Engaging Injured Workers in Change

Presented by: Arthur Papagiannis

Managing Director AP Psychology and Consulting Services

Motivational Interactions

A Motivational Interaction (MI) is a “A brief, collaborative, person centred intervention focussing on behaviour change in clients. The role of the Claims Manager is to facilitate the individual in resolving the Ambivalence about change.” Why use Motivational Interaction’s in compensable injury schemes?

A number of research studies support the need for evidence based practices such as MI in addressing motivational issues involved in obtaining, maintaining better health or returning to employment persons with injuries and disabilities.

MI Definition…

A Continuum of Communication Styles

DIRECTING GUIDING FOLLOWING

Working with the person next to you:

SPEAKER: Describe something you want to change about yourself, but have not changed yet. i.e. eating less chocolate, exercise, health

LISTENER: Find out what the person wants to change: a) Explain why the person should make this change

b) Give at least three specific benefits of making the change

c) Tell the person how they could make the change

d) Emphasize how important it is to make the change

e) Persuade the person to do it

NB. If you meet resistance repeat the above

Activity: Understanding Change

Traps that promote disengagement

The Expert trap

The Power trap

The Problem Solving trap

The Question & Answer trap

The Yes-But trap

The Labelling trap

The Blaming trap

The Confrontation Trap

PERSUASION traps are likely to fuel the

process of DISENGAGEMENT &

RESISTANCE. This is likely to keep the

injured worker stuck.

Working with the person next to you on the issue you discussed earlier:

LISTENER: Listen carefully with a goal of understanding the dilemma: Give no advice

Ask these four open questions: 1. Why would you want to make this change?

2. How might you go about it, in order to succeed?

3. What are the three best reasons for you to do it?

4. On a scale from 0 to 10, how important would you say that is for you to make the change?

Follow up: And why are you at ____and not e.g. zero?

Give a short summary/reflection of the speaker’s motivation for change

Then ask: ‘So what do you think you’ll do?’ and just listen with interest

Activity: Understanding Change

Activity: The Four Statements

1) You are not really ready to think about this – in fact it feels a bit uncomfortable or unnecessary to be talking about it.

You really are in two minds about this, but fairly unsure about how to go forward – you’re wondering is it worth it even if you could manage it.

4)

2)

3) You have decided that change is definitely necessary and are thinking about “How” to change.

You have made the change and are wondering whether to keep it up – still not sure whether it’s a good thing or a bad thing on the whole.

Slide 4 M2

Lapse

Relapse

Pre-Contemplation

Maintenance Contemplation

Action

Exit?

The Cycle of Change

Slide 6 M2

The 5 Principles of Motivational Interactions i. Listen & Express

Empathy • Establish rapport • Respect • “get alongside” the client

• Personal warmth • Non judgmental approach

ii. Understand the Clients Motivation & Develop Discrepancy

• Highlight differences between present behaviour and future goals • Discuss and explore consequences • Client presents arguments for change

iii. Avoid argumentation

• Arguments are counterproductive • Likely to entrench behaviour and raise Resistance • Resistance is a signal to change strategies

iv. Roll with Resistance • A client cannot push if you give them nothing to push against

v. Empowerment • Help the client to find belief that they really can change • Clarify skills and strength

Slide 7 M2

The 4 Skills of Motivational Interactions

i. Open Questions • General open questions

ii. Affirmation • Find and show back a person’s own strengths and abilities • Create empowerment • Not the same thing as praise

iii. Reflective Listening • Content • Meaning

• Feeling

iv. Summary • Keeping track of the main points discussed •A synopsis which clarifies and highlights main themes

Using strategies appropriately Keeping pace with the individual Working at their point in the Cycle of Change

Slide 8 M2

The Spirit of MI

The Spirit of MI is the

foundational element that

guides good practice.

MI Spirit

Acceptance

Partnership

Compassion

Evocation

Motivational Interactions Screening Tool

Pre – Training

administration by facilitator prior to

participant’s learning the spirit, principles

and skills of MI

6 Months Post Training

Facilitated by the

organisation to assess the retention of

knowledge

Post – Training

administration by facilitator after

participant’s have practiced the spirit, principles and skills

of MI

MIST Scores: Pre MI, Post MI, 6 Post MI Training

Questions?