CEP Workshop Series 2013 Module 3: Engagement and Motivation Fraser Todd and Michelle Fowler 2013 Workshop Introduction Workshop Agenda Mihi, introductions, Housekeeping and Workshop overview Introduction to the Workshop and Exercise 1 Strategies to Enhance Engagement Exercise 2 Motivation Motivation Tools Session Structure and the Motivational Framework The Spirit of MI Change Talk Exercise 3 Implementation Intention and Mental Contrasting Exercise 4 Action Planning - Take Home Homework Three Dimensions of CEP Practice Spirit - Principles - Techniques: SpiriL 7 key Principles techniques.
Original Description:
Original Title
3. Engagement and Motivation for CEP Workshop (NXPowerLite)
CEP Workshop Series 2013 Module 3: Engagement and Motivation Fraser Todd and Michelle Fowler 2013 Workshop Introduction Workshop Agenda Mihi, introductions, Housekeeping and Workshop overview Introduction to the Workshop and Exercise 1 Strategies to Enhance Engagement Exercise 2 Motivation Motivation Tools Session Structure and the Motivational Framework The Spirit of MI Change Talk Exercise 3 Implementation Intention and Mental Contrasting Exercise 4 Action Planning - Take Home Homework Three Dimensions of CEP Practice Spirit - Principles - Techniques: SpiriL 7 key Principles techniques.
CEP Workshop Series 2013 Module 3: Engagement and Motivation Fraser Todd and Michelle Fowler 2013 Workshop Introduction Workshop Agenda Mihi, introductions, Housekeeping and Workshop overview Introduction to the Workshop and Exercise 1 Strategies to Enhance Engagement Exercise 2 Motivation Motivation Tools Session Structure and the Motivational Framework The Spirit of MI Change Talk Exercise 3 Implementation Intention and Mental Contrasting Exercise 4 Action Planning - Take Home Homework Three Dimensions of CEP Practice Spirit - Principles - Techniques: SpiriL 7 key Principles techniques.
Fraser Todd and Michelle Fowler 2013 Workshop Introduction Workshop Agenda Mihi, Introductions, Housekeeping & Workshop overview Introduction to the Workshop & Exercise 1 Strategies to enhance engagement Exercise 2 Motivation Models of Motivation Motivation Tools Session Structure and the Motivational Framework The Spirit of MI Change Talk Exercise 3 Implementation Intention and Mental Contrasting Exercise 4 Action Planning Take Home Homework Three Dimensions of CEP Practice Spirit Principles - Techniques: SpiriL 7 Key Principles Techniques 1. Cultural Considerations 2. Recovery & Well-being 3. Engagement 4. Motivation 5. Assessment 6. Management 7. Integrated Care Person-focused care Well-being orientated care Integrated care Walk the Talk Engagement Principle 3: Engagement The Importance of Engagement: 35 - 50% of all CEP patients drop out of treatment 50% of MH patients do not comply with treatment Factors Associated wit Poor Engagement o Lack of belief that treatment is effective o Low sense of psychological safety in treatment (stigma, MH environment) o Single mode treatment (psychotherapy OR pharmacotherapy o Young age o Lack of social pro-treatment support o Male gender o Drug dependence o High levels of daily stress Principle 3: Engagement What is Engagement? : !"#$#%&%"' WlLh cllnlclan WlLh servlce WlLh managemenL plan 1o be acuvely lnvolved resence 1 C C 1 1 Exercise 1: Presence See age 9 of Lhe Workbook Principle 3: Engagement A Structure for Thinking About Engagement : !"