Case Management and Motivational Interviewing in the German Heroin Trial

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Case Management and Motivational Interviewing in
the German Heroin Trial

• Irmgard Vogt,
• Martina Schu, Martin Schmid, Wilfried Görgen,
  Hans Oliva
• Fachhochschule Frankfurt am Main/ FOGS, Köln

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Case Management and Motivational Interviewing in
the Heroin Trial

• Case Management and Motivational Interviewing is
  introduced into the Heroin Trial as one variation
  of psychosocial support of clients
• Case Management emphasises structure and an
  organisational framework, networking and
  cooperation with other agencies Motivational
  Interviewing embraces motivational factors, style
  of interaction, collaboration with clients
• The two concepts blend well as both of them have
  a long history in individual counselling and are
  related to each other
• To facilitate comparison of results in a
  multicenter setting, implementation and
  documentation are standardised, and coaching of
  counsellors during trial is part of the standard
  procedure

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Case Management Background

• CM has a long history in individual counselling
• CM is a variation of a client-centred approach
  in a well structured setting, designed
  specifically for the care of people with complex
  problems
• CM is target-orientated
• CM is designed for long term interventions and
  geared to solutions and sustained support in a
  continuum of care
• Case Managers work "in the field making use of
  clients resources as well as organisational
  networks in cooperation with clients they plan,
  organise and coordinate a needs-based,
  comprehensive and efficient package of care,
  crossing institutional and professional
  boundaries.

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Case Management Techniques

• CM is well structured and organised along
  stages or steps of the helping process
• CM asks for networking and cooperation of
  (welfare) agencies and organisations
• CM includes re-assessment and evaluation of the
  helping process and of its outcome
• CM blends well with MI. However, CM underlines
  structure, MI counselling style and techniques.
  Mixing both requires a delicate balancing of form
  and content, structure and style of interaction

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Model of Case Management and Motivational
Interviewing
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Case Management

• CM has been evaluated in the USA, within the
  framework of a control study of drug addicts with
  complex problems (cf. Ball Ross 1991, Mejta et
  al. 1997)
• Result CM is more successful than "treatment as
  usual
• CM has been implemented in Germany as well (cf.
  Oliva et al. 2002), but not yet in comparative
  studies

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Motivational Interviewing

• MI has developed out of a client-centred
  counselling approach, integrating elements of
  motivational psychology and cognitive behaviour
  therapy
• MI is based on the stages-of-change model
• MI stresses the style of interaction between
  counsellor and client. Counselling techniques are
  tailored to facilitate the exploration of
  motivational conflicts of client and to support
  motivation to change

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Stages of Change
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Motivational Interviewing, Stages of Change
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Motivational Interviewing Basic Skills

• Unconditional Acceptance - the counsellor accepts
  the client as a person regardless of his or her
  values, life-style or actual problems he is
  respectful towards the client
• Empathy - understanding another persons emotions
  and feelings from that persons frame of
  reference the counsellor is warm, caring and
  interested in the client
• Enhancing Self-efficacy in clients - the
  counsellor fosters hope and optimism in the
  clients capacities to change

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Motivational Interviewing Techniques

• Showing interest in client via reflective
  listening and open-ended questions
• Developing discrepancies between clients current
  situation and hi/her hopes for the future
• Avoiding to argue, moralise, blame and label
• Avoiding interpretations - clients statements
  are taken as such and not analysed for hidden
  meanings
• Roll with resistance - instead of confrontation
  shift perspectives and reframe statements
• Supporting self-efficacy - strengthen clients
  belief in change

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Motivational Interviewing

• MI was used and analysed in the USA in several
  efficacy studies, eg. in project MATCH (1998)
• In the study, alcohol dependent clients were
  randomly assigned to 3 groups of intervention
  methods, one of it was MI. Results were monitored
  and treatment outcomes evaluated. Result MI is
  an effective intervention method
• MI is widely used in Germany, especially in
  counselling persons with alcohol problems (John
  et al. 1996, Kremer et al. 1999) and in short
  interventions

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Case Management and Motivational
InterviewingSteps to Standardization

• Development of guidelines to Case Management and
  Motivational Interviewing - Manual for
  counsellors
• Development of questionnaires and fact sheets to
  facilitate assessment, treatment planning,
  minutes etc.
• Trainings of Case Managers in the trial in
  methods, techniques and use of questionnaires
• Re-trainings of Case Managers 3 and 6 months
  after start of the trial
• Coaching of Case Managers at work place

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Case Management and Motivational Interviewing
Steps to Standardization

• Development of questionnaires and fact sheets
• General information sheet for clients regarding
  Case Management and Motivational Interviewing
• contract to collaboration while in trial
• Client files and documents
• Documentation of daily work schedule of Case
  Managers
• Questionnaire of Generalised Competence
  Expectation
• Final evaluation assessment sheet

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Case Management und Motivational
InterviewingSteps to Standardization

• Client files and documents
• Structured assessment forms regarding patterns
  of drug use and abuse, general aspects of health,
  relationship to family members and friends,
  education and employment, actual income and
  debts, problems with the police and the judicial
  system, self-reported problems
• Checklist of regional support system (e.g.
  counselling organisations and welfare agencies)
  and establishing a network according to the needs
  of the client
• Forms for treatment plans and for conferences to
  discuss treatment plans
• Re-assessment forms
• Final evaluation form

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Case Management und Motivational
InterviewingSummary

• The blending of CM and MI is suitable and offers
  a wide range of methods and techniques to
  psychosocial care for substance dependents
• The combination of CM and MI is tailored to care
  for people with longstanding and complex problems
  including clients with dual diagnosis
• Steps to standardise the helping process allow
  for a control of the number and type of
  interventions in multicenter settings

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Case Management and Motivational Interviewing
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Case Management and Motivational Interviewing
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Case Management and Motivational Interviewing
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Case Management and Motivational Interviewing
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Case Management and Motivational Interviewing