Melissa Alexander
U.S. Probation
Eastern District of Missouri
Scott W. VanBenschoten
Office of Probation and Pretrial Services
Administrative Office of the U.S. Courts
Scott T. Walters
University of Texas School of Public Health
Evidence-Based Practice
The recent push toward evidence-based practice (EBP) has brought new attention to correctional practice. EBP stresses that the programs and services we offer to offenders should be those that are related to subsequent reductions in recidivism (e.g. rearrest, reconviction, reincarceration). Research suggests that effective correctional programs share similar characteristics in terms of targeting offender risk, needs, and responsivity. For instance, a number of studies show that programs that match higher-risk offenders to more intensive services (e.g., risk) and address dynamic criminogenic factors (e.g., needs) can significantly reduce recidivism (Andrews & Bonta, 2003; Andrews, Zinger, Hoge, Bonta, Gendreau, & Cullen, 1990). However, there has been much less research on the EBP principle of responsivity, which suggests that providers interact with offenders in ways that will effectively engage the offender. In placing Motivational Interviewing (MI) within an EBP framework, MI is best understood in terms of its consistency with the responsivity principle, because it suggests a way of talking with offenders to increase motivation for change.
Role of the Probation Officer
For those placed on supervision, probation officers are the main brokers of the probation process. Probation officers meet regularly with offenders, conduct intake and other assessments, report to the court on progress, and have a degree of latitude on the intensity of monitoring and programs to which offenders are referred. Thus, from a systemic standpoint, probation officers are uniquely situated to function as change agents who prepare an offender motivationally to comply with conditions of probation, engage in special programs, and make other positive changes. There has long been evidence that brief interactions can significantly influence client outcome (Miller, 2000; Moyer, Finney, Swearingen, & Vergun, 2002), and recent evidence suggests that the relationship between an officer and the offender can be “a pivotal source of influence on the implementation of treatment mandates” (Skeem, Encandela, and Eno Louden, 2003, p. 444). The most effective relationship seems to involve a positive working alliance, balanced with aspects of procedural justice (i.e., firm but fair and respectful). In fact, one recent study that looked at the relationship between the officer and the offender found that probation outcome (probation violations, probation revocation, and new arrests) could be predicted by the quality of the dual-role relationship (Skeem, Eno Louden, Polaschek, and Camp, 2007). This is consistent with many studies in other fields that suggest that the style of the provider has a large impact on eventual client outcome (e.g., Miller, 2000).
Motivational Interviewing in Criminal Justice
Motivational Interviewing (MI) is a communication style that involves strategic use of questions and statements to help clients find their own reasons for change (Miller & Rollnick, 2002). MI borrows from Client-Centered Counseling in its emphasis on empathy, optimism, and respect for client choice ( Rogers, 1961). MI also draws from Self-Perception Theory, which says that people become more or less interested in change based on how they talk about it (Bem, 1972). Thus, an offender who talks about the benefits of change is more likely to make that change, whereas an offender who argues and defends the status quo is more likely to continue in the present behavior. Finally, MI is also logically connected to the Stages of Change model, which says that people go through a sequence of stages when considering change (Prochaska, DiClemente, & Norcross, 1992). Although MI seems to work well throughout the change process, research suggests that it may be particularly useful for clients who are more oppositional or defiant, higher-risk, or otherwise less ready for change.
Because MI is a communication style, it is usually introduced as a set of stylistic principles: 1) Express Empathy, which involves a sincere attempt to understand the offender’s point of view; 2) Roll with Resistance, which emphasizes avoiding arguments whenever possible and finding other ways to respond when challenged; 3) Develop Discrepancy, which means working to elicit the offender’s own reasons for change; and 4) Support Self-Efficacy, which emphasizes positive language and an environment that is supportive of change.
