Etty Matalon Clinical Training Manager (02) 9385 0262 04111 94568 etty@unsw.edu.au
outline •
learning outcomes • To provide participants who treat individuals presenting with cannabis use disorder and mental heal heath issues with a brief and efficacious intervention based on Motivational Interviewing • To familiarise participants with the material related to the delivery of a brief intervention
objectives for today By the end of the workshop participants will be: * familiar with a brief intervention aimed at reducing cannabis related harms for clients suffering from anxiety and/or depressive disorders * familiar with resources and materials related to the brief intervention
Quik Fix is a Brief Intervention • Targets: • Depression/Anxiety • Substance use • Treatment attendance/adherence • Any other presenting issue • 1 to 4 sessions (usually 45-60 minute individual sessions) • Screening • Personal Feedback • Psychoeducation • Motivational Interviewing • Brief Coping Skills Training
Quik Fix uses …… the spirit and principles of MI to : • Engage the young person • Conduct a brief assessment • Provide assessment feedback and Psychoeducation • Build readiness to change and commitment to make a change • Assist the young person to develop a plan for making a change (if willing) • And provide brief coping skills to manage the presenting issues (if willing)
Quik Fix aims … Use the spirit and principles of MI in order to : • Engage the young person • Help them identify and develop an understanding of their presenting issues • Provide them with relevant information on the issues • Increase their motivation and commitment to make a change in their presenting issues • Develop a plan for making a change • Enhance their ability to cope with their presenting issues • Motivate the young person to attend further treatment or follow-up
Motivational Interviewing W. Miller and S.Rollnick 1991, 2002 edition, Guilford press Treatment Approaches for Alcohol and Drug Dependence Jarvis,Tebbutt and Mattick 1995, 2004 edition
what is a Brief Intervention? (BI) • “A time -limited, patient-centred counselling strategy that focuses on changing patient behaviour and increasing patient compliance with therapy” (Fleming & Manwell, 1999: 129) • “Any therapeutic or preventative activity of short duration undertaken by a healthcare professional” (Aalto et al , 2000: 372)
stages of the Quik Fix (p11) STAGE 1: Conduct a Brief Assessment and provide Assessment Feedback STAGE 2: Offer Psychoeducation STAGE 3: Explore Motivation to Change STAGE 4: Assess Importance and Confidence to Make a Change STAGE 5: Explore Options for Change STAGE 6: Negotiate a General Change Plan STAGE 7: Offer Brief Coping Skills Training STAGE 8: Summarise the Change Plan & Rate Confidence to Implement the Plan
Motivational Interviewing “ Motivational Interviewing is a client- centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” ~Miller & Rollnick, 2002~
what is motivation? • Ready: a matter of priorities • Willing: the importance of change • Able: confidence for change
limitations • Client • The client may want longer term treatment • ?Effectiveness among clients with severe mental health and substance use problems • Who will deliver it? • Availability of training • Perception BI isn‟t „enough‟ treatment • How will it be funded? - Compatibility with Medicare funding
advantages • Some YP may prefer short term treatment • Increases number of YP who can access treatment • Easily disseminated to a range of allied health professionals across multiple settings • May be used as a first step in stepped care interventions for mental health and substance use problems
intervention philosophy There is no confrontation regarding the participants‟ use, There is the provision of a non-judgmental atmosphere in which questions may be asked.
motivation relates to ambivalence • Ambivalence – feeling two ways about something • Ambivalence is normal • Getting stuck in ambivalence can intensify problems • Exploring ambivalence is to work at the heart of the problem
spirit of MI Fundamental approach of MI Mirror-image opposite approach to some counselling Collaboration: Create an atmosphere Confrontation: Counsellor imposes their „reality‟ that the client cannot see or will conducive to change by developing a partnership that honours the client‟s not admit to expertise and perspectives Evocation: The resources and Education: The client is presumed to motivation for change are presumed to lack key knowledge necessary for reside within the client. change to occur. Autonomy: The counsellor affirms the Authority: The counsellor tells the client client‟s right and capacity for self - what he or she must do. direction and facilitates informed choice. Source: Miller & Rollnick, 2002
general principles of MI 1. Express Empathy 2. Develop Discrepancy 3. Roll with Resistance 4. Support Self-Efficacy
principle 1: Express Empathy • One of the most important elements of MI • Acceptance facilitates change • Skilful reflective listening is fundamental • Ambivalence is normal Miller & Rollnick 2002
principle 2: Develop Discrepancy • Motivation is a function of the discrepancy between present behaviours and values • Discomfort can enhance motivation to change • The client presents the arguments for change • Change is motivated by a perceived discrepancy between present behaviour and important personal goals or values
principle 3: Roll with Resistance • Avoid argumentation • Avoid direct confrontation of resistance • New perspectives are invited, not imposed • The client is the primary source of „solutions‟ • Resistance is a signal to respond differently Miller & Rollnick 2002
principle 4: Support Self-Efficacy • Nurture the clients‟ belief in the possibility of change – Build hope & optimism • Counsellor believes in the client‟s ability to change & communicates this to the client Miller & Rollnick 2002
methods for eliciting change talk - OARS O pen questions A ffirming R eflective listening S ummarising
STAGE 1: ENGAGEMENT, BRIEF ASSESSMENT & ASSESSMENT FEEDBACK
gather information • Establish rapport • Undertake assessment • Find out how the client sees their situation at present
principles of effective feedback • Be understandable • Be accurate • Be positive • Be collaborative • Be appropriate • Be responsible • Undertake assessment
feedback • The provision of assessment feedback can raise the clients awareness of their presenting issues • Aim is to help the client to understand the assessment results and develop a discrepancy between how things are and how the YP wants them to be • Avoid using the results to “prove” anything or to pressure the client to accept a diagnosis or prescribed course of action • Describe results and provide information needed to understand what the assessment means
feedback • Present results within a context that allows clients to form own conclusions and allows freedom of choice, for example • “I don‟t know what you will make of these results, but…” • Avoid “scare tactics”; this style may diminish the client‟s openness to feedback • Solicit and reflect the client‟s reactions to the feedback, for example: • “What do you make of this?”
feedback • Summarise the feedback in terms of: • The risks and problems that have emerged from assessment findings • The client‟s own reaction to the feedback, including self-motivating statements that have been made • An invitation for the client to add to or correct the summary
consider barriers to engagement • External obstacles to treatment attendance • “ even when people want help, it can be hard to do so. What things might get in the way of you coming to treatment?” • Psychological obstacles • “If we could magically solve these practical issues, what else might get in the way of you coming?” • Quick fix, stigma • Cultural obstacles • “Sometimes it is difficult for YP to come to treatment because their friends or family do not believe they need treatment or see the value of treatment. Do you have any concerns like these?
STAGE 2: OFFER PSYCHOEDUCATION
what is Psychoeducation? Steps …. • 1 acknowledge the YP‟s knowledge about their symptoms and substance use • 2. ask permission to provide information • 3. provide appropriate psycholeducation • 4. enquire about the YP‟s reaction to the information • 5. provide take home resources (p20)
Search for „mental health‟ on our website to download PDF Psychoeducation • Information should be delivered in a understandable & acceptable language and format • Include info on the common symptoms of depression/anxiety & substance misuse & the links between them
STAGE 3: Explore motivation to change (focus on strategies to elicit change talk)
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