Expand Motivational Interviewing for Pregnant People

Introductory Paragraph

Motivational Interviewing 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.

Key Information

Motivational interviewing is a collaboration approach that is an interview process between the provider and the patient. With this approach patients are encouraged to be empowered to create their own goals as opposed to a therapist or interviewer imposing sobriety or other goals.

When individuals in recovery feel as though they are in control of their own recovery, they are empowered in the ownership of the success and moving forward with these goals. This encourages patient autonomy. When a patient feels responsible for their actions and confident in their recovery, they are more likely to stay sober and 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. It is also an effective part of an inpatient treatment regiment, or before seeking other recovery treatment options. Though 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 other forms of treatment.

The Four Processes of Motivational Interviewing Motivational Interviewing was founded by Dr. William Miller and Dr. Stephen Rollnick, and is stated to be a therapeutic tool intended to be used in conjunction with other forms of therapy or addiction treatment. MI is meant to inspire change in clients who may otherwise feel reluctant to do so. To achieve this, Dr. Miller and Rollnick formulated 4 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.

An instructional brief overview of the four processes is included on the website of the founders of Motivational Interviewing and is also included in tools and resources. It may be found at this reference link.

The SAMHSA Guide for using Motivational Interviewing in Substance Use Treatment identifies MI as a model of change and has five process 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.

Relevant Research

Training in motivational interviewing in obstetrics: a quantitative analytical tool Published in April 2014.

Motivational Interviewing in prenatal clinics

Psychosocial interventions for Substance Use during Pregnancy

Impactful Federal, State, and Local Policies

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

Available Tools and Resources

Pregnant & Post-partum Women with SUDs A training for motivational interviewing

Training and Motivational Interviewing for professionals Training provided by the founders of motivational interviewing including online trainings and free resources

Pregnancy and Substance Use: A Harm Reduction Toolkit

Using Motivational Interviewing in Substance Use Disorder

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.