From its beginnings in addiction counseling, MI has been translated into a number of behavior-change areas. MI currently has strong research support in areas such as alcohol and drug use, smoking cessation, medication compliance, HIV risk behaviors, and diet/exercise. Two recent meta-analyses of more than 70 MI outcome studies in different areas suggest an overall significant and clinically-relevant effect (Hettema, Steele, & Miller, 2005; Rubak, Sandboek, Lauritzen, & Christensen, 2005). Across a range of behavior al areas, MI was significantly better than other approaches in three out of four studies, and outperformed traditional advice-giving 80 percent of the time. Even when looking at very brief encounters of 15 minutes or less, 64 percent of studies showed a lasting effect using this method. Overall, one review concluded that MI “outperforms traditional advice giving in the treatment of a broad range of behavioral problems” (Rubak, et al., 2005, p. 305).
Although MI has good support in many areas of behavior change, there has been comparatively little research on the use of MI in criminal justice settings, and even fewer studies that are specific to probation settings. A recent review focusing specifically on MI in criminal justice (McMurran, in press) identified 19 studies where MI was used to target substance-misusing offenders (N=10), domestic-violence offenders (N=3), DWI offenders (N=5) and general offending (N=1). The review concluded that MI improved overall retention in treatment, enhanced motivation to change, and reduced offending, although there were variations across studies. As an example, Ginsburg et al. (2000) randomized prison inmates to MI or control conditions. Compared to control participants, those who received a motivational interview showed increased recognition of their drinking behavior as a problem. In another study, first-time DWI offenders with a 28-day incarceration sentence were randomized to receive or not receive a treatment program that incorporated MI principles (Woodall et al., 2007). At 6, 12, and 24 months after discharge, those who received the program reported greater reductions in alcohol consumption and less drinking and driving, compared to participants who were only incarcerated. In addition, among participants who met criteria for antisocial personality disorder (ASPD), the program resulted in larger gains than those experienced by ASPD participants who did not receive treatment. Finally, in a probation setting, Harper and Hardy (2000) reported greater positive effects on probationers’ problem recognition as a result of being assigned to an MI-trained officer, compared to probationers assigned to a non-MI trained officer. However, it is unclear whether the study used random assignment, and the control group also showed some progress over the course of the study.
In addition to this direct evidence, there are at least three practical reasons to believe that MI might be applicable to a criminal justice setting, and a community corrections setting in particular. First, MI has a strong track record in areas that may be relevant to community corrections, such as preparing clients to engage in alcohol and drug treatment programs (Baker et al., 2002; Daley, Salloum, Zuckoff, Kirisci, & Thase, 1998; Miller, Meyers, & Tonigan, 1999). Further, MI has been shown to be effective in other settings where provider-client interactions may be brief and multi-focused, such as in medical consultations (Heather, Rollnick, Bell, & Richmond, 1996). Finally, large addictions treatment studies such as Project MATCH (Project MATCH Research Group, 1998) have reported similar effects of MI across offending and non-offending clients. Based on this rationale, a recent handbook published by the National Institute on Corrections (Walters, Clark, Gingerich, & Meltzer, 2007) outlines strategies for adapting MI to probation and parole settings. In particular, the handbook discusses ways to integrate the MI style with some of the technical features of community corrections, such as the dual officer role, multiple behavior focus, and time constraints. This effort is consistent with past efforts to adapt MI to healthcare and other brief settings, while still retaining the overall style of the approach (Resnicow, DiIorio et al., 2002; Rollnick & Heather, 1992).
Many criminal justice agencies, convinced of the utility of MI, have begun training officers in MI, most typically through one- to two-day workshop trainings. However, most agencies have not fully appreciated the complexity involved in learning MI. In fact, there is good evidence that the typical one- to two-day training workshop may not be the ideal format for learning MI (Walters, Matson, Baer, & Ziedonis, 2005). Rather, it appears that competency in the MI style is achieved through long-term training that involves skill practice and feedback. This article describes the theoretical underpinnings of learning MI and, based on this model, provides a rationale and plan for implementation of MI training within a criminal justice setting.
