Motivational Interviewing in HIV Counseling and Testing A Basic Training Manual for Community-Based Organizations Motivational Interviewing in HIV Counseling and Testing A Basic Training Manual for Community-Based Organizations Sin How Lim, Herlianna Naning, Mohd Akbar, Rumana Saifi, Alison Jackson, Sajaratulnisah Othman, Joselyn Pang, Sutayut Osornprasop, Adeeba Kamarulzaman June 2018 Adapted from Motivational Interviewing Training New Trainers Manual, MINT. Attribution-ShareAlike 4.0 International (CC BY-SA 4.0) http://creativecommons.org/licenses/by-sa/4.0/ Acknowledgements This manual is a joint product of the World Bank and University of Malaya staff. The manual is part of the World Bank’s Advisory Services and Analytics for Malaysia under HIV Implementation Support in the East Asia and the Pacific region (P160428). The manual preparation was under the overall guidance and supervision of Dr. Sutayut Osornprasop (Senior Human Development Specialist) of the World Bank and Professor Dr. Adeeba Kamarulzaman and Dr. Rumana Saifi of the University of Malaya. The authors of the manual are Sin How Lim, Herlianna Naning, Mohd Akbar, Rumana Saifi, Alison Jackson, Sajaratulnisah Othman, Joselyn Pang, Sutayut Osornprasop, and Adeeba Kamarulzaman. The content is solely the responsibility of the research team and does not necessarily represent the official views of the World Bank. The study was funded by World Bank and University of Malaya Research Grant (RP009A). The task team appreciates the valuable inputs from the following technical peer reviewers from the World Bank: Robert Oelrichs, Tushar Malik, and Mei Ling Tan. The task team appreciates the guidance and support from Ulrich Zachau, Mara K. Warwick, Faris H. Hadad-Zervos, Firas Raad, Toomas Palu, Gabriel Demombynes, David Wilson, Marelize Gorgens, Richard Record, Pimon Iamsripong, Joshua Chee Yan Foong, Min Hui Lee, Kanitha Kongrukgreatiyos, Elenor Flora Gomez, Aziaton Binti Ahmad, and Minisha Deepu. The manual layout was designed by Kane Chong. We would like to thank the World Bank especially Dr. Sutayut Osornprasop and Ms. Joselyn Pang for their insights and wisdom in ensuring the study achieves its objectives, and at the same time balancing the risks and needs of MSM communities in Malaysia. We would also like to thank Kuala Lumpur AIDS Society Service (KLASS), especially for their peer case workers who have been journeying with us, for their willingness to learn about Motivational Interviewing and tireless recruitment of participants for this study. We had many challenges in completing this study but those who stayed and persevered are indeed the backbone of this study. We also owe the success of this study to Mr. Martin Choo, the General Manager of KLASS, who has been very supportive in the implementation of MI in their existing case management intervention for MSM population. We are very grateful to Professor Dr. Adeeba Kamarulzaman and Dr. Rumana Saifi, for their unwavering support and guidance for this study. But most of all, we would like to thank all our participants, for without them, we would not be able to complete this study successfully. We thank them for their time and willingness to participate in the online survey, motivational interviewing session and the focus group discussion. They are the core of this study and the main reason why we have conducted this study. 4 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Table of Contents Acknowledgements 4 Abbreviations 6 Introduction 7 Objectives 7 Why motivational interviewing? 7 The manual structure 8 Monitoring and evaluation 8 Additional information 8 Trainee Section 9 Activity 1: Icebreaker 10 Activity 2: Introduction to your practice 11 Activity 3: Non-verbal listening 12 Activity 4: Relating MI processes to personal experience 13 Activity 5: Taste of MI 14 Activity 6: Introduction to OARS 15 Activity 7: OARS practice: Reflecting 16 Activity 8: OARS practice: Affirmations 17 Facilitator Section 18 Activity 1: Icebreaker (15 mins) 19 Activity 2: Introduction to your practice (15 mins) 20 Activity 3: Non-verbal listening (15 mins) 21 Activity 4: Personalizing (30 mins) 22 Activity 5: Taste of MI 23 Activity 6: Introduction to OARS (20 mins) 24 Activity 7: OARS*practice: Reflecting (20 mins) 25 Activity 8: OARS* practice: Affirmations (Optional) 26 References 27 Appendix 28 Appendix I: Flow chart of motivational interviewing 28 Appendix II: Motivational interviewing indicators for VCT 30 Appendix IIIi: Further reading on