Friday, 21 February 2014

Challenging Behaviour and Motivational Interviewing - could it be relevant to other instances?


A new article by Noud Frielink & Petri Embregts explores a technique called Motivational Interviewing in their work with people with mild intellectual disability and challenging behaviour.

Many of the techniques identified in the research would be recognisable to many people working in the field of Intellectual Disability. In fact, the authors do state the themes and subthemes identified are what a Speech Pathologist and other skilled practitioners would say are essential communication techniques for good communication.

Think about this: Motivational Interviewing involves: 
·         open ended questioning;
·         reflective listening;
·         affirming;
·         summarising
·         eliciting change-talk.

The research considered what needs to be modified to ensure this technique works for this population of people. There were 3 subthemes identified - the form of language, the structure of language and its content.  Importantly, the research also identifies characteristics of the interaction partner essential for motivational interviewing to be successful.

 The following techniques were identified:
- use concrete and clear language;
- use short sentences, and query words, (but avoid why questions);
- focus on 1 topic at a time;
 - give the person time to respond. Don't repeat the same question again and again to fill this thinking space.
Clients identified pictures or film segments, role play or a drawing aided their understanding.
In addition, it was critical for the communication partner to observe both verbal and non verbal cues to determine the persons understanding of questions or information in the interaction.

Communication partner characteristics.
Once again, a skilled practitioner would not be surprised by the following list, but it is great to see it stated in the research. Communication partner characteristics important in interactions include:
- mutual trust and relationship;
- equality of input from both communication partners;
- being an active listener;
- being authentic and honest, including showing empathy and compassion, when appropriate;
- the client is seen as an individual, and not just 'part of a group’;
- respect for the client as a person; and,
 - there are concrete and clear agreements and rules in place for the interaction.

Finally, an important point to consider is people with intellectual disability and other disabilities can respond based on social desirability - that is, what they think the communication partner wants to hear.  To be an active member of society, clients, need to be supported to be active participants in their own environments.

When else could this technique be used? Are plans developed for people with intellectual disability and other disabilities in the new National Disability Insurance Agency www.ndis.gov.au using these good communication and interaction skills? Are planners and others being active listeners? 

Talk to Cathy about how these essential communication skills can be incorporated into daily activities in the persons environments. 

Cathy

0466 579 855

Reference:
Frielink, N., & Embregts, P. (2013) Modification of motivational interviewing for use with people with mild intellectual disability and challenging behaviour. Journal of Intellectual & Developmental Disability, 2013 Vol. 38, No. 4, 279. Downloaded 20 February 2014. www.informahealthcare.com/doi/pdf/10.3109/13668250.2013.809707

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