The Eight Stages of Learning Motivational Interviewing
In 2006, Bill Miller and Teresa Moyers outlined eight critical stages in learning MI (Miller and Moyers, 2006). These stages are considered sequential and outline the spirit, skills, and strategies necessary to become proficient in MI. Our plan for MI training draws from the training literature (Walters et al., 2005), as well as this stage model.
Stage 1: The Spirit of Motivational Interviewing. At its heart, MI is collaborative, evocative, and respectful of autonomy (Miller and Moyers, 2006, p. 5). The officer respects the individual’s autonomy (even though he/she may not agree with the choices the offender makes) and approaches the relationship as a collaborative one. This spirit is difficult for some officers, who have been trained to see themselves as the “expert” whose main role is to provide advice or direction. MI focuses on a “strengths” approach, which means that rather than instilling in offenders something they lack, MI assumes that offenders already have the capacity for positive behavior change. Thus an early training focus is on the philosophical underpinnings of the approach; officers work primarily to evoke the individual’s own reasons, ideas and solutions about behavior change.
Stage 2: OARS - Client-centered Counseling Skills. Because MI focuses on drawing out information from the offender, empathic listening is foundational. In this model, empathy is not “feeling sorry” for offenders nor agreeing with their point of view. Rather, accurate empathy involves a sincere attempt to listen to and understand the offender’s point of view. In addition to asking thoughtful questions, the officer demonstrates empathic listening through the use of reflective statements and summaries. For example, consider an unemployed offender who says “I’ve looked everywhere and can’t find a job. Nobody’s going to hire a convicted felon.” An empathic response might be one that summarizes the statement using similar language (e.g., “You feel that your conviction makes it more difficult to find a job.”) or different language (e.g., “You’re really frustrated. You feel stuck.”). These kinds of statements tell the person that you have been listening and allow him/her to hear back what has been said. Reflections can serve many purposes, including focusing on offenders = desire for change, or pointing out discrepancies in what they have said. OARS is the acronym used in MI to refer to skills that are used to demonstrate good listening. It stands for Open-ended questions, Affirmations (positive comments about what clients say/do), Reflections, and Summarizations (providing a cohesive picture of what has been discussed).Training at this stage involves practice in basic listening skills—emphasizing open questions, affirmations, reflections, and summaries. In the model implementation plan, we use a simple measure of listening, the Officer Responses Questionnaire (ORQ; Walters, Alexander, & Vader, in press), to evaluate gains in this area of listening skills.
Stages 3 and 4: Recognizing, Reinforcing, and Strengthening Change Talk. MI is by definition goal-directed; the goal is to help someone resolve ambivalence about behavior change. But unlike traditional approaches that rely mainly on providing advice or suggestions, the aim is to have the client articulate his/her own reason for change. “Change talk” is client language that expresses a desire to change (e.g., “I really want to stop drinking.”), ability to change (e.g., “I guess my wife would help me.”), reasons for change (e.g., “If I got a job I could pay my child support.”), need to change (e.g., “I need to do something about my drug use. It’s killing my body.”), or commitment to change (e.g., “I’ll go to an AA meeting tonight.”). The skill on the part of the officer is to be able to recognize change talk when it occurs, and reinforce it through questions (e.g., “How would you do that?”) and reflections (e.g., “So, it’s important to you and you’re willing to put in the time to make it happen.”). The goal is to keep a person talking in the direction of change, while minimizing statements in the opposite (non-change) direction. For instance, if an officer asks an open-ended question (e.g, “What are some good things that might happen if you stop drinking?”) that results in more change talk (e.g., “I guess it would get my wife off my back.”), then the officer has successfully elicited change talk. The logic behind this approach is simple: The more people talk about something, the more likely they are to carry through with it. In one striking example, abstinence from illegal drugs at 12 months could be predicted by the strength of a client’s commitment language during a single MI session (Armhein et al., 2003). This skill involves not only responding to and reinforcing change talk, but also may mean not responding to comments about not changing. Otherwise, officers fall into the trap of arguing for change ( “If you stop drinking your wife won’t nag you”) while the client argues against change ( “She nags about everything, it’s not a big dea”). To practice this skill, initial training involves identifying and responding to simulated client statements. Follow-up training includes viewing audio or videotapes of actual practice to determine which questions and reflections are working to draw out more positive client language.
