Motivational Interviewing

What Is Motivational Interviewing Assessment?

Motivational Interviewing (MI) is integrated into the clinical assessment interview for all HealthStat Rx clients. The goal is to understand the motives clients have for addressing their adherence problems and to build and strengthen their motivation for change in these areas. Through their MI assessment, the specific aims are to improve client engagement and overall health outcomes.

HealthStat Rx Patient Care Managers conducting the assessment strive to create an accepting and nonjudgmental therapeutic alliance, elicit self-motivational statements or “change talk”, reduce resistance and develop similarities between the client’s goals, values, self-perceptions and their medication adherence. Once ready to change, the client begins to identify personal goals and methods to achieve them in collaboration with the treatment program’s clinicians.

Why Do It?

This intervention has the benefit of targeting two important aspects of the clinical assessment:

• Obtaining needed administrative and clinical information from the client that will help the pharmacist develop a treatment plan targeted to client needs and treatment readiness, and
• Conducting the interview in a way that will result in the client’s willingness for open and honest communication.

Implementing The Motivational Interviewing Assessment

Step 1 - Building a Bond with the Client
During the initial minutes of the interview the Patient Care Manager uses MI skills to build rapport and elicit a discussion of the client’s perception of his/her problems. Things such as greeting the client in a respectful and friendly manner, inquiring about how the client is feeling and what prompted the request for service helps establish good rapport. It is an excellent time to use open-ended questions to explore what the client wants from the pharmacy and affirming the client’s decision and potential for change. During this initial segment of the interview the counselor gets an idea of where the client is on the stages of change continuum, what kinds of resistance may emerge, and the client’s readiness for change.

Step 2 - Gathering Essential Information and/or Providing Feedback
Depending on the amount of assessment data gathered previously, Step 2 involves either conducting the pharmacy’s standard psychosocial assessment or the review of assessment data already available which can then be used to facilitate a feedback discussion of the effects of noncompliance on different areas of the client’s functioning. During this time, the counselor gathers more information about the client’s problems and treatment objectives. This information will be useful in developing discrepancies and eliciting self-motivational statements later in Step 3.

Step 3 - Summarizing and Reconnecting with the Client
At this point the counselor lets the client know that the next portion of the interview will shift back to a more open-ended format with the purpose being to better understand what the client wants to achieve during treatment. The counselor utilizes strategies for eliciting change or dealing with resistance in this phase. The material obtained during the standard assessment provides the counselor with ideas about questions that might be asked to establish discrepancies and enhance motivation for change. More resistant or pre-contemplative clients should be approached using techniques designed to manage and reduce resistance. More openly ambivalent or contemplative clients may benefit from a discussion of the pros of good adherence or discussing their level of readiness to change. More motivated (prepared, determined, ready to act) clients may benefit from the development of a formal or informal change plan. HealthStat Rx Patient Care Managers have received considerable training in all of these techniques.