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Evidence Based Practices Working Together: Motivational Interviewing and High FidelityWraparound
TCOM Conference 2020
Presenter bios
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Sharon Weber serves as the trainer-coach for the Wyoming Care Management Entity. Sharon lives in Laramie, Wyoming and comes to Magellan from Cathedral Home for Children, where she served as community programs director and in many other positions over the past 26 years. Sharon has spearheaded efforts with landmark implications in areas such as peer mediation and improved graduation rates. Her advocacy for children and families has extended to the Wyoming legislature. Sharon has achieved credentialing as a High Fidelity Wraparound facilitator, trainer and coach and a Wraparound process mentor.
Barbara Ann Dunn, LCSW, ACSW, is Director of Program Innovationand Outcomes for Magellan Healthcare and is responsible for proposing, implementing and evaluating innovative programs across the public sector. Barbara’s work includes creating data collection systems using evidence-based and emerging assessment tools. Before joining Magellan, Barbara worked in early childhood and alternative education, child welfare, faith-based organizations and community mental health. She holds a master’s degree in social service administration from the University of Chicago and a bachelor’s degree in psychology from Binghamton University.
Abstract
Using MiiWrap, which combines HFWA and Motivational Interviewing (MI), demonstrated early success and high potential. Wraparound in Wyoming
shows how implementation of an early version of MiiWrap improved fidelity in specific key elements and fared in a pre-post cohort study. Long
term outcomes using engagement, implementation and graduation success rates in a provider scorecard model will be reviewed. The experience of model integration will be discussed from a coach trainer perspective.
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Learning objectives
Identify thepurpose of integrating Motivational Interviewing into High Fidelity Wraparound, including the mutually supportive elements of MI and the high fidelitycoach training model
Consider the tools being used to analyze the impact of integrating Motivational Interviewing and High Fidelity Wraparound, such as key elements in wraparound fidelity
Hear the effect of Motivational Interviewing on the wraparound process as described by a coach trainer
Evaluate the studyof integration of the two evidence-based practices in field research
High Fidelity Wraparound in Wyoming
6 *CME: Care Management Entity; WFI-EZ: Wraparound Fidelity Index – short form; CANS: Child and Adolescent Needs and Strengths Comprehensive
System of Care Grant
2009 2010 2013 2015 2018
WY Access demonstration
seven SE counties
Provider Scorecard and Beta group on
integration of MI into Wraparound
Foundations training
CHIPRA Grant
HFWA goes statewide with CME requiring WFI-EZ and CANS*
Eligibility• Youth ages 4-20• CASII 20+ or ECSII 18-20• Risk of Out of Home
Placement• Medicaid Waivers
1915(c) and a 1915(b)
In WY we’ve found that families involved in Wraparound for at least six months have better outcomes
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Why Motivational Interviewing Informed Wraparound (MiiWrap)?
We are passionate about supporting families, but if they aren’t engaged that can’t occur – So how can we increase engagement?
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Process of integrating MI and Wraparound in Wyoming
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2017 trained as a supplemental practice –
Integrated (MiiWrap)
Fall 2018 - Beta version of a training
6-week MiiWraptraining
Integrated into Foundations
Trainings re-written to integrate MI
Integration of MI
What’s different when teaching with MI integrated?
Mindset
• Write, draw, bring a song that shows your approach
• Luke Byron, “Most People are Good”
• https://www.youtube.com/watch?v=liqktLC7xR0
Practicing language
• Promotes open conversation
• Tell me about your family
• Use of Reflections• Evoking Change Talk
Listening
• What Stage of Readiness?
• Right from the beginning
• Meeting families where they are
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Reinforcement
What’s your mindset to working with families??
Danelle’s favorite quote: “The most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing
we ever give each other is our attention. A loving silence often has far more power to heal and to connect than the most well-intentioned
words!”-Rachel Naomi Remen
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The study questionsHOW DOES MI TRAINING INTEGRATED WITH HFWA TRAINING IMPROVE:
Fidelity Engagement Outcomes
• Baseline• Pre-MI
Data:-WFI-EZ-Scorecard
Roll-in 60 FCC in 6-week cohortsdata collection by cohort compiled
• Outcomes• Post-MI
Program interventions
2018 2019 2020
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Cohort 1
Cohort 2 Pre-Cohort Fidelity Measures Post-Cohort Fidelity Measures Engagement and Outcomes
Cohort 3
training
training
training
Logic model: Impact of MI training on HFWA Fidelity and outcomes
Eligibility Criteria• FCC• MI training• Assigned to
cohort
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Post Cohort Fidelity
By the numbers…
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31
88
Pre Post
CG Survey Count
5848
2239
MI Training ALL FCC trained* FCC pre withWFI-EZ
FCC post withWFI-EZ
Count Staff and FCC TrainedActive FCC with WFI-EZ pre and post
• 58 staff trained in MI
• 48 continued as FCC
• 22 FCC had WFI pre-MI
• 39 FCC had WFI post-MI
57% 63%
Pre Post
Percent Youth with surveys
• 31 WFI pre-MI
• 88 WFI post-MI
• 57% youth had CG WFI pre
• 63% youth had CG WFI post
Wraparound scorecard measures
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Quarter over quarter outcomes June 2020
Final Fidelity Results June 2020
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72.0%
75.3%76.8%
77.5%
75.1%76.2%
National Mean Baseline2017/18
Pre MITraining
Post MITraining
WY FY2019 WY FY2020
Total Fidelity
In an already high-fidelity environment, adding Motivational Interviewing increased the fidelity scores in the study group, and increased year over year fidelity all FCC.
