1. Community Support Services Training Direct Care Series – Session 2
Rutgers, The State University of New Jersey
School of Health Professions
Department of Psychiatric Rehabilitation and Counseling Professions

2. Review of Session 1 CSS Overview
Goals, Values, and Principles of Psychiatric Rehabilitation
Learning Application
Value life role

3. Learning Objectives Define and demonstrate the use of OARS
Demonstrate an understanding of Motivational Interviewing principles
Verbalize an understanding of the stages of change concept
Define and demonstrate the use of OARS
Practice communication skills
Practice using a motivational interviewing strategy

4. You would think…
That having had a heart attack would be enough to persuade a man to quit smoking, change his diet, exercise more, and take his medications.
That hangovers, damaged relationships, an auto crash, and memory blackouts would be enough to convince a woman to stop drinking.
That time spent in the dehumanizing privations of prison would dissuade people from reoffending.
The key is that motivation is the key to change. The role the support worker plays in moving people toward motivation for change

5. Openness and collaboration
What is motivation?
Low resistance
Openness and collaboration
Expressing emotion
Adhering to a change plan
Changing
All of which are strongly influenced by what a support worker does

6. Motivational Interviewing (MI)
An evidence-based treatment that addresses ambivalence to change
A conversational approach designed to help people with the following:
examine ambivalence
expressing the desire to change (in their own words)
enhance confidence in taking action
elicit and strengthen change talk
strengthen commitment to change
plan for and begin the conversation for change
(Miller & Rollnick, 2013)

7. Motivational Interviewing Clip
MI Video Clip
(Fader, 2012)

8. Stages of Change Pre-contemplation Contemplation Preparation Action
Maintenance

9. Stages of Change
Pre-Contemplation-Not seeing a problem behavior or not considering change.
Contemplation-Acknowledging that there is a problem but struggling with ambivalence. Weighing pros and cons and the benefits and barriers to change.
Preparation-Taking steps and getting ready to change.
Action-Making the change and living the new behaviors, which is an all-consuming activity.
Maintenance-Maintaining the behavior change that is now integrated into the person's life.
(Rosengren, 2009)

10. Stages of Change Activity

11. How does this translate to interventions
Pre-Contemplation
Contemplation/Preparation
Action
Maintenance
Outreach
Trusting Relationship
Practical Support
Assessment
Motivational Interventions
Education
Skill building
Social Support
Cognitive Behavioral Interventions
Planning
Recovery Lifestyle

12. Principles of Motivational Interviewing
Express empathy
Develop discrepancy
Avoiding argumentation
Roll with resistance
Support self efficacy
(Miller & Rollnick, 2013)

13. Change Talk – DARN CAT Desire: I want to… Ability: I can…
Reason: It’s important…
Need: I should…
Commitment: I will…
Activation: I am ready…
Taking steps: I am doing it tomorrow…

14. Engagement Strategies
Open-ended questions, Affirmations, Reflections, Summarization (OARS)
Stop periodically to review comprehension and understanding
Provide examples of content to enrich learning process
Use actively listening skills to participate in the meeting
SOLER
Listen more than you talk
(Rosengren, 2009)

15. Communication
“The main goal and purpose is to build rapport or trust with people. It is something that we have to work at and realize that building trust can be difficult.”
(Mead, 2008)

16. Communication
Communication is the reciprocal exchange of information, ideas, beliefs, feelings, and attitudes between individuals.
It’s the primary vehicle for establishing a relationship
The means by which we influence the behavior of others
Contributes to a safe and effective collaborative relationship
(Mead, 2008)

17. Communication Activity
Pair up
Identify who will be the communicator and who will be the listener
Sit back to back
Rules for the communicator:
Describe the picture to your partner
Can only give the directions once
Rules for listener:
Can not ask for any clarification
Can not see the picture

18. Developing Relationships…
Essential characteristics
Genuineness
Unconditional Positive Regard
Empathy
Shared agreement
Integration of humor
(Rogers, 1967)

19. Filtering and dreaming
Listening Blocks
Comparing
Mind-reading
Rehearsing
Filtering and dreaming
Judging
Identifying
Advising
Derailing
Placating
(Rosengren, 2009)

20. Activity-ICR Scale
Observer use OARS worksheet.

21. Motivational Interviewing (MI) Resource

22. Learning Application
Practice communication skills while completing an ICR scale with a consumer.

23. Zakia Clay, MSW, LCSW, CPRP Anthony Zazzarino MA, LPC, ACS, CPRP
Contact Information
Zakia Clay, MSW, LCSW, CPRP
Ann Reilly MA, LSW, CPRP
Anthony Zazzarino MA, LPC, ACS, CPRP

24. References
Druss, B.G & Reisinger W, E. (2011) Mental disorders and medical comorbidity. Biological Psychiatry, 54(3),
Fader, J. (2012, June 13). Dr. jonathan fader demonstrates motivational interviewing skills [Video file]. Retrieved from
Mead, S. (2011, April). Intentional Peer Support as Social Change. Speech presented at Trauma Informed Peer Support Workshop, Oakland, CA.

25. References Miller, W., Rollnick, S. (2013). Motivational interviewing:
helping people change. [3rd edition]. New York, NY: Guilford Press.
Rogers, C. (1967). On becoming a person: A therapist view of psychotherapy. Mariner Books
Rosengren, D. B. (2009). Building motivational interviewing skills: A practitioner workbook. New York, NY: Guilford Press.