How Motivational Interviewing was Integrated with Wraparound

In this article:
MiiWrap was created from a thoughtful marriage of Wraparound and Motivational Interviewing. Motivational interviewing provided promising structure to improve Wraparound outcomes.

Integration Process

The process of integrating Wraparound with Motivational Interviewing was accomplished over seven years with the help of hundreds of people across North America.  The developmental process was completed through four stages beginning by having staff receive separate standalone MI training coupled with onsite group coaching and process evaluation. The next Stage evolved as I partnered with MI expert David Duresky to develop a model that combined the two processes leaving each intact.  During this time, we consulted with MI developers William Miller, Teresa Moyer and Denise Ernst, reviewed the updated MI literature and became proficient in MI fidelity tools.  We created training and coaching materials and a draft manual.  A learning community was formed in the third Stage consisting of over 40 wraparound experts across North America.  These individuals reviewed the draft manual, participated in and supported MiiWrap training and coaching in their sites, participated in a series of online learning community meetings and a four-day discussion session at Red Rocks.  During Stage Four I reworked and integrated the two models and published the Foundations manual based on the accumulated feedback and experience and began training, coaching and evaluating MiiWrap.

Much was learned and changed throughout the developmental process and is described in detail by Rast (2020).  Some of the highlights of each stage are described below. During the process of separate training and coaching in Stage One, most staff increased using Simple Reflections and Open-ended Questions and avoided some of the more egregious roadblocks to communication and conversational traps.  Few, however, consistently used the complex Reflections necessary to create and resolve ambivalence and showed little use or improvement in cultivating change talk or true partnering with youth/families. Discussions and focus groups suggested the amount of material between the ten principles and 100 plus steps of wraparound and the MI spirit, relational skills, technical skills, roadblocks and conversational traps were overwhelming and lacked a cohesive focus.  In addition, the funding and monitoring requirements for providing and documenting wrapround were barriers to effective service.

During Stage Two we tried to pull these many aspects of both models together while leaving both models intact.  The reviews and evaluations of Stage Three revealed that this did not simplify or focus the two models.  Learning community members provided feedback and many suggestions for integrating the process.   Stage Four required a complete reconceptualization of the process to create true integration.  By this time David had other commitments and I moved forward with the support of the learning community. The first step was to integrate and simplify the spirit of MI with the principles and theory of change of wrapround into a unified MiiWrap Mindset.  The relational and technical skills of MI were refocused on the wraparound process and the phases and activities of wraparound were simplified and integrated with the processes of MI.

Read more details of the process at Integrating Wrap with MI

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