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Case Management and Motivational Interviewing in the German Heroin Trial

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Title: Case Management and Motivational Interviewing in the German Heroin Trial


1
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

2
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

3
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.

4
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

5
Model of Case Management and Motivational
Interviewing
6
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

7
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

8
Stages of Change
9
Motivational Interviewing, Stages of Change
10
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

11
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

12
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

13
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

14
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

15
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

16
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

17
Case Management and Motivational Interviewing
18
Case Management and Motivational Interviewing
19
Case Management and Motivational Interviewing
20
Case Management and Motivational Interviewing
21
Case Management and Motivational Interviewing
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