Expand Motivational Interviewing for Pregnant People

Introductory Paragraph

Motivational Interviewing (MI) is an evidence-based practice that is effective in helping people make decisions to stop negative behaviors and start positive ones. It has a high potential to help women who are pregnant and misusing opioids to make choices to get on a path to recovery. MI is a therapeutic tool intended to be used in conjunction with other forms of therapy or addiction treatment. It is meant to inspire change in clients who may otherwise feel reluctant to change.

Key Information

MI was founded by Dr. William Miller and Dr. Stephen Rollnick. It is a collaboration approach that is based on an interview process between the provider and the patient. With the MI approach patients are empowered to create their own goals, as opposed to imposing goals that are set by a therapist, such as sobriety. When individuals in recovery feel as though they are in control of their own recovery, they take ownership of their success and move forward with their own goals. This encourages patient autonomy. When a patient feels responsible for their actions and is confident in their recovery, they are more likely to stay sober and to not relapse after treatment. Motivational interviewing does not focus on the underlying causes of an addiction, such as past traumas or mental illnesses. It is intended to be used in addition to other forms of therapy, such as cognitive behavioral therapy. Although MI pulls from various therapeutic styles and theories, such as humanistic therapy, cognitive dissonance theory, therapeutic relationship building, and positive psychology, it is most effective when used in conjunction with one of these forms of treatment. MI is also an effective part of an inpatient treatment regimen, before seeking other recovery options.

Miller and Rollnick formulated four client-centered processes to help patients identify their goals and begin to work towards them. They are as follows:

• Engaging – Getting to know the client and establishing a trusting and respectful alliance.
• Focusing – Coming to a shared idea about the main focus of a client’s recovery.
• Evoking – Bringing out the client’s own arguments for change.
• Planning – The client is willing and able to envision change and how they will manifest it.

Relevant Research

This article titled, "Psychosocial Interventions for Substance Use During Pregnancy," provides a review of the literature. The author notes the limited amount of research that has been done on MI with this population and focuses on early investigations into the practicality and efficacy of contingency management, motivational support, and cognitive behavioral therapies adapted for pregnant women.

This article documents the results of MI training for obstetric healthcare professionals working with obese pregnant women. Participants made more interventions towards the principles of motivational interviewing and asked fewer closed and more open questions than they had before the training.

Impactful Federal, State, and Local Policies

SAMHSA identifies MI as as a model of change and indicates that it aligns to the five "stages for change:"

• Precontemplation — Individuals currently using substances are not thinking of making a change now or in the future.
• Contemplation — Individuals currently using substances are aware that they need to make a change.
• Preparation — Individuals currently using substances begin weighing the pros and cons of making a change and preparing for how to deal with urges and triggers.
• Action — Individuals currently using substances decide to change their behavior and successfully attempt to do so.
• Maintenance — Individuals who changed their substance use behaviors are engaged in efforts to continue doing so over the long term.

Available Tools and Resources

• SAMHSA has published a guide titled "Using Motivational Interviewing in Substance Use Treatment."

• The Founders of MI provide a website that offers an instructional overview of the four MI processes, online trainings, and free resources.

• University of Arizona has a website dedicated to information on pregnant and post-partum women with SUDs. It includes a one-hour video training titled "Essentials of Motivational Interviewing."

• 'The National Harm Reduction Coalition has published "Pregnancy and Substance Use: A Harm Reduction Toolkit" that includes information on MI.

Motivational Interviewing in an Integrated Care Setting: A Three-Part Series

Safe Project Addiction and Mental Health Resources for Women

Promising Practices

Electronic Motivational Interviewing The patient can either use a tablet or be given a link on their smartphone to access the app. The link has a 3-D animated guide who walks them through an intervention specific to the patient’s responses, using the technique of motivational interviewing. The guide can ask questions like “what you like about the opioid use, and why do you use it, and what it does for you?” The guide then reflects their answers. At the end of the session, if the patient indicates a need for change, the guide in the app can 1) help them develop a plan to change, 2) send tailed text messages after they leave the doctor’s office, and 3) suggest treatment options in there area. This type of intervention has already shown success in some communities and is currently being tested to address opioids. This intervention could be very successful for the following reasons 1) Using an electronic based system to ask these difficult questions could remove stigma from the situation 2) Most women will have access to a mobile device 3) It automates follow-up 4) Does not require additional motivational interviewing training for doctors as they do not have much time for in-depth screenings. Contact for app: Steven Ondersma, Wayne State University

Expanding Training for Doing Motivational Interviewing

Motivational Interviewing Network of Trainers

The Motivational Interviewing Network of Trainers (MINT) is an international organization of trainers in motivational interviewing, incorporated as a 501(c)(3) tax-exempt non-profit charitable organization in the state of Virginia, USA. The trainers come from diverse backgrounds and apply MI in a variety of settings. Their central interest is to improve the quality and effectiveness of counseling and consultations with clients about behavior change. Started in 1997 by a small group of trainers trained by William R. Miller and Stephen Rollnick, the organization has since grown to represent 35 countries and more than 20 different languages.

Clinical Health Coach online training

The Clinical Health Coach® training is provided by the Iowa Chronic Care Consortium (ICCC), a not for profit, population health consulting, training and planning organization. Their mission is to build capacity with other organizations to deliver effective, personalized health improvement and chronic care strategies. Clinical Health Coach Training Online is a flexible, 26-hour self-paced, six to twelve week experience engaging participants in an online learning platform for topics that include Motivational Interviewing.