motivational interviewing 31 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 5 Abbreviations CERiA Centre of Excellence for Research in AIDS CMS Case management specialist* HIV Human Immunodeficiency Virus MI Motivational Interviewing MINT Motivational Interviewing Training New Trainers Manual MSM Men who have sex with men PWUD People who use drugs SW Sex workers TG Transgender women VCT Voluntary counseling and testing for HIV OARS Open-ended questions, Affirming, Reflection, Summarizing *In the report, the term ‘case management specialist’ and ‘case worker’ are used interchangeably 6 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Introduction Introduction Objectives The main objective of this manual is to provide a simplified and practical guide to community partners who are interested to introduce the Brief Intervention using Motivational Interviewing (MI) approach in their existing programs for high risk populations. This manual has been used to train peer case workers for a World Bank-funded study which aims to increase HIV testing uptake and retention in men who have sex with men (MSM). The manual was culturally and linguistically adapted from “Motivational Interviewing Training New Trainers Manual, MINT”, published by Attribution-ShareAlike 4.0 International (CC BY-SA 4.0) http://creativecommons.org/licenses/by-sa/4.0/ in 2014. This manual is not intended to replace the comprehensive MINT manual of MI but was developed with the aim of providing community-friendly guidance for community-based organizations to introduce and incorporate the basic principles of MI in their programs. Why Motivational Interviewing? MI is a directive, client-centered counseling method developed from experience of alcohol and drug addiction treatment. Listed as one of the best interventions by the US Centers of Disease Control and Prevention, MI has been proven to elicit behavioral change by helping clients to explore and resolve ambivalence across many clinical and non-clinical settings. Previous studies have shown that MI increases uptake of HIV testing and improves health outcomes among high risk populations who struggle with adherence to antiretroviral treatment, depression and risky sexual behaviours.1-9 Particularly, in a randomized controlled trial, participants who received MI were twice as likely to undergo HIV counseling and testing compared to the those in the control group (49% versus 20%, x2=17.94, p<0.001). In March 2017, the Centre of Excellence for Research in AIDS (CERiA) of Faculty of Medicine, University Malaya, embarked on a study to introduce and evaluate an MI approach into the existing HIV case management program or MSM in Malaysia. In this study, a total of 112 participants received the brief intervention using MI principles. After the brief intervention, 87 (77.7%) agreed and underwent HIV testing. Participants took a short survey before and after the brief intervention with MI. All specific concerns prior to HIV testing were significantly reduced after the brief intervention. At the post-MI survey, a majority of the participants (90%) agreed that they were satisfied with the MI intervention while 27% felt that they were being lectured and 9% felt pressured in the conversation. Furthermore, case workers from KLASS reported high levels of satisfaction in delivering MI as it helps build trust and rapport with their clients. Formal training on MI by international organizations such as the Motivational Interviewing Network of Trainers (MINT) is costly and is designed for individuals with medical backgrounds such as doctors, nurses, psychiatrists, public health practitioners and epidemiologists. Together with members of the Department of Primary Care Research Group from the Faculty of Medicine, University of Malaya, the research team adapted the MINT training resources to create a simplified MI manual to train case workers using peer Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 7 Introduction facilitators. The manual has been further revised for the use of community partners and can be applied with other key populations such as Sex Workers (SW), Transgender women (TG) and people who use drugs (PWUD). This manual is designed for MI-trained case workers to train other case workers on the basic skills of MI. The activities included in the manual can be conducted in any private room with sufficient space for group activities. The Manual Structure The manual is structured with hand-outs and notes for both trainees (from page 9 