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SSRC Notes: Expanding the use of motivational interviewing to welfare participants

Date Added to Library: 
Friday, June 15, 2018 - 16:49
Individual Author: 
Arkin, Monica
Reference Type: 
Place Published: 
Washington, DC
Published Date: 
Published Date (Date): 
Friday, June 15, 2018

Posted by Monica Arkin, Self-Sufficiency Research Clearinghouse Staff

Case workers and other practitioners in the welfare system benefit from keeping abreast of new research and clinical approaches when working with clients. One such method that has been around for decades but has only recently been popularized in the field of self-sufficiency is motivational interviewing. Developed in the 1980s by clinical psychologists William R. Miller and Stephen Rollnick, motivational interviewing was created as an approach to behavioral change particularly for individuals dealing with substance use disorders. Compared with the more traditional dynamic of counselor-patient relationships, which commonly features an expert counselor educating or persuading a less-informed client, motivational interviewing occurs in the context of a partnership where client autonomy is the foundation. Together, the counselor and client engage in a collaborative conversation about identifying problems and solutions, particularly by focusing on barriers to change that are preventing progress toward the client’s goals. Rather than imposing change externally, motivational interviewing seeks to elicit and strengthen an individual’s intrinsic motivation for change.

Since its initial development in substance abuse treatment spaces, motivational interviewing has proven to be an effective approach for facilitating productive change in various client contexts. With respect to self-sufficiency, studies of TANF-eligible client outcomes have shown that motivational interviewing is a valuable addition to case worker interventions. For example, a six-month follow-up evaluation of 322 randomly selected TANF-eligible clients participating in Kentucky’s Targeted Assessment Program (TAP), which combines motivational interviewing, holistic assessment and strengths-based case management, found medium-to-strong decreases in self-reported barriers to self-sufficiency. These included barriers related to physical health (at six-month follow-up the percentage of participants who had seen a doctor in the previous 12 months decreased, as did the percentage of participants who wanted to see a doctor but reported being unable to), mental health (feeling badly about oneself, having thoughts of self-harm, and feeling worried or anxious), substance use, and intimate partner violence. Additionally, TAP participants reported lower work difficulty and higher employment rates at the time of follow-up.

Another study found a connection between motivational interviewing and veterans’ self-sufficiency. Eighty-four veterans who had psychiatric disorders and had applied for service-connected compensation were assigned to either a control condition, where they received an orientation to the U.S. Department of Veterans Affairs health care system and services, or an experimental condition, where they received four 50-minute sessions of individual counseling that followed a motivational interviewing framework. At a six-month follow up, veterans in the experimental group reported significantly more days of paid employment compared with participants in the control group. This suggests that motivational interviewing may reduce barriers to employment that are associated with disability payments for psychiatric disorders.

The benefits of motivational interviewing serve the client as well as the practitioner. A qualitative study in Alamance County, North Carolina gathered the perceptions of case workers within the child welfare system that were trained in motivational interviewing. When initial training was supplemented with coaching from clinical coaches, case workers reported that motivational interviewing “helped them deal with difficult issues they encountered, changed-long held perspectives, and provided a new approach to working with families.”

The SSRC Library contains numerous reports and stakeholder resources about motivational interviewing, including:

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