The Efficacy of Motivational Interviewing with Offenders

The New Zealand Psychological Society Annual Conference 2009

Kevin Austin and Dr. Mei Wah Williams

Introduction

I will:

• briefly outline relevant motivational interviewing (MI) and correctional rehabilitation literature

• introduce and describe the current study

• describe the results, discuss the findings and recommend further research

Literature• Motivation was historically (pre 1970s) viewed

as a stable personality trait

• In the late 1970s research demonstrated that therapist variables better predicted motivation

• As such, attention shifted to how therapists could foster motivation

• MI emerged as a “promising approach”

Literature

• Applications of MI proliferated

• However, MI’s popularity out-stripped the evidence

• Unlike MI, the efficacy of correctional rehabilitation was rigorously refuted (Martinson, 1974)

• Scholars counter argued for the efficacy of correctional rehabilitation based on empirical studies

• The “what works” approach emerged

Literature

• Risk, need and responsivity (RNR)

• Motivation as a component of responsivity

• MI was adapted for use with offenders

• Like other fields, MI was used with offenders despite little empirical support

Research questions

• Can MI foster motivation to change among a high risk of recidivism offender sample?

• How well is MI delivered to offenders?

Participants• A power analysis to calculate sample sizes (26 for t-tests; 21 for ANOVA)

• 38 male offenders from Waikeria and Tongariro-Rangipo prisons (Roc*RoI M = .78, SD = 0.09)

• 18 - 42 years, M = 27.24, SD = 6.7 (younger than the general prison pop)

• 76.3% identifying as Māori (disproportionate number of Māori)

• High criminal versatility

• Fairly typical high risk offender profile (Wilson, 2004)

• 12 offenders consented to a follow-up assessment of motivation to change and programme integrity.

• Five registered clinical psychologists

The Short Motivational Programme (SMP)

• Delivered over five sessions by psychologists (manualised)

• Focuses on rehabilitative needs

• Reflects MI and correctional rehabilitation principles

• High risk offenders – serving short sentences

Principles

Skills

Change Talk

Commitment Talk

Behaviour Change

Spirit

Courtesy of:Dr J. Porter, PsyD

Hypotheses

1. Offenders will demonstrate a sustained increase in motivation to change.

2. Psychologists will demonstrate MI skills.

3. Offenders will experience MI principles.

MethodOutcome: repeated measures - within group • Shift in motivation: pre- to post-intervention.

• A sub-group consented to a third time period: follow-up• University of Rhode Island Change Assessment Questionnaire – adapted for the

SMP (SMP URICA)

• Balanced inventory of desirable responding (BIDR)

Process comprised two parts:• Psychologists’ use of MI skills

• Motivational interviewing treatment integrity code 3.0 (MITI)

• Offenders’ experiences of MI principles• Assessment of the five principles of MI (A5PMI)

Results - outcome• A statistically significant increase in SMP URICA scores from

pre-SMP to post-SMP for the total sample

Mean SMP URICA Total Scores at Pre and Post SMP

Time period N M SD

Time 1 (pre-SMP) 38 129.61 13.23

Time 2 (post-SMP) 38 133.89 14.51

P < .05 (two tailed)

Results - outcome• For the sub-group, there was a significant and large effect for

time (pre - post SMP - follow-up)

• Pairwise comparison showed the significant effect was from pre - post-SMP; not from post-SMP to follow-up

Mean SMP URICA Total Scores across the SMP at Pre, Post and Follow-up

Time period N M SD

Time 1 (pre-SMP) 12 126.42 19.21

Time 2 (post-SMP) 12 133.50 21.71

Time 3 (follow-up) 12 134.92 15.83

P < .15

Results - processPsychologists’ MI skills

• Psychologists demonstrated full competency in using direction

• Psychologists closely approached competence for global clinician ratings, percent open questions, evocation, collaboration, autonomy and empathy.

• Psychologists did not achieve competency for reflection to question ratio, complex reflections and MI adherent behaviours (skills specific to MI).

• The hypothesis that psychologists would demonstrate competence in the use of MI skills was not fully supported.

N = 5

Results - processA score of 4 or above indicated an offender strongly experienced the MI principle

Mean A5PMI scores for the Offender Sub-group

Scale M SD

Developing discrepancy 4.64 .67

Avoiding argumentation 4.78 .39

Rolling with resistance 3.55 1.1

Expressing empathy 4.69 .45

Supporting self-efficacy 4.64 .49

(N = 12)

Discussion

• MI, a brief intervention, can effect a shift in motivation to change with high risk offenders

• Somewhat contradicts the risk principle

• Together, this study and Anstiss’ 2005 study, support the use of MI across the risk spectrum

Discussion

• Offenders strongly experienced MI principles

• MI principles tend to reflect general clinical competencies, such as expressing empathy

• Psychologists’ strengths may reflect general clinical training rather than specific training in MI

• The principles have better predicted shifts in motivation to change than MI skills

• But, greater outcomes are likely if MI skills are also used, such as reinforcing change talk

Limitations• The omission of a control group

• The use of self report measures

• Increased risk of Type one error for follow-up group

• Demand characteristics may have affected psychologists’ audio-taping

• Difficult to generalise across risk profiles

Future studies

• Does the SMP alone (with high risk offenders) reduce re-offending and therefore contradict the risk principle

• Norms and cut-off scores for the SMP URICA

• How are the principles of MI and correctional rehabilitation effectively combined

• There is a paucity of internal validity studies

• Research on the use of MI with offenders remains in its infancy - a robust replication (addressing limitations)

Thanks to:

• The study participants (offenders and psychologists)

• Dr. Mei Wah Williams; Massey

• The Department of Corrections• Glen Kilgour (Principal Psychologist)

• Dr. Llewelyn Richards-Ward