to page 17) and facilitators (from page 18 to page 26). It consists of eight main activities with each activity designed based on MI principles and skills. The activities are designed to be interactive among trainees and facilitators, and use role play methodology to increase trainees’ ability to learn and practice an MI approach with confidence. This manual highly recommends that for this training, the ratio of trainees to facilitators is 2:1 and participants should include not more than eight trainees to allow more time for role play activity to maximize the learning process. The recommended duration of the training session is 2.5 to 3 hours. For the convenience of the community partners, this manual has been prepared in English and the local language (Bahasa Malaysia) as many peer case workers are more comfortable communicating in the local language. Monitoring and Evaluation At the end of this manual, we have also included a sample flow chart of how MI can be incorporated into the existing interventions (Appendix I). However, this is only for reference and partners’ organizations are encouraged to adapt and modify them to suit the current local setting. To ensure quality of MI delivery, we have suggested a list of qualitative indicators to be captured and this has been included in a simplified form for peer case workers for documentation and reporting. This will be very useful for monitoring and evaluation of the intervention. We would also recommend, if possible, that the MI session is conducted in a quiet and closed room where clients feel secure and comfortable to express their concerns. MI can be time-consuming for a person who has just learned it. In fact, the central idea of MI is to resolve ambivalence about HIV testing from the client’s perspective. A client may be at the “pre-contemplation” stage and may not be ready for HIV testing and the counselor should not persuade clients to undergo testing. Instead, MI will first help case workers establish relationship with clients by creating trust and empathy for clients’ needs. Additional information For further reading about MI, you may refer to books and online materials we have listed at the end of this manual. Several limitations of MI should be noted. First, MI is effective when the clients are in the “contemplation” stage of behavioral change. If the clients are in a “pre-contemplation” stage, it may take multiple counseling sessions before a client resolves ambivalence and affirms his/her motivation to go for HIV testing. Second, MI is an individual-level intervention and it does not address the barriers of HIV testing at the community and societal level, such as the stigma of HIV. Lastly, other individual factors such as drug addiction, lack of knowledge or empowerment may reduce the client’s motivation to get HIV tested. 8 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Trainee Section Trainee Section ACTIVITY 1 Icebreaker Group activity 1. Please could each person introduce themselves by giving their first name, and telling us something about themselves that nobody here knows. (Something you are willing to reveal!) 2. Why did we do this activity? 3. Did we learn anything surprising? Why were we surprised? Was it interesting? What is your take home message? 10 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Trainee Section ACTIVITY 2 Introduction to your practice Activity in pairs 1. A interviews B about their work as a Case Management Specialist (CMS) for three minutes. a. What are you good at or comfortable with when you work as a CMS? b. What tasks are you less comfortable with in your work as a CMS? c. What do you hope to do better after this training? 2. Then A summarizes what B has said in 30-60 seconds. 3. Then reverse roles. What did it feel like to be interviewed? Was there anything the interviewer did that made it easier to talk about this topic? Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 11 Trainee Section ACTIVITY 3 Non-verbal listening Activity in pairs 1. A talks for 3-4 minutes on one of the following: a. What it was like growing up in my home b. The good and not-so-good things about my years at secondary school c. How I came to be doing this work d. What I hope to do in the next ten years e. Describe one of your parents or someone close to you f. Ways in which I have changed over the years 2. B listens, says nothing, not even “Uh-uh”, but shows non-verbally that he/she is listening. It is useful to be aware of the importance and value of nonverbal (“passive”) listening skills. 