Total FidelityFidelity
Basics A1Fidelity
Basics A2Fidelity
Basics A3Fidelity
Basics A4Key ElementTeamwork
Key ElementNat/CommSupports
KeyElements
Needs
Key ElementOutcomes
Based
Key ElementStrength and
FamilyDriven
National Mean 72.00% 0.00% 0.00% 0.00% 0.00% 67.80% 65.60% 73.80% 75.30% 77.60%
Baseline 2017/18 75.30% 88.40% 87.40% 86.40% 90.30% 71.40% 69.10% 76.20% 77.70% 82.10%
Pre MI Training 76.79% 93.55% 93.55% 90.32% 100.00% 68.94% 69.14% 78.91% 83.11% 83.85%
Post MI Training 77.50% 97.75% 96.64% 95.52% 97.75% 72.77% 71.02% 78.65% 78.41% 86.49%
WY Fidelity Threshold and Baseline vs. Cohorts Pre and Post MI Training
Fidelity score changes Pre and Post MI Training FINAL
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Outcomes results
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engagement >60 daysimplementation >180
daysSuccessful graduation>180 days + goal met
CANS improvements Qover Q
Pre-MI 85% 63% 39% 53%
Post-to-date 85% 61% 46% 55%
Pre-MI to Post June 2020 Program
FY2020 CANS Scores by Global Sum
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Admission Discharge
max 78 74
75th% 52 42
mean 44.5 33.1
median 42 28
25th% 33 19
SD 16.7 19.6
min 16 3t-test 2 tailed paired P<0.00000000001
Outcomes: Increased Useful Strengths, Decreased Actionable Needs
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5.7
8.58.1
4.8
Strengths Needs
SY2020Increased Useful Strengths and
Decrease Actionable Needs8.7
6.2
5.0
7.8
Global Needs Strengths
SY2019Decreased Actionable Needs and
Increased Useful Strengths
Initial Discharge
2.4 Needs 1.3 Strengths 2.4 Needs 2.4 Strengths
Next steps
Aug 2020 started intensive Coaching-the-Coaches as part of coach re-certification
Dec 2020 complete meetings with Jim Rast on MiiWrap research plan for 2021
Jan 2021 transition to FidelityEHR with aligned documentation and MiiWrap process
Jan 2021 MiiWrap Foundations on-line training
Dec 2021 more granular analysis on the differences seen on fidelity through the implementation of MiiWrap
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Lessons learned so far
Using MiiWrap, which integrates HFWA and Motivational Interviewing (MI), has the possibility of increasing engagement, self-efficacy and motivation in Wraparound.
As a Trauma Informed Care approach, MI appears well suited to the WY HFWA population characteristics.
Families report that moving from “focusing on needs” to “making change” is empowering and denotes hope.
Learning change skills is built in and is an important skill for families to take with them through life.
Further integration of MI and HFWA is necessary to continue to improve fidelity to wraparound.
Just teaching MiiWrap demonstrates mild improvement in WFI-EZ fidelity in an already high-fidelity environment.
MiiWrap has early signs of impact on engagement, implementation and graduation success.
Adding a measure of MI fidelity would strengthen this study.
Studies from an MI perspective may shed more light on HFWA impact as there are more studies on the mechanisms of change and the outcomes in MI than in wraparound.
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References
Miller, W. R., & Mount, K. A. (2001). A small study of training in motivational interviewing: Does one workshop change clinician and client behavior? Behavioral and Cognitive Psychotherapy, 29, 457-471.
Miller, W. R., & Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 37, 129-140.
Miller, W. R., & Rollnick, S. (2013) Motivational Interviewing: Helping people change (3rd ed.). Guilford, New York, New York.
Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64(6), 527-537.
Moyers, T. B., & Martin, T. (2006). Therapist influence on client language during motivational interviewing sessions. Journal of Substance Abuse Treatment, 30, 245-251.
Rast, J. (2019) Foundation of Motivational Interviewing Informed Wraparound - MiiWrap (Manual). Vroon VanDenBerg. Centennial, Colorado. Revised August 8, 2019.
Rosengren, D. Building Motivational Interviewing Skills. Second Edition (2017) Guilford, New York, New York.
Substance Abuse and Mental Health Services Administration (2014). Trauma - Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
Walters, S. T., Matson, S. A., Baer, J. S., & Ziedonis, D. M. (2005). Effectiveness of workshop training for psychosocial addiction treatments: A systemic review. Journal of Substance Abuse Treatment, 29, 283-293.
Wraparound Fidelity Index, short form (WFI-EZ). (2011) University of Washington School of Medicine. Seattle, WA.
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Legal
This presentation may include material non-public information about Magellan Health, Inc. (“Magellan” or the “Company”). By receipt of this presentation each recipient acknowledges that it is aware that the United States securities laws prohibit any person or entity in possession of material non-public information about a company or its affiliates from purchasing or selling securities of such company or from the communication of such information to any other person under circumstance in which it is reasonably foreseeable that such person may purchase or sell such securities with the benefit of such information.
The information presented in this presentation is confidential and expected to be used for the sole purpose of considering the purchase of Magellan services. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential. The attached material shall not be photocopied, reproduced, distributed to or disclosed to others at any time without the prior written consent of the Company.
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Confidentiality statement
By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.
The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment.
The information contained in this presentation is intended for educational purposes only and should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors.
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