Supporting the “MI Spirit” Through an Intensive TA Process: Clinical Supervisory Staff Improve Their Communication Skills For Use with Clients and Each Other

Laura Cooley
Northwest ATTC Technology Transfer Specialist

How would you rate your skill level in motivational interviewing (MI)?
On the first day of a two-day MI workshop, 35 behavior analysts were asked this question about their perceived skill and confidence level in using MI. The behavior analysts, all of whom work as clinical supervisors at a Washington-based organization, proceeded to line themselves up in the training room according to self-ratings on a 0-10 scale (from ”not at all ready” to ”extremely ready”). One small group thought they had a very low level of ability in this area, two placed themselves in the intermediate to high range, and the rest ranked themselves somewhere in the middle.

The workshop was the start to an intensive technical assistance (TA) process led by the Northwest ATTC in partnership with Connections Behavior Planning and Intervention, LLC. The results of this TA process, which relied on use of an adapted EPIS (Explore-Prepare-Implement-Sustain) model, proved to be impressive:

By the end of the intensive TA process in MI, 96% of survey respondents reported intermediate or better confidence that they would be able to maintain use of the techniques they had learned after more than half a year of sustained technical support.

Today, an internal implementation team at the organization is busy putting the “MI spirit” into action by using their MI skills with clients, on-boarding new staff, or coaching their colleagues.

Getting the “buy-in” to take on this intensive TA was the easy part; Connections’ senior leadership team, James Kidwell and Paul Mullan, recognized MI’s value and wanted to improve staff satisfaction. They saw MI as a core skill that could “…both improve their staff-client interactions and be helpful in improving staff interactions with other staff,” said Mullan.

Dusty Dixon, director of continuing education, added, “From the start, we were committed to doing this because we recognized that ongoing practice and feedback are in line with our understanding of best practices.”

A real strength of this project has been the plan for sustained support from a highly skilled MI trainer, Dr. Ann Marie Roepke, who supported Connections on two levels:

  1. Virtual sessions focused on specific MI skill development and practice, and
  2. Creation of an internal implementation team to lead and sustain the improved MI capacity.
Commitment of senior leadership has been crucial. Senior leadership actively took part in the TA process and further demonstrated their buy-in by freeing up staff time. They committed the organization to the effort over the long haul and dedicated time normally allocated for administrative duties to further MI coaching.

IMPLEMENT The 5 main phases of this TA process consisted of:
  1. A two-day, in-person training on motivational interviewing;
  2. A series of videoconference calls over a 7-month period focused on further MI skill development and practice;
  3. Targeted observation of staff who volunteered to be observed as they practiced their MI skills, and some observation of senior management communication styles;
  4. TA coaching and support to an internal sustainability implementation committee; and
  5. Creation of a set of recommendations for sustaining MI skills at the organization.

Flexibility was intentionally built into the intensive TA process to ensure staff would have ample opportunity to practice their skills. They also received personalized, expert feedback from Dr. Roepke.

Coaching was offered through targeted observation of staff who volunteered to demonstrate their skills and discuss strengths and areas for further development. For the implementation team, this ongoing support proved to be “immensely beneficial,” according to Dixon.

Using videoconferencing helped meet the needs of the organization’s co-located staff. Sustained coaching of MI skills over several months led to implementation team members learning the basics of how to code MI skills. They can now coach new employees through on-boarding and model MI skills for others.

Keeping development and refinement of MI skills in-house is an organizational priority. As part of the sustainability plan moving forward, Connections staff have been revising some of their policies and procedures. These have “…shifted to align better with the ‘MI Spirit,’” says Dixon, who has been an in-house champion and key to facilitating the entire process. Another key in-house champion, David Cole, who directs their training programs, worked with the implementation team to promote MI’s use organizationally. MI is now being used to refine the training and coaching offered during the onboarding process.

Another sign of the “MI spirit” in action? The last of the regular virtual sessions was entirely run by the internal sustainability team.

Next steps for the Northwest ATTC team include working with Connections staff to identify recommendations for ongoing sustainability of MI support and training to staff.

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