12 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Trainee Section ACTIVITY 4 Relating MI processes to personal experience Activity in pairs 1. A is the ‘client’ and will talk to B. Client A, think of a behavior you would like to change or think you should change: something you are considering but have not changed yet, something you are uncertain or ambivalent about; e.g. from the list below (obviously something you are willing to talk about). • Always wear seat belt • Never speak or text on handphone while driving • Exercise for 30 mins 3 times per week • Stop nagging partner/housemates about tidiness at home • Not eating in front of the television • Eat less fatty food (e.g. nasi lemak) • Quit smoking • Spend less time on Facebook/Twitter • Drink less alcohol 2. B is the ‘counselor’: Your task is to persuade A to make this change: a. Explain why A should make this change b. Emphasize at least three benefits of the change c. Explain why it is important, perhaps tell A the dangers of not making the change d. Tell A how to make this change e. If A resists your arguments, go back over the steps above How did A feel? Persuasion (Negative Practice) is not what we are trying to learn. This exercise will help you to realize what persuasion feels like. Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 13 Trainee Section ACTIVITY 5 Taste of MI By way of contrast, maybe in fresh pairs. 1. A the ‘client’, thinks of a behavior to change as above. 2. B the ‘counselor’, does not try to persuade A to make this change, does not give advice, but asks four questions and listens carefully to the answers These are some of the examples of questions used in MI • Why do you want to change this? • If you did decide to make this change, how would you do it in order to succeed? • What three reasons would be most important for you? • How important is this change for you, on a scale of 0-10 where 0 is not at all important and 10 is extremely important? 3. Then B gives A a summary of A’s motivation for this change. 4. B asks A a final question, “What do you think you will do?” How did A feel? 14 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Trainee Section ACTIVITY 6 Introduction to OARS* Watch a YouTube video Link: https://www.youtube.com/watch?v=_KNIPGV7Xyg Based on the video presentation just now, which one do you think is more effective in changing the patient’s behavior? What skills did the counselor use? *Open-ended questions, Affirming, Reflection, Summarizing Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 15 Trainee Section ACTIVITY 7 OARS* practice: Reflecting Exercise in group of three 1. A says one sentence about themselves: “One thing I like about myself is that…” 2. BC asks a question about meaning: “Do you mean…?” 3. A can only answer “Yes” or “No” (may feel frustrated) 4. BC tries another question about meaning 5. When they seem to have exhausted the topic, rotate ABC THOMAS GORDON MODEL OF LISTENING Communication can go 1 3 wrong because: Words the speaker says What the speaker means a. The speaker does not say exactly what is meant b. The listener does not hear the words correctly 2 4 c. The listener gives a Words the listener hears What the listener thinks different interpretation to the speaker means what the words mean The purpose of reflection is to make sure No. 4 matches with No. 2 *Open-ended questions, Affirming, Reflection, Summarizing 16 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Trainee Section ACTIVITY 8 OARS* practice: Affirmations Group activity 1. Affirming strengths of clients This is a group activity. You need a flip chart. a. Think of a client you like. • State a characteristic of the client > flip chart. • What strength underlies this? • Compose an affirmation statement you could say to the client. b. Think of a client you find difficult. Repeat the process above. Debrief How can we see strengths in difficult clients? List strengths of clients. What do clients do to survive or thrive in difficult circumstances? 2. Personal compliments Think of a time someone paid you a compliment. What made it particularly meaningful for you? *Open-ended questions, Affirming, Reflection, Summarizing Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 17 Facilitator Section Facilitator Section ACTIVITY 1 15 mins Icebreaker Group activity 1. Please could each person introduce themselves by giving their first name, and telling us something about themselves that nobody here knows. (Something you are willing to reveal!) 