MotivationalEnhancementTherapy-LADCP：动机增强疗法LA课件.ppt

1、“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 environment Brain development Different priorities Peer pressure To piss us offWhats up with the

2、 parents?Single parents Overworked/overscheduled parents Grandparents Overwhelmed parents Parents who have given up Parents who have their own AOD problems Parents who seem like they“dont care”Enabling parents/parents who are part of the problem Parents who are doing everything rightA Word About Bra

3、in 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.MacArthu

4、r Foundation Research Network on Adolescent Development and Juvenile Justice:They think differently To 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 ar

5、e not skilled at doing this Teens 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 differently Adolescents are not very skilled at distinguishing the subtlety of facial expression(excitement,anger,fear,sad

6、ness,etc.)results in a lot of miscuesleads to lack of communication and inappropriate behavior Differences 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/pu

7、blications/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 assets I

8、nternal Assets External Assets Protective 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,oft

9、en 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 Moti

10、vationWhose job is it to assist the youth in increasing his or her motivation?Increasing Motivation Stages of Change Motivational 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 t

11、han clients who received the standard intake evaluation.(Carroll,et al.,2006.)Stages of Change Readiness(Prochaska and DiClemente,1992)PrecontemplationContemplationPreparationActionMaintenanceStages of ChangeStages of Change Not thinking about changing Happy user Learned helplessness Has no intentio

12、n to take action within the next 6 months Stages of Change Thinking about changing Ambivalence Chronic contemplators Intends to take action within the next 6 months.Stages of Change Decision made Firm plans Possibly recent attempts at change Intends to take action within the next 30 days.Has taken s

13、ome behavioral steps in this direction.Stages of Change Overt behavioral change Stopping main issue Grief issues Counter-conditioning Stimulus control Contingency management Has changed overt behavior for less than 6 monthsStages of Change Sustained behavior over time Alternatives established Later,

14、becomes a non-issue Has changed overt behavior for more than 6 months.What 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 techniques An important goal is to clarify

15、values and amplify discrepancies Purpose is to move person through the stages of change from Morgenstern-”Motivational Interviewing”Philosophy of Motivational Interviewing MI is a technique in which you become a helper not a dictator in the change process for your client.In criminal justice we are u

16、sed 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 change

17、s.Confrontation:A Goal Not a StyleAMBIVALENCE “I want to but I dont want to”Important Assumptions in Motivational Interviewing Clients are AMBIVALENT about changing.There are BOTH pros AND cons to getting off of drugs vs.continuing to use.Ambivalence about quitting We in criminal justice dont typica

18、lly 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

19、 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 ch

20、angeHigh 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 DISCREPANCY Motivation for change is enhanced when clients perceive the discrepanc

21、ies 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

22、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 inte

23、rviewers,to articulate and resolve his or her ambivalence.Exercise Pair up Pick 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 en

24、d,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?Assessment Interviewing-ASK HE

25、R!Comprehensive case management Realistic case planning Incremental objectives Treatment matching Gender appropriate Culturally relevantWhat do youth in Drug Court need?Case Planning Questions Is there more than one case plan?If there is,can they be combined?If they cant,how can your team be sure th

26、ey 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 the

27、re 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?Exercise As a team:identify two strengths of your case management services.identify two challenges with your case management process,and discuss possible solutions.