Case Study

Interview by Chris Collision, Media Specialist.

Chris: What impact do you imagine your trainings have?

Sarah: I have seen the trainings have an effect on how individual service providers engage and treat their clients, but also in the way that agencies, as a whole, engage with the communities they serve.

Chris: Can you give an example?

Sarah: I recently provided a Motivational Interviewing training to an agency focused on the prevention and treatment of H.I.V. One of the participants was concerned with the way that the agency attracted clients and the effect that this had on retention. Potential clients were given gift certificates if they completed an assessment, and at least some assessment domains that focused on risky behaviors. The training participant shared that the assessments seemed to traumatize the potential clients, participants became guarded and/or did not come back to receive services. The training participant explained to me that the gift certificates were needed to bring potential clients in the door.

Chris: What was your advice?

Sarah: The participant, and his colleagues, held the treatment solutions, but I facilitated a conversation using the skills and tools that Seeds of Change provides at all trainings. We began by identifying where they thought this set of clients was at in relation to the high-risk behaviors. The group felt that most of these clients did not verbalize their behavior as problematic, or were only beginning to do so.

We then looked at “the why”. The group felt that these clients had a desire to stop the high-risk behavior, but a low perceived ability to do so. We named this as denial, with an understanding that denial is an adaptive means of coping with a high level of anxiety. We then discussed that this anxiety was probably rooted in the low perceived ability to change. It’s scary when you want to change and you don’t think you are able to do so. The group came to the conclusion that the assessments they were using were created for clients already prepared to make a change.

Chris: Where did this take you?

Sarah: Two places. The group was able to take a more empathic stance, understanding their clients’ experience as something more than “resistance”. Secondly, the group discussed how to introduce the assessments in a way that prepared the client for the discomfort of analyzing the high-risk behaviors: share that the discomfort would be time-limited; and explain that the Interviewer understood the client as a beautiful and complex being, with risky behaviors as a small part of their bigger selves.

Chris: Did the group identify any possible challenges to this plan?

Sarah: They did, but not in relation to how the client would react. Their concern was more rooted in how they felt that funders and records/file auditors would perceive the plan as slow change. I provided guidance around ways of documenting their use of Motivational Interviewing and strength-based assessment tools in a way that demonstrated thoughtful, evidenced-based treatment. We discussed this is what funders and auditors are looking for. If the agency provides thoughtful, evidenced-based treatment, and is able to increase retention, more clients will complete treatment. This would be perceived as a success by funders and auditors.

Chris: Did it work?

Sarah: I ended up running into the training participant that had raised the concern 2-3 months later. He excitedly shared that our collaboratively identified intervention had been effective. He and his colleagues were retaining more clients post-assessment.

Chris: I notice your smiling as you describe your encounter with this participant.

Sarah: I think human potential is beautiful and I thoroughly enjoy watching it unlocked. The people I have trained share this passion.