Stage 5. Rolling with Resistance. Resistance refers to talk that is focused against change—the opposite of change talk. The MI strategy of “rolling” with resistance is contrary to some cognitive therapy techniques that focus on directly refuting such verbalizations. MI is neutral on the question of whether there are indeed “thinking errors” that are common to people who break the law. What it does suggest is that calling attention to these errors in a pushy, confrontational style is likely to evoke the opposite of what the officer is hoping for; the harder the officer confronts, the harder the offender resists. MI stresses that denial, argumentation, and resistance, which in the past were assumed to be a hallmark of an unmotivated client, are instead largely a function of the provider’s communication style. To minimize resistance toward change, officers first try to avoid arguments wherever possible. Officers can also use other strategies such as offering reflections (e.g., “It makes you angry, because you don’t like to be told what to do.”), emphasizing the offender’s choice and control (e.g, “Ultimately, it’s your choice. What do you want to do here?”), or reframing the resistance (e.g., “It does bother you that people are in your business, but I appreciate the fact that you’re taking it seriously.”). This skill is probably one of the most difficult ones for officers, because we get stuck in trying to refute client resistance. In training, this skill is emphasized through practice responding to hypothetical client statements. It can be strengthened through examining audio or videotapes to see how and why arguments occur.
Stages 6 and 7. Developing and Consolidating Commitment to Change. As clients talk more about change, the officer can move from reinforcing change talk to developing a plan for change. It can be difficult to know when to push a client toward planning, because moving too early may cause resistance—the client begins to tell you all the reasons they can’t change. But when done at the appropriate time, the focus can move from motivation to a concrete plan for change. It again involves careful listening to what clients are saying. One way to “tip the balance” toward change is to ask an action question about change (e.g., “What do you want to do about that? What’s your plan?”). Other ways involve asking about change in the hypothetical (e.g., “How would you do that if you wanted to?”) or offering a menu of options (e.g., “There are a few things you might be interested in…Which of these would you like to try?”). Because people are more likely to act on things they themselves have chosen, advice provision takes a back seat as we try to elicit the offender’s own ideas about change and emphasize his/her personal responsibility in the change process. In training, we focus on recognizing and consolidating “commitment talk,” usually in the form of “I will” statements.
Stage 8. Switching Between MI and Other Approaches. MI is geared toward motivating behavior change, such as decreasing alcohol or drug use, finding employment, paying fees, or other probation conditions. MI may also be useful for increasing the likelihood that an individual will participate in subsequent interventions. For instance, several studies have shown that use of MI prior to substance abuse treatment increases the retention rate while in treatment (i.e., fewer individuals drop out of treatment). In addition to behavior change, there may be other tasks that the officer needs to accomplish such as assessing progress, conveying information, assessing risk, or dispensing sanctions. Even when focusing more narrowly on behavior change, MI is frequently integrated into other approaches such as cognitive behavioral techniques, skills training, or education. Different tasks might call for different techniques, but the overall style need not change (see Walters et al., 2007). Finally, MI also needs to be integrated into overall session management. No matter what the approach, officers have to make decisions about what topics are important at this moment, and what can be left for later. In our opinion, decisions about when to use or not use MI are best addressed through case planning, ongoing supervision and case reviews.