2. Why did we do this activity? 3. Did we learn anything surprising? Why were we surprised? Was it interesting? The point is: we tend to make assumptions about people. Part of MI is not to make assumptions, but to be curious, wanting to find out about clients. This is a fun way to begin introductions and to teach one part of MI: • remaining CURIOUS • making NO ASSUMPTIONS Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 19 Facilitator Section ACTIVITY 2 15 mins Introduction to your practice Activity in pairs 1. A interviews B about their work as a CMS for three minutes. a. What are you good at or comfortable with when you work as a CMS? b. What tasks are you less comfortable with in your work as a CMS? c. What do you hope to do better after this training? 2. Then A summarizes what B has said in 30-60 seconds. 3. Then reverse roles. Debrief • What did it feel like to be interviewed? • Was there anything the interviewer did that made it easier to talk about this topic? Responses could be written on board or flip chart and linked to principles of MI. What have you learned of MI principles from the first session that can be applied here? This exercise is a way to learn more about each other and interactivity. It also focuses attention on what aspects of conversation facilitated exchange. 20 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Facilitator Section ACTIVITY 3 15 mins Non-verbal listening Activity in pairs 1. A talks for 3-4 minutes on one of the following: a. What it was like growing up in my home b. The good and not-so-good things about my years at secondary school c. How I came to be doing this work d. What I hope to do in the next ten years e. Describe one of your parents or someone close to you f. Ways in which I have changed over the years 2. B listens, says nothing, not even “Uh-uh”, but shows non-verbally that he/she is listening. Debrief What was this experience like for the speakers? For the listeners? Ask listeners to indicate the kinds of things they might have said had it been permitted. The experience is often a mixture of pleasure and frustration, who would like interaction. It is useful to be aware of the importance and value of nonverbal (“passive”) listening skills. BREAK Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 21 Facilitator Section ACTIVITY 4 30 mins Personalizing Activity in pairs 1. A is the ‘client’ and will talk to B. Client A, think of a behavior you would like to change or think you should change: something you are considering but have not changed yet, something you are uncertain or ambivalent about; e.g. from the list below (obviously something you are willing to talk about). • Always wear seat belt • Never speak or text on handphone while driving • Exercise for 30 mins 3 times per week • Stop nagging partner/housemates about tidiness at home • Not eating in front of the television • Eat less fatty food (e.g. nasi lemak) • Quit smoking • Spend less time on Facebook/Twitter • Drink less alcohol 2. B is the ‘counselor’: Your task is to persuade A to make this change: a. Explain why A should make this change b. Emphasize at least three benefits of the change c. Explain why it is important, perhaps tell A the dangers of not making the change d. Tell A how to make this change e. If A resists your arguments, go back over the steps above Debrief How did A feel? Persuasion (Negative Practice) is not what we are trying to learn. This exercise will help you to realize what persuasion feels like. 22 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Facilitator Section ACTIVITY 5 30 mins Taste of MI By way of contrast, maybe in fresh pairs. 1. A the ‘client’, thinks of a behavior to change as above. 2. B the ‘counselor’, does not try to persuade A to make this change, does not give advice, but asks four questions and listens carefully to the answers These are some of the examples of questions used in MI • Why do you want to change this? • If you did decide to make this change, how would you do it in order to succeed? • What three reasons would be most important for you? • How important is this change for you, on a scale of 0-10 where 0 is not at all important and 10 is extremely important? 3. Then B gives A a summary of A’s motivation for this change. 