MotivationalEnhancementTherapyLADCP动机增强疗法LA课件

“Because I Said So”:How to Support Juvenile Clients through ChangeLouisiana Association of Drug Court ProfessionalsApril 11-13,2012Jane E.Pfeifer,MPAWhy do kids do what they do?Lack of control over their environmentBrain developmentDifferent prioritiesPeer pressureTo piss us offWhats up with the parents?Single parentsOverworked/overscheduled parentsGrandparentsOverwhelmed parentsParents who have given upParents who have their own AOD problemsParents who seem like they“dont care”Enabling parents/parents who are part of the problemParents who are doing everything rightA Word About Brain DevelopmentTeenage brains are much more influenced by emotional arousal,peer pressure,and risk taking than adult brains,because their impulse control and judgment is less well developed.Laurence Steinberg,a Temple University psychology professor and director of the John D.and Catherine T.MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice:They think differentlyTo appreciate consequences of risky behavior,one has to have the ability to think through potential outcomes and understand the permanence of consequences,due to an immature prefrontal cortex,teens are not skilled at doing thisTeens do not take information,organize it,and understand it in the same way that adults dothey have to learn how to do thisThey seeand process,things differentlyAdolescents are not very skilled at distinguishing the subtlety of facial expression(excitement,anger,fear,sadness,etc.)results in a lot of miscuesleads to lack of communication and inappropriate behaviorDifferences in processing,organization,and responding to information/events leads to misperceptions and misunderstanding verbal and non-verbal cuesSpecial Issue on Juvenile Drug Courtshttp:/www.ndci.org/publications/drug-court-review/special-issue-juvenile-drug-courtsPractical StrategiesStrengths PerspectiveDennis Saleebey,University of Kansas“explore and exploit clients strengths.”“The problem is not the person.”Asset IdentificationSearch Institute (www.search-institute.org)40 developmental assetsInternal AssetsExternal AssetsProtective factorsFirst Question:Q.:What agency/organization provides primary case management services for your Drug Court?EngagementWhose job is it to engage the youth?EngagementEngagement activities are intended to identify and fulfill the clients immediate needs,often with something as tangible as a pair of socks or a ride to the doctor.Center for Substance Abuse Treatment.Comprehensive Case Management for Substance Abuse Treatment.Rockville(MD):Substance Abuse and Mental Health Services Administration;1998(Treatment improvement protocol;no.27).Increasing MotivationWhose job is it to assist the youth in increasing his or her motivation?Increasing MotivationStages of ChangeMotivational Strategies In a recent study,clients assigned to receive motivational interviewing techniques at intake had significantly better retention rates at the 28-day follow-up than clients who received the standard intake evaluation.(Carroll,et al.,2006.)Stages of Change Readiness(Prochaska and DiClemente,1992)PrecontemplationContemplationPreparationActionMaintenanceStages of ChangePre-contemplationPre-contemplationContemplationContemplationPreparationPreparationActionActionMaintenanceMaintenanceRelapse-Lapse-ChangeRelapse-Lapse-ChangeStages of ChangeNot thinking about changingHappy userLearned helplessnessHas no intention to take action within the next 6 months Pre-contemplationPre-contemplationStages of ChangeThinking about changingAmbivalenceChronic contemplatorsIntends to take action within the next 6 months.ContemplationContemplationStages of ChangeDecision made Firm plans Possibly recent attempts at changeIntends to take action within the next 30 days.Has taken some behavioral steps in this direction.PreparationPreparationStages of ChangeOvert behavioral changeStopping main issueGrief issuesCounter-conditioningStimulus controlContingency managementHas changed overt behavior for less than 6 monthsActionActionStages of ChangeSustained behavior over timeAlternatives establishedLater,becomes a non-issueHas changed overt behavior for more than 6 months.MaintenanceMaintenanceWhat is MOTIVATIONAL INTERVIEWING?Intervention designed to mobilize clients internal resources for change by enhancing intrinsic motivation.A style of being with people,not just a set of techniquesAn important goal is to clarify values and amplify discrepanciesPurpose is to move person through the stages of change from Morgenstern-”Motivational Interviewing”Philosophy of Motivational InterviewingMI is a technique in which you become a helper not a dictator in the change process for your client.In criminal justice we are used to telling people what to do.This is a different style of interview and counseling.Goal Of Motivational InterviewingThe goal of MI is to create a safe and supportive rapport with a person,in order to facilitate their thinking about their behavior and whether/how they might go about making changes.Confrontation:A Goal Not a StyleAMBIVALENCE “I want to but I dont want to”Important Assumptions in Motivational InterviewingClients are AMBIVALENT about changing.There are BOTH pros AND cons to getting off of drugs vs.continuing to use.Ambivalence about quittingWe in criminal justice dont typically see that for the client there are at least some good reasons to continue to use.MI recognizes that ambivalence about quitting is NORMAL.Change Importance of ChangeABILITYLow importance:Low confidenceThese people dont see the need for change nor do they believe that could effectuate the change,if they decided to changeLow importance:High confidenceThese people are confident they can make the change but are not convinced that change is needed.TOCHANGEHigh importance:Low confidenceHere the problem is not the willingness of the person to change but the persons confidence in their ability to changeHigh importance:High confidenceThese people see the necessity of change and believe they can succeed.ExerciseShare an example with your team of how you,in your role,can assist with increasing motivation.DEVELOPING DISCREPANCYMotivation for change is enhanced when clients perceive the discrepancies between their current situations and behaviors,and their hopes and goals for the future.Let the client present the argument for change.“Tell me the good parts about using.”“Tell me the negatives.”You will often hear about damaged family relationships,especially with the clients children.“How do these weigh out to you?”“Where do you think you go from here?”Have the client state the solution of what he must do to achieve his stated goals,desires,wants,and wishes.Take Home Message:Motivation to change is elicited from the client,and not imposed from without.It is the clients task,not the interviewers,to articulate and resolve his or her ambivalence.ExercisePair upPick a real-life behavior change you want to make(be sure its one you want to share!)One is the case manager and one is the drug court participantthen switch.As the case manager,help your partner develop discrepancy.By the end,and without asking directly,see if you can determine if your partner is low importance/low ability;low importance/high ability;high importance/low ability;high importance/high ability.Meeting Clients Needs“clients”not“clients”What does this client need?How do we know?AssessmentInterviewing-ASK HER!Comprehensive case managementRealistic case planningIncremental objectivesTreatment matchingGender appropriateCulturally relevantWhat do youth in Drug Court need?Case Planning QuestionsIs there more than one case plan?If there is,can they be combined?If they cant,how can your team be sure they dont contradict each other?Do all team members know whats on all case plans?Does the youth know whats on all case plans?!Involve the Youthin case planningWhat are their goals?What do they want to change?“Case planning happens with the client,not to the client.”What Goals are set for Youth?Are there target behaviors that all youth must achieve?Are they different in the beginning of the program?Does your department/agency have differing goals for youth than the drug court,or are they consistent?How individualized can goals be for each youth?ExerciseAs a team:identify two strengths of your case management services.identify two challenges with your case management process,and discuss possible solutions.