Addressing Ambivalence to Change Within the Healthcare System : Motivational Interviewing in Community Health Work
By: Abigail K. Ivancicts, BSW
Imagine hearing this: Stop Smoking. Attend your PCP appointment. Quit Heroin. Find a job. Take your medications. Call me back. These constant demands are not easy to hear. It’s safe to say that most CHWs understand how this type of language and conversation wouldn’t be effective with clients. So, what works? Motivational Interviewing. Motivational Interviewing (MI) is a short-term process to help our clients with ambivalent feelings to find their internal motivators to help them achieve change. MI allows CHWs to help clients make decisions on their own while allowing them to think about multiple sides of the decision. It allows clients stuck in ambivalence to make a decision. MI is done in a way that is non-judgmental and therapeutic. MI also uses readiness measures to determine a client’s likelihood to change. I have been using MI since I started as a CHW. It has allowed me to connect with clients in times when doctors and other traditional healthcare staff have been ineffective in evoking change within the client. One of the things that makes CHWs so important, is our ability to connect with and build rapport with clients. I look at MI as another tool to help CHWs help clients in a respectful and appropriate manner. MI takes away the feeling of beating your head against a wall because nothing else is working with a client. I feel that it is also a definitive way to allow our clients autonomy, something many clients do not feel they have, as a result of past trauma.
For example, instead of instructing a client to attend their PCP appointments, MI takes a different approach. A CHW would use MI to help the client identify goals in their life. If the client’s goal is to run a marathon, but they are diabetic and often have extreme blood sugars, the CHW would help the client to see the importance of attending PCP appointments as it relates to them achieving their goals. By attending PCP appointments, the client would be able to get the tools to be able to get her blood sugar under control. Then, the client would be able to work to run her marathon in a safe manner. With the CHWs help, the PCP and client will be able to work together towards the clients goals while also addressing health issues. The work of Community Health Workers combined with Motivational Interviewing is a powerful force in improving our healthcare system and patient care.
CHWs have and continue to foster supportive, therapeutic relationships with clients who often are not engaged in the traditional healthcare system. Motivational Interviewing is another tool available to CHWs to help client’s to create meaningful and lasting change within their lives. Motivational Interviewing is a modality that is widely available to be learned and shared with people. The SIU Office of Community Initiatives and Complex Care has created a program to share Motivational Interviewing with Community Health Workers so they can be universally trained in this skill. Please reach out if you have questions or want to discuss the use of MI more, I can be reached at firstname.lastname@example.org.