization and among their peersLine Staff: Invest in their “growth” and ability to influence culture from the ground up

Coaching


CQI

Admin Supports

Selection

Training



Project MATCH• Clinicians accounted for 12% of variance in client drinking

outcomes.• With the removal of one very poorly performing clinician

amount of variance accounted for decreased by 3%• Treatment accounted for 7% of the variance.

The COMBINE Study• Manual guided and supervised treatment approach combining

CBT, MET and 12 Step• With ≥ master’s level specialist counselor

Selection: Why do we care who we select

What should we think when selecting staff?

• Knowledge & belief in the intervention• Individual stages of “change” • Identification with organization• Staff: ability to accept feedback & connect with empathy• Supervisors: ability to support a culture of learning

Coaching


CQI

Admin. Supports

Selection

Training



Coaching


CQI

Admin Supports

Selection

Training



Direct Leadership Initiated Support

Supervisor to Staff: • Supervisors are targeted for coaching

support to develop skill to support staff• Provide the direct support to staff• Supervisors turnover less than line staff• Develops internal capacity & supports

on-boarding

SME Coach to Staff:• Staff are targeted for skill attainment by

coach• May cause for on-going reliance on

outside support as staff turn over

Communities of practice

• Initially developed in education

• Groups come together with no manager or supervisor to report to

• Goal is to increase skills and fidelity

• Focus is practice and skills and peer feedback

• Orgs can support this by giving time and space with no requirement of supervision support

Coaching Models

Coaching


CQI

Admin Supports

Selection

Training



Why bother?

• Practitioners recognize and embrace MI

• See differential response from clients

• Understand that fidelity is related to effectiveness (Gaume et al.2008)

• Without on-going evaluation and feedback skills drift

• Formal: Administrators may want to change agency culture

How should it happen?

• Fidelity or competency tools as a part of on-going supervision/coaching support

• Tools guide conversation around skill attainment

• On-going feedback loop between the supervisor/coach & data collected with the tools

• Identify staff trends over time to develop booster opportunities

Individual Evaluation and Feedback

Coaching


CQI

Admin Supports

Selection

Training



What is CQI?• CQI is the process of using data to

inform on-going implementation. • Typically conducted through a Plan,

Study, Do and Act (PDSA) model, the agency uses data collected in “real” time to guide implementation efforts.

How does this work?

• Identification of an Implementation team

• Communication plan between staff and the Implementation team includes key data points

Continuous Quality Improvement (CQI)

Potential Points: • Staff skill attainment (Fidelity Measures)• Process supports and barriers or other

organizational data ****• Client satisfaction and outcome

Did you know?

Successful implementation of a new EBP can be impacted by staffs’ view of their supervisor?Staff need to know you:1. Have a plan2. Can set clear standards3. Can remove obstacles to implementation4. Can answer questions5. Know what you are talking about

Implementation Leadership Scale (ILS) (Aarons, Ehrhart & Farahnak, 2014) in Espinosa et. al, 2016

AND… did you also know?

Successful implementation of a new EBP can be impacted by staffs’ belief that the model

actually works and can meet the needs of youth they are

supporting.

Organizational Readiness to Change Assessment (ORCA) (Helfrich, Sharp & Sales, 2009) in Espinosa et. al, 2016

So…

As a supervisor you need to have knowledge of the practice model, create a plan for implementation,

and be willing to look for answers.

Accountability

Thank you!For more info, visit www.nccdglobal.org

Erin M. Espinosa, PhD Senior Researcher, at [email protected]

or (510) 874-5531

erin m. espinosa, phd –senior researcherof practitioner-initiated change •provides training...

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