+ What Keeps Adolescents Moving Forward in Treatment? Motivational Interviewing Techniques in...

+ What Keeps Adolescents

Moving Forward in Treatment?

Motivational Interviewing Techniques in Juvenile Drug

Court

Developed by NDRI, Inc.www.ndri.org

Joe Lunievicz, BA, RYTDirector Training Institute

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+Dyads: What Motivated You?

What was most important to you:•When you were 13?

•When you were 16?

•When you were 19?

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+

What Motivates your participants to move towards graduation?

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+Important Considerations

Adolescence is about identity.

Autonomy issues are powerful.

The adolescent brain is still developing.

Adolescent culture and values are different than adult culture and values.

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+Why not just change?

Keep in mind the family dynamics adolescents go home to: Do their parents use? Were they born addicted? Are they safe? Have they witnessed the unimaginable? Are there co-occuring mental health issues? Are there learning disabilities? How early did they start using?

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+Motivational InterviewingA directive, client-centered

counseling style for eliciting

behavior change by helping clients

to explore and resolve

ambivalence. It is a style of

helping that uses a set of specific

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+Motivational Interviewing (Cont.)

Motivation- or presumed lack of it- is not viewed as a personality problem or character trait, but as a state of readiness for change that can be influenced by a helping relationship.

Rollnick & Miller, 1995

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+MI Basic Principles

Expressing Empathy

Developing Discrepancy

Rolling with Resistance

Supporting Self-Efficacy

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+Why use MI in Drug Court?

Better EngagementMore Information

Better Assessments

More Relevant Recommendations

More Successful Outcomes

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+

“You don’t understand.”

“You won’t understand.”

- Anonymous Adolescent

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+

Seek first to understand, then to be understood.

-Stephen R. Covey

7 Habits for Highly Effective People

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+MI Strategies - OARS

Open Ended questions

Affirm

Reflection

Summarize

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+Impact of Communication

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+Open Ended Questions

Who, what, where, when

Tell me about…

How did you…

Redirect: Now tell me about…

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+Open-ended Examples:

What worries you about your current situation?

What difficulties have you had with your drug use?

What do you think will happen if you don’t change?

How has your anger interfered with your life?

What would your life be like 5 years from now?

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+Practice:

Open-ended Questions

Interview your partner by asking only open ended questions.

Buzzer sounds whenever a closed ended question is asked.

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+Affirm (but don’t flatter)Strengths based technique

Verbally supports or validates a participant’s thoughts, emotions, or actions

Demonstrates: Appreciation, Understanding, Support

When you see a strength, notice it

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+Affirmation Example:

1. Participant arrives on time for his case management appointment.

“You’re punctual. That will be a big help in this program.”

2. Participant: “I don’t want to do anything more than I need to. I just want to finish the program and get on with my life.”

“Determination is a good characteristic to have in treatment. It will help to keep you focused.”

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+Practice: Affirming

Read the statement to your partner and your partner must respond with a strength’s based affirmation.

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+Reflective Listening

Rationale Conveys willingness to try to understand

Serves as a perception check

Clarifies feelings Leads to more exploration

Demonstrates empathy

Common Errors Not listening

closely Limited feeling

vocabulary Monotone vocal

qualities Premature focus

on problem solving

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+Reflection

Expressing Empathy:“So, what I hear you saying is…”Reflecting Conflict:“On the one hand…but on the other hand…”“So what you’re saying is…but you are not able to…”Rolling with resistance:“You don’t have to do anything you don’t want to.”

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+Practice: Reflection

1. Paraphrase2. Reflect conflict3. Roll with resistance

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+Summarizing

The set-up statementLet me see if I understand correctly…

Reflection, Reflection, Reflection

Open ended QuestionWhat did I miss?What other concerns do you have?

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+Practice:

Summarize

• Let me see if I understand correctly…

• Reflection• Reflection• Reflection

• What did I miss?

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+Questioning SkillsEffective vs. Ineffective Questions

Ineffective Too many questions Accusatory questions: Why? Multiple questions Explanatory questions Closed questions

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+ Questioning SkillsEffective vs. Ineffective Questions

EffectiveHave specific objectives in mindState background for questionUse language of the clientCheck out whether client is understandingAsk openly: Who, What, When, Where & How

Use open-ended questionsParaphrase; Reflect; Summarize

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+Resources: EBPs that Address Adolescents Behavior Therapy (BT)

Cognitive-Behavioral Therapy (CBT)

Motivational Interviewing (MI) Motivational Enhancement Therapy/Cognitive Behavioral

Therapy (MET/CBT

Relapse Prevention Therapy (RPT)

Adolescent Community Reinforcement Approach (A-CRA)

Seeking Safety (SS)

National Registry of Evidence-based Programs and Practices, SAMHSA

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+Resources: EBTs that Address Familial Issues

Multisystemic Therapy (MST) Addresses COD issues also

Brief Strategic Family Therapy (BSFT)

Functional Family Therapy (FFT)

Family Behavior Therapy (FBT) Addresses COD issues also

From: Evidence-Based Practice Recommendations for Juvenile Drug Courts by the National Center for Mental Health and Juvenile Justice in collaboration with the Louisiana Supreme Court Drug Court Office - 2009

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+Resources: EBTs that Address CODs

Trauma Focused Cognitive Behavioral Therapy ( Individual, outpatient modality

Motivational Enhancement Treatment (MET, CBTS) Individual and Group sessions

Continuous, Comprehensive, Integrated System of Care Nodel (CCISC) A set of practice guidelines for dual diagnosis treatment

From: Evidence-Based Practice Recommendations for Juvenile Drug Courts by the National Center for Mental Health and Juvenile Justice in collaboration with the Louisiana Supreme Court Drug Court Office - 2009

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