Motivational Interviewing Training: A Model Plan
As might be gleaned from the description above, learning MI can be more difficult than it appears. With the increase in training over the past five years, many officers have now been exposed to at least some of the tenets of MI; however, few have likely used the skills in a comprehensive way. This may be partially due to the training models that are frequently used by agencies. Though some criminal justice agencies have attempted to train officers through discrete one- or two-day workshops, research suggests that such workshops do not often result in long-term skill changes (Walters, Matson, Baer, and Ziedonis, 2005). Although participants often report an increase in knowledge or self-reported skill following brief workshops, measures of actual interactions show much more modest gains (e.g. Miller and Mount, 2001). If the goal is to have officers who are using MI in a comprehensive, effective way, a more useful training format appears to be a workshop followed by feedback and/or coaching (Miller, Yahne, Moyers, Martinez, and Pirritano, 2004).
To ensure comprehensive training for those districts interested in receiving it, the Administrative Office of the U.S. Courts (AO), with guidance from several expert MI trainers, developed a model implementation plan (see Table 1; the entire plan is available from the first author). The plan begins with a brief overview of evidence-based practice so officers can relate MI to the overall model of EBP and understand its role in effective supervision. Next, officers attend a two- or three-day workshop on basic MI skills. The plan emphasizes that the workshop trainer must be both qualified to train MI and familiar with the criminal justice system. The Motivational Interviewing Network of Trainers (MINT; www.motivationalinterviewing.org) provides a list of trainers who have demonstrated competence in MI and completed a three-day training for trainers event.
As part of the initial implementation of this training plan, we asked officers to complete the Officer Responses Questionnaire (Walters et al., in press) before and after the initial two-day training, in order to evaluate gains as a result of attending the introductory workshop. On a sample of 80 officers in five districts, we found that officers increased their overall ORQ score by 68 percent, suggesting that officers did improve their basic listening skills as a result of attending the initial training.
Following the initial training, officers submit audio or videotapes of their use of MI with clients and receive monthly feedback on their skill development. Feedback is given using one of several different rating sheets that have been developed by various MI trainers; the plan includes several example forms for districts to use. Finally, the plan utilizes a formal coding system, the Motivational Interviewing Treatment Integrity (MITI; Moyers, Martin, Manuel, & Miller, 2003) to document when officers reach proficiency in MI. This formal coding process allows districts to adequately document officers’ skill level and ensure that they are effectively “doing” MI. Once a district demonstrates officer proficiency in MI, it can then move to evaluating the impact of MI on offender behavior.
| Table 1. Summary of Model Implementation Plan |
Pre-Training:
MI Trainer Qualifications:
Structure:
Measurement:
|
The Model Implementation Plan and accompanying resources (i.e. feedback sheets, coding systems) were distributed to those districts receiving Research to Results grant funding from the AO, and grantees were required to follow the plan. However, the plan is considered a work in progress, and thus it is continuously revised based on feedback from the districts utilizing the plan. For instance, the original plan called for first-line supervisors to provide coaching/feedback to officers. However, we discovered that many supervisors did not have the experience to provide competent MI supervision. Thus, the plan was revised to indicate that feedback sessions should be provided by someone already qualified to supervise MI. Additionally, districts were encouraged to develop internal capacity for MI coaching/mentoring. The AO has supported this effort by providing additional trainings to grant districts focused on developing MI coaches.
Future Directions
MI is intended as an additional tool for officers to use as they provide supervision and services to offenders. MI is not a replacement for everything officers currently use, nor is it appropriate for all situations. In many ways MI is still in its infancy as it relates to criminal justice, though many research projects underway are focused on better understanding the role and effectiveness of MI in criminal justice settings (see Walters et al., 2007). The training plan outlined here was developed to ensure quality training of federal probation officers, in order to increase the likelihood that officers become proficient in their use of MI. The authors hope that the plan will continue to be informed by the experience of districts utilizing the plan, with modifications occurring as needed. There are also plans to develop outcome measures to determine what impact MI has on the supervision process. Ultimately, the goal of all EBP is to increase the safety of the community by providing the most effective supervision and programs available.