#$#%&%"' LxLernal hyslcal - LransporL, chlld care SupporL for LreaLmenL e.g. famlly, peers Coerclon e.g. courLs rogramme conslsLency Soclal norms re-LreaLmenL & LnLry lnLo 1reaLmenL SympLoms severlLy Mouvauon for change 8eadlness for LreaLmenL asL LreaLmenL experlence AnxleLy & hosullLy Lmouon dysregulauon 1 1 WlLhln 1reaLmenL & 8eLenuon 1herapeuuc relauonshlp Asseruve follow-up Cognluve funcuonlong CuLcome expecLancles SLrucLured sesslons Cognluve funcuonlng 1 Principle 3: Engagement Factors Influencing Engagement: Principle 3: Engagement Strategies to Enhance Engagement 1: Values, vision of well-being Cognitive mapping MI Engagement Interview Autonomy-supportive environment (3-5 choices) Treat hostility, emotional dysregn early Clearly structured sessions Adapt to coping style Remove barriers Consistency of approach Peer Support to engage Assertive follow-up Adapt for cultural needs Principle 3: Engagement Cognitive Mapping: Cognluve Mapplng lncreases engagemenL by 1.7x resenL lnformauon as a dlagram CllenL or cllnlclan may compleLe lL 1wo dlsuncL channels for Laklng ln lnformauon: 1. verbal 2. vlsual Lach has llmlLed capaclLy uslng boLh doubles lnpuL C C C C C Principle 3: Engagement Cognitive Mapping: Cognluve Mapplng lncreases engagemenL by 1.7x resenL lnformauon as a dlagram CllenL or cllnlclan may compleLe lL 1wo dlsuncL channels for Laklng ln lnformauon: 1. verbal 2. vlsual l = lnuences L = leads Lo n = nexL C = CharacLerlsuc = arL 1 = 1ype A = Analogy Co = CommenL Lx = Lxample Lach has llmlLed capaclLy uslng boLh doubles lnpuL C C C C C
Principle 3: Engagement Cognitive Mapping: Cognluve Mapplng lncreases engagemenL by 1.7x resenL lnformauon as a dlagram CllenL or cllnlclan may compleLe lL 1wo dlsuncL channels for Laklng ln lnformauon: 1. verbal 2. vlsual l = lnuences L = leads Lo n = nexL C = CharacLerlsuc = arL 1 = 1ype A = Analogy Co = CommenL Lx = Lxample Lach has llmlLed capaclLy uslng boLh doubles lnpuL C C C C C
Principle 3: Engagement Cognitive Mapping: Cognluve Mapplng lncreases engagemenL by 1.7x resenL lnformauon as a dlagram CllenL or cllnlclan may compleLe lL 1wo dlsuncL channels for Laklng ln lnformauon: 1. verbal 2. vlsual l = lnuences L = leads Lo n = nexL C = CharacLerlsuc = arL 1 = 1ype A = Analogy Co = CommenL Lx = Lxample Lach has llmlLed capaclLy uslng boLh doubles lnpuL C C C C C
use arrow Lo lndlcaLe sLrengLh v v Principle 3: Engagement Rachel Cognitive Map of Formulation: ulagnoses roblems Aeuologlcal lacLors SLrengLhs values Well-belng 8ape Sexual Abuse Muluple prlmary schools SLu LxLernallslng behavlours AvoldanL coplng Principle 3: Engagement Autonomy-Supportive Environment: AuLonomy-Supporuve LnvlronmenL Cpumally 3-3 cholces Shape dlrecuon by oerlng cholce CllenL encouraged Lo make declslons Principle 3: Engagement The Engagement Intervention: Exercise 2: Rachel Engagement See age 12 of Lhe Workbook Motivation Model of Motivated Behaviour: Principle 4: Motivation )%*+," - ./'0$1," /"'%*$21," 321," 40'2,&% 5,"+%60%"2%+ lnLenuon lormauon lnLenuon lnluauon lnLenuon ueacuvauon uellberauon lannlng Acuon Lvaluauon erson: needs mouves goals SlLuauon: opporLunlues lncenuves Principle 4: Motivation Key Principles of General Motivation: 1. AccesslblllLy rlnclple Mouvauonal consLrucLs are acuvaLed from memory Worklng memory has llmlLed capaclLy Muluple goals = 'spreads' Lhe avallable resources across Lhem, weakenlng each of Lhem 2. lnLerconnecLedness rlnclple 1here are several alLernauve paLhways Lo aualnlng each goal. When one paLhway ls problemauc, lL ls posslble Lo subsuLuLe oLher paLhways 3. Coal Shleldlng rlnclple 1he power of a goal ls relaLed Lo Lhe deslrablllLy of Lhe ouLcome Muluple goals = hlgh value goals wlll be proLecLed, low value goals lnhlblLed 4. rlnclple of Lmouonal 1ransfer 1he emouon auached Lo a goal can be Lransferred Lo Lhe means of aualnlng Lhe goal Principle 4: Motivation Implications of the Key Principles of General Motivation: LlmlL Lhe number of goals belng acuvely worked on C8 lncrease compeung goals for unwanLed behavlours. LsLabllsh a persons mouvauon for subsLance use. llnd alLernauve paLhways Lo provlde Lhls emouonal sLaLe. AlLer Lhe deslrablllLy and value of a goal by auachlng lL Lo hlgher value goals e.g. auach Lhe goal of noL uslng subsLances Lo hlgh value llfe goals 1he emouons auached Lo pursulng a goal may be re-Lralned e.g. auach avoldanL acuons and emouons Lo drug seeklng behavlour - go/no go, [oysuck Lechnlque Principle 4: Motivation Stages of Change (Prochaska & DiClemente): re- conLemplauon ConLemplauon reparauon Acuon MalnLenance Non-autonomous Autonomous Amotivation Extrinsic Motivation Internal Motivation External Regulation Introjected Regulation Indentified Regulation Integrated Regulation Intrinsic Regulation ! CompeLence, auLonomy & relaLedness - greaLer mouvauon for LreaLmenL - LreaLmenL belng more valued - less amblvalence abouL LreaLmenL - hlgher levels of self-emcacy & self-esLeem - beuer engagemenL ln LreaLmenL - beuer LreaLmenL ouLcomes - lncreased ablllLy Lo overcome barrlers Lo change Principle 4: Motivation Self-determination Theory (Ryan &Deci): Principle 4: Motivation Theory of Planned Behaviour Change (Azjen): 7%8$9/,0* lnLenuon Lo AcL AmLude Lowards behavlour Sub[ecuve norms (felL soclal pressure Lo acL) ercelved 8ehavloural ConLrol 8ehavloural bellefs CuLcome evaluauon normauve bellefs Mouvauon Lo comply ConLrol bellefs ercelved power Internal Motivation MI re-conLemplauon ConLemplauon reparauon Acuon MalnLenance 8elapse 5,&:%'%"2% 30',",&; <%=$'%>"%++ lnluauon of Acuon .%=?@%A2$2; 7%8$9/,0*$= 5,"'*,= B&:=%&%"'$1," /"'%"1," C%"'$= 5,"'*$+1"# D/"E ', =/?% F$=0%+ $"> )0*:,+% !"#$%"%&'()*& ,-)*& ./0&10&2 Mixed Model of Change: Principle 4: Motivation Principle 4: Motivation Crucial Transitions: lacLors LhaL lnhlblL Lhe lnluauon of acuon Low self-emcacy Low behavloural conLrol over Lhe acuvlLy unwllllngness Lo suer shorL Lerm cosLs for long Lerm galns Plgh lmpulslvlLy (dlsLracuon) Lack of value auached Lo Lhe goal (ouLcome expecLancy) Muluple goals SLress lncongruence beLween lmpllclL/expllclL mouves SLraLegles Lo enhance Lhe lnluauon of acuon Lnhance Lhe value of a goal by auachlng lL Lo llfe values and well-belng lncrease self-emcacy lncrease behavloural conLrol Lhrough creaung an auLonomy supporL envlronmenL ConLrol lmpulslvlLy wlLh mlndfulness LlmlL Lhe number of posluve goals belng acuvely worked on Make Lhe lnluauon of acuon 'auLomauc' Lhrough menLal conLrasung and lmplemenLauon lnLenuons (MCll) Coal lnLenuon (lnsumclenL Lo eecL change) lnluauon: *lmplemenLauon lnLenuon (speclc plans Lo lmplemenL goal lnLenuons) When, Where, Pow Acuon Lack of goal commlLmenL rocrasunauon Low 8ehavloural ConLrol ShorL Lerm cosLs > Long Lerm beneLs Plgh lmpulslvlLy Low self-emcacy - - Principle 4: Motivation Initiation of Action: Principle 4: Motivation The Spirit of MI MI3: )arLnershlp 3mrmauon 5ompasslon !vocauon Principle 4: Motivation MI Process: 1. Lngage 2. ldenufy roblems 3. LvaluaLe sLage of change 4. LvaluaLe readlness and condence (self-emcacy) 3. SLraLegles Lo lncrease readlness and condence (lncrease change Lalk) 6. Acuon when ln Lhe rlghL space Principle 4: Motivation Readiness Rulers: noL 8eady unsure 8eady