Motivational Interviewing and Wraparound: A Good Match?

A very important part of implementation management and overall wraparound success is motivating and encouraging the family and team.  One approach to doing this is through using an evidence based treatment called motivational interviewing. Motivational interviewing is designed to increase intrinsic purpose and incentive to change and follow through on change plans (Miller & Rollnick, 2002).  Here is a little bit about motivational interviewing:

  • Motivational interviewing is an interactional approach that is non-judgmental and non-confrontive. The approach attempts to increase the person’s awareness of the need to change and follow through by focusing on the results of a better future (Miller & Rollnick, 2009). The principles, assumptions, and strategies are a good match to wraparound’s goal to support families to achieve their own vision.
  • Motivational interviewing recognizes that people who need to make changes to achieve their long-range vision are often ambivalent about making the needed changes (Miller & Rollnick, 2009).  There may be many reasons for this – including a lack of confidence that they can achieve their vision, that the changes will lead to the vision, and that there may be negative impacts to making the changes.
  • While the process is non-judgmental and non-confrontive, it is not a neutral discussion. The dialogue helps the family clarify for themselves why the change is needed.  At this point, the wraparound staff becomes a support for the change, not the person advocating for the change.  This recognizes that true change and growth must come from the individual (or family) and cannot be effectively imposed by an outside entity.  The goal of motivational interviewing is to help the family make the decision to change and then support the change (Miller & Rollnick, 2002).

Now let’s compare that to the VVDB Theory of Change.  Wraparound works when it focuses on the needs families identify as most important. In the process of developing the SNCD and long-rage vision, we help the family assess their own status and needs across life domains.  This process helps the family identify their own goals and priorities for change.  This directly addresses the first area of ambivalence, and the vision can then be used as the focus for future interactions.

The second component of the theory of change is self-efficacy or the confidence and skills to accomplish their vision. This is the drive that comes from within the individual.  As self-efficacy increases, so does motivation to accomplish their vision. By identifying current strengths, celebrating accomplishments, and building skills through purposeful transition, wraparound builds self-efficacy and strengthens the decision to change.

Thinking about how motivational interviewing works and can lead to lasting change can suggest effective strategies for wraparound.  It is the family’s change process, so we begin through active listening to understand the family’s point of view (empathy).  We design our strategies to identify and celebrate strengths, create success, and build transition assets to support self-efficacy and motivation. Resistance and ambivalence to change are all natural responses, so we should not view them personally or see them as a failure.   We should, however, help the family view the discrepancy the resistance and ambivalence cause and let them address them.

We cover some of the basics of motivational interviewing as it relates to wraparound in our Foundations Textbook, and encourage people and programs to look into it further. Have you done any motivational interviewing training at your program? How has it worked for you?

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