Presentation @ Homes For Families \'New Approaches for Ending Family Homelessness\' 6/16/10 Conference in Worcester, MA. Topic: "Housing & Substance Use: Using a Client-Centered Philosophy of Care"

1. Housing and
Substance Use:
Using a
Client-Centered
Philosophy of Care
© All rights reserved by Victory Programs, Inc.

2. VPI’s Philosophy of Care
Victory Programs delivers care to clients in
accordance with our “Standards of Excellence”.
All services are individualized and client-driven,
focusing on client strengths, and supporting clients in
establishing individualized goals.
In order to provide the most effective services, we
utilize evidence-based techniques such as
Motivational Interviewing (MI) in a harm reduction
setting.

3. The Challenge
• Housing and Shelter Providers may or may not
have substance use & treatment
expertise/capacity on staff
• Alcohol and substance use can amplify a
family’s constellation of barriers to stability.
• How can housing and shelter providers
effectively respond to substance use in a non-
clinical setting?

4. A First Thought…
…For Providers
Feel like you’re ‘running against the wind’
sometimes with your clients?
______________________
“You can’t change the
direction of the wind,
but you can change
the direction of your sails.”

5. One Way to Work With the Wind
• Motivational Interviewing is a well-tested, evidence-
based practice that can be used to structure goal
oriented interactions.
• It works with the myriad of possibly contradictory
motivations, desires and goals that people have.
• It assumes that people may be deeply ambivalent about
changing their lives.
• That includes substance use but also being a parent,
finding work, moving to a new community, even finding
their own home.

6. Motivational Interviewing -
Defined
“Motivational Interviewing is a directive, client-
centered counseling style for eliciting behavior
change by helping clients to explore and resolve
ambivalence.
MI takes the health care professional past technique
and humanizes the counseling session. MI is more
than just a series of techniques; it changes how
the professional interacts with the client in a
positive way. MI is a client centered approach for
behavior change.”
Miller and Rollnick, 2002

7. Cookie Cutters are not for People

8. Assumptions of MI
• Hesitance to change is natural and should be
expected and explored, not punished.
• People have real reasons for behaving the way
that they do.
• Clients are the experts on themselves and their
lives.

9. Assumptions of MI
• Planning and motivating for change (whether
about substance use, employment, housing
search, parenting skills, etc) will ONLY be
effective if based in the client’s perspective and
own goals.
• Goal of client work is to foster readiness and
support plans for change.

10. Principles of Motivational
Interviewing
• Express Empathy - understanding of the client through
the skill of reflective listening
• Roll with Resistance – symptom of client/staff
misalignment of goals, not inherent traits
• Develop Discrepancy – explore gap between client goals
and behavior

11. Principles of Motivational
Interviewing
• Support Self-efficacy - increase client perception about their skills,
resources and abilities that they may access to achieve their desired
goal.
• Avoid Argumentation - Client opinions, thoughts and beliefs are
explored, reflected and clarified, not contradicted

12. Spirit of Motivational
Interviewing
• It is collaborative, not a power struggle.
• It is provocative, for both parties
• It is evocative, drawing out and exploring
• It is based in autonomy and choice

13. Research shows that…
“…the counselor need only offer these three
critical conditions to prepare the way for natural
change:
- accurate empathy,
- nonpossessive warmth,
- and genuineness.”
Miller and Rollnick,
2002

15. Tools of Motivational Interviewing
• Stages of Change – Pre-contemplation,
Contemplation, Decision-making, Action,
Maintenance
• Decisional Balance – discussing pros and cons
of making changes/taking action vs. status quo
• Making Plans for Change – based on pros and
cons, recognizing resistance and challenges

16. Basic Elements of MI Practice
• Listen more than you talk.
• Ask open-ended questions that evoke real responses.
• Use more reflections than questions.
• Focus on what an action or change means for the
resident, the pros and cons.

17. In Practice
• Rules are negotiated based on behavior, not on substance use per
se.
• Studies show, confrontational strategies do NOT work.
• Plans of action are developed collaboratively and based on the
goals of the client.
• Ambivalence and ‘resistance’ are understood to be a part of the
process.
• Dancing, not wrestling.