4. B asks A a final question, “What do you think you will do?” Debrief How did A feel? Persuasion & Confrontation Reactance theory (Brehm 1966) • for every force pushing in one direction, there will be a counter-force moving people away from this position • the counter force will be strongest when a negated position (or behavior) is perceived as important and as comprising a free behavior MI Definition A person-centered, goal-oriented counseling method for helping people to change by working through ambivalence. BREAK Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 23 Facilitator Section ACTIVITY 6 20 mins Introduction to OARS* Watch a YouTube video Link: https://www.youtube.com/watch?v=_KNIPGV7Xyg Purpose of this video presentation is to show participants a sample of how MI is conducted by using OARS skills. Also, to help participants to identify OARS skills in the video. *Open-ended questions, Affirming, Reflection, Summarizing 24 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Facilitator Section ACTIVITY 7 20 mins OARS* practice: Reflecting Exercise in group of three 1. A says one sentence about themselves: “One thing I like about myself is that…” 2. BC asks a question about meaning: “Do you mean…?” 3. A can only answer “Yes” or “No” (may feel frustrated) 4. BC tries another question about meaning 5. When they seem to have exhausted the topic, rotate ABC THOMAS GORDON MODEL OF LISTENING Communication can go 1 3 wrong because: Words the speaker says What the speaker means a. The speaker does not say exactly what is meant b. The listener does not hear the words correctly 2 4 c. The listener gives a Words the listener hears What the listener thinks different interpretation to the speaker means what the words mean The purpose of reflection is to make sure No. 4 matches with No. 2 Debrief What did the participants learn? Highlight how many different meanings a seemingly simple statement can have (the no of “yes”) as well as the fact that many early guesses are wrong, which also happens during good reflective listening. Common themes during debriefing Satisfaction: The speaker felt good, understood Frustration: It is frustrating to only be able to say “yes” or “no” because the speaker wants to say more Fascination: It’s amazing how easy it is to miss, and how things can be interpreted in many different ways *Open-ended questions, Affirming, Reflection, Summarizing Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 25 Facilitator Section ACTIVITY 8 (Optional) OARS* practice: Affirmations Group activity 1. Affirming strengths of clients This is a group activity. You need a flip chart. a. Think of a client you like. • State a characteristic of the client > flip chart. • What strength underlies this? • Compose an affirmation statement you could say to the client. b. Think of a client you find difficult. Repeat the process above. Debrief How can we see strengths in difficult clients? List strengths of clients. What do clients do to survive or thrive in difficult circumstances? 2. Personal compliments Think of a time someone paid you a compliment. What made it particularly meaningful for you? People have trouble offering affirmations, especially to their more ‘difficult’ clients. This exercise assist in shifting perspective and practice. *Open-ended questions, Affirming, Reflection, Summarizing 26 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations References References 1. Dillard PK, Zuniga JA, Holstad MM. An integrative review of the efficacy of motivational interviewing in HIV management. Patient Educ Couns 2017; 100(4): 636-46. 2. Chen J, Li X, Xiong Y, Fennie KP, Wang H, Williams AB. Reducing the risk of HIV transmission among men who have sex with men: A feasibility study of the motivational interviewing counseling method. Nurs Health Sci 2016; 18(3): 400-7. 3. Rongkavilit C, Wang B, Naar-King S, et al. Motivational interviewing targeting risky sex in HIV-positive young Thai men who have sex with men. Arch Sex Behav 2015; 44(2): 329-40. 4. Rongkavilit C, Naar-King S, Koken JA, et al. A feasibility study of motivational interviewing for health risk behaviors among Thai youth living with HIV. J Assoc Nurses AIDS Care 2014; 25(1): 92-7. 5. Parsons JT, Lelutiu-Weinberger C, Botsko M, Golub SA. A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. J Consult Clin Psychol 2014; 82(1): 9-18. 6. Rongkavilit C, Naar-King S, Wang B, et al. Motivational interviewing targeting risk behaviors for youth living with HIV in Thailand. AIDS Behav 2013; 17(6): 2063-74. 7. Naar-King S, Parsons JT, Johnson AM. Motivational interviewing targeting risk reduction for people with HIV: a systematic review. Curr HIV/AIDS Rep 2012; 9(4): 335-43. 