Principle 4: Motivation Readiness Rulers: noL CondenL unsure CondenL Principle 4: Motivation Use of the Rulers: use of Lhe ruler wlLhln Ml: Ask Lhe person Lo raLe on Lhe ruler where Lhey are now ln Lerms of belng ready Lo change? Commend Lhe response Ask why Lhe person dld noL plck a lower number Ask whaL lL would Lake Lo raLe Lhe number hlgher 1he condence ruler ls usually used once Lhe person has shown some lnLeresL ln maklng a change. lL can also be used Lo raLe a person's self-emcacy ln general or ln relauon Lo a range of dlerenL problems. Principle 4: Motivation Readiness + Confidence: 8eadlness Condence 10 10 0 lrusLrauon Lack of knowledge Success Skepuclsm Principle 4: Motivation Readiness + Confidence: 8eadlness Condence (Self-emcacy) 10 10 0 reparauon ConLemplauon re- conLemplauon 35GB4H MalnLenance lnLegraLe key sLraLegles lnLo follow-up/Lherapy sesslons Structured Follow-up Session: 1 1ake opporLunlues Lo reecL and summarlse Change Lalk CommlLmenL Lalk Well-belng Lalk 3a 2 3b 4 Principle 4: Motivation lnLegraLe key sLraLegles lnLo follow-up/Lherapy sesslons Motivational Framework for Session Structuring: 1 1ake opporLunlues Lo reecL & summarlse Change Lalk Well-belng Lalk 3a 2 3b 4 8elnforce commlLmenL Lalk SeL Agenda SplrlL of mouvauonal lnLervlewlng Principle 4: Motivation Principle 4: Motivation Change Talk: Ieslre 3blllLy <easons Heed 5ommlLmenL . Lo change !=/2/1"# 58$"#% G$=EJ Ask for lL WhaL would you llke Lo see dlerenL? WhaL wlll happen lf Lhlngs don'L change? B>%"1?;/"# 58$"#% G$=EJ Exercise 3: Identifying Change Talk 3 Exercise 4: Reflective Listening 3 Self-Efficacy: Principle 4: Motivation 1he convlcuon LhaL one can successfully carry ouL Lhe behavlours needed Lo produce a cerLaln ouLcome Plgh self-emcacy ls assoclaLed wlLh: lncreased llkellhood of lnluaung behavlour change lncreased llkellhood of movlng lnLo acuon phase Laklng responslblllLy for ouLcome fasLer recovery from seLbacks hlgher raLes of goal achlevemenL Self-Efficacy: Principle 4: Motivation SLraLegles Lo lmprove self-emcacy: Lxperlences of masLery Cognluve resLrucLurlng vlcarlous experlence 8educe sLress, anxleLy, faugue and lack of sleep Speclc feedback - accuraLe buL encouraglng Soclal supporL Coplng skllls Lo deal wlLh anxleLy and sLress ShorL-Lerm achlevable goals Avold comparlson wlLh oLhers SupporL auLonomy Principle 4: Motivation Mental Contrasting and Implementation Intentions (MCII): 1. MenLal ConLrasung Choose a speclc LreaLmenL goal Lnvlslon Lhls goal when successfully compleLed someume ln Lhe fuLure Lnvlslon where Lhlngs are aL currenLly ln relauon Lo Lhe goal ldenufy barrlers ln achlevlng Lhe goal 2. lmplemenLauon lnLenuons 1hlnk of Lhe barrlers Lo Lhe goal 1hlnk of sLeps Lo achleve Lhe goal lan speclc deLalls abouL when Lhe sLeps wlll be underLaken, whaL, how, when lf. 1hen. 8e very speclc. Exercise 5: Mental Contrasting and Implementation Intentions 4%% #(2% 56 0& 7*819**1 Implicit Motivation: Principle 4: Motivation !-:=/2/' B&:=/2/' Consclous non-consclous - unaware verbal non-verbal Culdes consclous goal semng lnLuluve goal pursulL 'LhoughL' Llke auLomauc LhoughLs 8oLh sysLems operaLe lndependenLly Can lnuence each oLher lncongruence when Lhey conlcL = depresslon, lack of mouvauon ldenufy lmpllclL mouvauons and emouons by envlslonlng (non-verbal) and noung Lhe aecL Action Plans
[Typological Studies in Language 14] John Hinds (Ed.), Shoichi Iwasaki (Ed.), Senko K. Maynard (Ed.) - Perspectives on Topicalization_ the Case of Japanese WA (1987, John Benjamins Publishing Company)