The International Journal of Psychosocial Rehabilitation


A Pilot Study of Introductory Motivational Interviewing
 Training for Supported Employment Case Managers



Trevor J. Manthey, MSW, Ph.D. Candidate

University of Kansas
School of Social Welfare

Twente Hall
1545 Lilac Lane
Lawrence, KS 66044-3184





Citation:
Manthey TJ (2013)  A Pilot Study of Introductory Motivational Interviewing Training for Supported
Employment Case Managers
.  International Journal of Psychosocial Rehabilitation. Vol 18(1) 133-138




Abstract
Purpose:  To conduct an initial pilot study to determine if introductory motivational interviewing will lead to initial knowledge and attitudinal shifts within case-managers who work in an employment focused setting. 
Method:  Using a pre-post design, 20 participants attending an introductory MI training filled out a questionnaire meant to assess an individual’s general knowledge of motivational interviewing and an individual’s attitudes about how to work with individuals attempting to gain employment.  
Results:  There were statistically significant improvements in motivational interviewing knowledge and attitude shifts about how to work with individuals attempting employment.  
Conclusion:  Introductory MI training may be an important initial step in an overall implementation effort to integrate motivational interviewing in employment rehabilitation contexts.  In other words, initial training may open the door for the more in-depth skill building efforts required to adequately build and sustain counselor skills in MI by helping counselors first shift their attitudes about how they work with individuals seeking employment.     


Introduction
It has been suggested that the field of vocational rehabilitation move toward greater use of evidence based practices (Chan, Travydas, Blalock, Strauser, & Atkins, 2009, Chan, Miller, Pruett, Lee, & Chou, 2003).  Motivational interviewing is an evidence-based practice which has been shown to be effective in a wide variety of behavior change fields outside of vocational rehabiltiation (Lundahl, Tollefson, Gambles, Brownell, & Burke, 2010; Miller & Rollnick, 2012). 

While many researchers have discussed conceptually how MI fits well within a vocational rehabilitation paradigm (Brooks, 2005; Graham, Jutla, Higginson, & Wells, 2008; Larson, 2008; Lloyd, Tse, Waghorn, & Hennessy, 2008; Manthey, 2011; Manthey, Jackson, & Evans-Brown, 2011; Muscat, 2005; Wagner & McMahon, 2004) and the few studies which have been conducted in employment settings outside of vocational rehabilitation have been encouraging (Larson, Boyle, Barr, Glenn, & Kuwabara, 2007; Leukefeld, McDonald, Staton, Mateyoke-Scrivner, et al., 2003; Rose, Saunder, Hensel, & Kroese, 2005), there has not yet been a pre-post or controlled trial to assess the effectiveness of MI within the unique vocational rehabilitation setting.   Despite this, some valuable lessons have been learned.  A large scale implementation project of motivational interviewing occurred in the Washington state vocational rehabilitation system to help facilitate a system wide cultural shift (Manthey, Jackson, Evans-Brown, 2011).   A post hoc analysis of outcomes from this project suggested that MI may have helped improve outcomes for clients in areas such as length of time to plan and overall cost per client (Evans-Brown, Jackson, Knizek & Copeland, 2011).  It was also found that skill development in MI took more than just introductory training in order to sustain skills.  A broad level systems change approach had to be undertaken in order to build MI skills and then later sustain them.  This is consistent with the motivational training literature found in other fields (Madson, Loignon, & Lance, 2009; Miller & Rollnick, 2012).  However, the results of the Washington State implementation project were tentative due to a lack of randomization, control group, and pre-post testing. 

The purpose of this pilot pre-post study was to determine what types of realistic initial gains might be expected from an initial introductory training.  In other words, if introductory trainings alone do not lead to sustained MI skill development, then what might be the benefit of conducting an introductory MI training within an employment rehabilitation setting?  We hypothesize that initial training in MI may lead to initial knowledge and attitude shifts which may make participants more amenable to the more intensive training and implementation efforts required by an agency to sustain MI skill development.

Method
Participants
Twenty participants participated in an introductory MI training in Kansas.  Seventeen of the participants were case-managers; the other three were supervisors.  All participants were employed either as supported employment workers or case-managers that had employment rehabilitation focused duties.  Nine of the participants were from urban areas and 11 of the participants were from rural.  Eleven of the participants were male and 9 were female.

Procedure

A pilot pre-post design was used to assess whether there would be increases in initial motivational interviewing knowledge and shifts in motivational interviewing attitudes.  As participants entered the training, they were given the Motivational Interviewing Knowledge and Attitudes Scale – Vocational Rehabilitation (MIKAT-VR) (described further in the measures section).  At the conclusion of the introductory training participants were asked to fill out the MIKAT-VR again and then were asked to fill out their regular training evaluations.

The Introductory MI Training
The training was facilitated by members of the Motivational Interviewing Network of Trainers (MINT).  The training included didactic, experiential, and written activities.  In addition, the training included a classroom response system (CRS) which allows for individual members of the course to confidentially answer questions in the middle of the training via remote responders and get immediate feedback regarding whether their answers were correct or not.  The training provided introductory training regarding the spirit and principles of MI, and introduced the four processes of MI.  Initial core skill development was also practiced. 

Measures
The MIKAT-VR is a scale meant to assess MI knowledge and attitudes that are essential for learning MI skills.  The MIKAT-VR is adjusted in language from the original MIKAT (Leffingwell, 2006) which served the same purpose except the language reflected MI knowledge and attitudes for learning MI in substance abuse settings as opposed to vocational rehabilitation. 

Data Analysis
A paired samples t-test was used to determine if there were statistically significant differences between the pretest and posttest scores on the MIKAT-VR. 

Results

Results indicated a significant difference between the pre (M = 7.26, SD = 1.62) and posttest (M = 11.26, SD = 1.28) MIKAT scores; t(19)=  -14.51, p = .001.  Employment workers who participated in introductory MI training shifted MI inconsistent attitudes and increased their knowledge of motivational interviewing.

Discussion

While this pilot study does include a pre and posttest the results of this study are interpreted with caution due to the limitations associated with limited sample size, lack of randomization and control group.  However, given these limitations it appears that initial training in motivational interviewing can lead to important attitude shifts and knowledge of MI.  While this does not mean the individuals participating in introductory MI trainings have increased their ability to do MI, it does mean that participants may have shifted personally held attitudes that are essential for practicing MI.  Essentially this means that introductory MI trainings may be an important initial step in the goal of long-term MI implementation.  While the current MI training research indicates that introductory MI trainings alone are not effective at building and sustaining MI skills (Madson et al. 2009) the present study indicates that introductory trainings may still have value in shifting attitudes.

Conclusion
This pilot study may serve as a launching point for further exploration of MI implementation, MI training, and systems change efforts within vocational rehabilitation contexts.  Future controlled trials may need to focus on evaluating what introductory training paired with advanced training, audio-coding, and other intensive MI implementation efforts produce regarding sustained MI skill development.  In addition, research within vocational rehabilitation which can link MI skill development with outcomes such as improved client working alliance, and related employment outcomes will be essential.   This pilot pre-post study lends support to the contention that initial training in MI can produce important knowledge and attitude shifts.  These attitude shifts may be an important first step when planning for the advanced implementation efforts needed to develop MI skills and sustain them.  This current study provides some initial footing for continued MI implementation research in vocational rehabilitation. 




References
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