8. Outlaw AY, Naar-King S, Parsons JT, Green-Jones M, Janisse H, Secord E. Using motivational interviewing in HIV field outreach with young African American men who have sex with men: a randomized clinical trial. Am J Public Health 2010; 100 Suppl 1: S146-51. 9. Naar-King S, Outlaw A, Green-Jones M, Wright K, Parsons JT. Motivational interviewing by peer outreach workers: a pilot randomized clinical trial to retain adolescents and young adults in HIV care. AIDS Care 2009; 21(7): 868-73. Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 27 Appendix Appendix Appendix I: Flow chart of motivational interviewing Before MI session (Phase 1) For MSM group Online Establish Agree to Arrange to MI session Outreach rapport meet face- meet face- (30 minutes) (MSM) with clients to-face? to-face No For SW, TG and PWUD Establish Outreach MI session rapport (30 minutes) with clients 28 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Appendix During MI Session (Phase 2) Motivational Interviewing Self-Reflection for Case Workers • Do I listen more than I talk? Or am I talking more than I listen? • Do I keep myself sensitive and open to this person’s issue, whatever they may be? Or am I talking about what I think the problem is? • Do I invite this person to talk about and explore his/her own ideas for change? Or am I jumping to conclusions and possible solutions? • Do I encourage this person to talk about his/her reasons for not changing? Or am I forcing him/her to talk only about change? • Do I ask permission to give my feedback? Or am I presuming that my ideas are what he/she really needs to hear? • Do I reassure this person that ambivalence to change is normal? Or am I telling him/her to take action and push ahead for a solution? • Do I help this person identify successes and challenges from his/her past and relate them to the present change effort? Or am I encouraging him/her to ignore or get stuck on old stories? • Do I seek to understand this person? Or am I spending a lot of time trying to convince him/her to understand me and my ideas? • Do I remind myself that this person is capable of making his/her own choices? Or am I assuming he/she is not capable of making good choices? After MI session (Phase 3) For all groups Arrange Ready Pre- Post- appointment HIV for HIV HIV test HIV test for HIV testing testing? counseling counseling testing No Arrange another MI session Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 29 Appendix Appendix II: Motivational interviewing indicators for VCT Case Worker Name: Client Code: Date: 1. Describe the client’s physical appearance or emotion. 2. What is the client’s stage of change? Precontemplation Contemplation Preparation Action 3. What is the main concern of the client (which may or may not be related to HIV testing)? 4. Can the client identify the benefit of HIV testing and the risk of not testing for HIV? Yes No If Yes, please provide details: Advantages of HIV testing Risks of not testing for HIV 5. In your opinion, what is the client’s motivation for HIV testing? 1 2 3 4 5 6 7 8 9 10 6. If client does not agree to test for HIV, provide date of follow-up call (after 3 days) 30 Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations Appendix Appendix III: Further reading on motivational interviewing 1. Miller, W. R., & Rollnick, S. (2014). Motivational Interviewing Training New Trainers Manual. http://www.motivationalinterviewing.org/sites/default/files/tnt_manual_2014_ d10_20150205.pdf 2. Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change, (3rd ed). New York, NY: Guilford Press. 3. Miller, W. R., & Rollnick, S. (2002). Motivational Interviewing: Preparing people for change, (2nd ed.). New York, NY: Guilford Press. 4. Sobell, L.C., & Sobell, M. B. (2008). Motivational Interviewing Strategies and Techniques: Rationales and Examples. https://ucedd.georgetown.edu/DDA/documents/mi_ rationale_techniques.pdf 5. Hill, S. Kavookjian, J. Motivational interviewing as a behavioral intervention to increase HAART adherence in patients who are HIV-positive: a systematic review of the literature. AIDS Care 2012;24(5):583-592. 6. Community Care of Wake & Johnston Counties. Motivational Interviewing Primer- CCWJC MI “Champions”. www.ccwjc.com 7. Cook, PF., Corwin, MA. & Bradley-Springer, L. (20013). Motivational Interviewing and HIV: Reducing Risk, Inspiring Change. Mountain Plains AIDS Education and Training Center. Motivational Interviewing in HIV counseling and testing: A basic training manual for Community-based Organizations 31