1. Training Overview and Expected Outcomes GPRA Tool Administration Training

2. Purpose Discuss interviewing techniques Train participants on administration of the GPRA Client Outcomes Demonstrate the techniques and skills required to administer the GPRA Tool

3. Objectives Discuss elements of the client interview and motivational interviewing Review the development of the GPRA Client Outcomes Review each item and instructions on the GPRA tool Practice the questions through a series of role plays

4. Outcomes At the end of the day you should… Be able to conduct a GPRA interview by understanding the data collection techniques and individual instructions Understand the intent of the GPRA questions Be ready to share what you learned with colleagues back at work

5. Questions

6. CENTER FOR SUBSTANCE ABUSE TREATMENT The Client Interview GPRA Tool Administration Training

7. RAISE YOUR HAND IF…

8. Goals To review issues that arise during the interview process To discuss client interviewing methods to facilitate successful GPRA administration To emphasize the importance of client- interviewer relationship-building

9. Interview Relationship Communication

10. Social & Cultural Issues Ethnicity Acculturation Racial Identity Socioeconomic Status GenderAge

11. Verbal Communication Words or phrase choice How you say it –tone, volume, speed –pauses, laughter

12. Interview Taboo

13. TABOO Outpatient Treatment Vaginal Sex Hallucinogens Stress Emotional Problems Violent Behavior Ketamine Anal Sex Important Activities Tylenol 2, 3, 4 Methamphetamine Marijuana Latex Barrier Inhalant Unprotected Sex

14. Client Motivation Differing perspectives Be sensitive Understand context

15. Client Cooperation I’ve been waiting… How many times do I have to answer these questions? When do I get what I came for?

16. Client Cooperation (continued) Hard to talk about sex, drugs, and HIV –personal –negative feelings –taboo –associated with upsetting events I’m not feeling my best –Substance abuse symptoms –HIV symptoms

17. Interviewer Issues Boredom and burn out Fear of hostility Too close to home Interviewer biases Self-doubt and conflict Comfort with questions and topics (e.g., sex, drugs)

18. FRAMES F: Provide feedback R: Promote responsibility A: Provide advice M: Provide a menu of options E: Provide empathic counseling S: Affirm self-efficacy

19. Provide Feedback Persuasive Respectful Constructive Non-confrontational FRAMES

20. Promote Responsibility Individuals can choose to change Encourage responsibility for change Increases empowerment and personal investment FRAMES

21. Provide Advice Advice can be persuasive Advice can be suggestive Advice can be educational Advice should be individualized FRAMES

22. Provide Menu of Options Lack of choice promotes resistance Having choices increases engagement Choices increase retention rates Choices decrease treatment resistance Choices promote personal responsibility FRAMES

23. Provide Empathic Counseling Strong predictor of success Warm, respectful, attentive Reflective listening FRAMES

24. Affirm Self-Efficacy Reinforce clients beliefs in their own capabilities Identify what has worked previously Affirm small steps Provide positive reinforcement FRAMES

25. Avoid Arguments Arguments are counterproductive Defending breeds defensiveness Resistance is a signal to change strategies

26. Roll With Resistance Resistance can indicate different viewpoint Resistance suggests a different approach Rolling with resistance demonstrates respect and empathy

27. Promote Discrepancy Current behaviors vs. future goals Identify future goals Identify behaviors which block goals Increase awareness of consequences of behavior

28. A Reminder Therapeutic context Interviewer-client relationship FRAMES and other therapeutic tools

29. Resources http://motivationalinterview.org Treatment Improvement Protocol No. 35 Toll Free: 1-800-729-6686

30. Overview of the Government Performance And Results Act Client Outcome Measures Tool

31. What Is the Government Performance and Results Act (GPRA)? 1993 legislation (Public Law 103-62) Develop strategic plans Set performance targets Report outcomes Conduct evaluations

32. Purposes of GPRA Act Increase accountability Initiate program performance reform Improve effectiveness

33. Purposes of GPRA Act (continued) Improve service delivery Improve congressional decision-making Improve internal management

34. What is the CSAT GPRA Tool? The CSAT GPRA tool is a list of broad items and questions Questions were taken from widely used data collection instruments –Addiction Severity Index (ASI) –McKinney Homeless Program reporting system –AIDS Risk Assessment (ARA) –Short Form-36 Health Survey

35. What’s the Big Deal? 1. Providers collect GPRA data 2. Project enters data into the GPRA Web Based Data Entry and Reporting System 3. CSAT Project Officers review data for adherence to goals 4. Branch Chief and Division Director review data.

36. What’s the Big Deal? (continued) 5. CSAT Director submits data to SAMHSA for review 6. SAMHSA analyzes data against CSAT performance measures and submits to DHHS 7. DHHS reviews SAMHSA data and submits to OMB 8. OMB reviews data and submits to Congress

37. What’s the Big Deal? (continued) 10. Limited resources require selective funding by Congress Administration for Children and Families Administration on Aging Agency for Healthcare Research and Quality Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention Centers for Medicare and Medicaid Services Food and Drug Administration Health Resources and Services Administration Indian Health Service National Institutes of Health Program Support Center Substance Abuse and Mental Health Services Administration Good data help convince Congress to continue funding treatment 9. Congress reviews data from all agencies under DHHS.

38. What’s In The Data for Me? You can use GPRA data… To determine client needs For other grant proposals To supplement presentations To market your program To make adjustments to service delivery To assist in budgeting and staffing

39. Questions