MIC Stories: National American Indian and Alaska Native MHTTC Training and Implementation of MI for Native Behavioral Health
Featuring the National American Indian and Alaska Native MHTTC:
Training and Implementation of Motivational Interviewing (MI) for Native Behavioral Health, HIV/AIDS and Native American Family Home Health Care Providers: Spirit of Communication: Motivational Interviewing and Traditional Teachings
MIC Stories (MHTTCs Implementing Change) feature technical assistance projects that had a significant impact on practice.
The National American Indian and Alaska Native MHTTC was invited by Johns Hopkins Department of Public Health (a previous collaborator) to help them train their Native American and Alaska Native home health care workers who work with families to address early childhood care and children experiencing Adverse Childhood Experiences (ACE).
The second part of this request from the same department was for us to provide feedback and coaching in the implementation of Motivational Interviewing (MI) for those working to address and prevent HIV / AIDS within American Indian and Alaska Native patients.
The first project was implemented in the Fall of 2021.
The 2nd project is ongoing and provided on an as-needed-basis as they can work remotely. They collaborated with John Hopkins Bloomberg School of Public Health to implement the Intensive Technical Assistance project.
National American Indian and Alaska Native MHTC Program Manger, Megan Dotson, provided this opportunity via Zoom, alongside Research Specialist, Kathy Tomlin, Ph.D. Member of the Cheyenne River Sioux Nation, who is an experience teacher/trainer in Motivational Interviewing and has been working with the National American Indian and Alaska Native MHTTC providing Motivational Interviewing training to Native Providers. Tomlin has also been instrumental in updating Motivational Interviewing to the 3rd Edition, with cultural adaptations. Participants were Lead Managers and Supervisors for staff and staff providing services from the Department of Public Health in Arizona.
Each request for technical assistance (TA) is evaluated by the Center program manager and discussed with the MHTTC team. We received email requests for TA and training regarding Motivational Interviewing in Native Communities, with focus on specific targeted intervention to facilitate behavior change in patients.
In the spirit of Community-Based-Participatory-Research and Programming (CBPR) we discuss/evaluate with each organizations the capacity to implement change and how the request can best be responded to in order for the organization to be successful in implementing their goals. We are also aware that MI is very in tune with Native Cultural ways of communicating.
What We Did
Initially for each project, we worked with onsite supervisor to determine the level of training needs for their respective teams to ascertain training needs. The National American Indian and Alaska Native MHTTC spends time developing a trusting relationship with the organizations we work with and the participants/trainees. Once the organization’s needs are identified, they worked with each project to determine a plan for training and/or refresher related to their staff knowledge, skills and exposure to Motivational Interviewing as a best practice beforehand. In collaboration with the onsite supervisors, select staff, the trainer and the MHTTC Manager, created a strategy for operationalizing the design of the program virtually using the Zoom format – usually 3-5 sessions over 2-5 weeks of 2.5 to 3 hours in length each time. For the feedback sessions for staff, one session lasted between 1,5 to 2 hours.
Finally, they provided post training booster/feedback sessions to reinforce learnings and implementation and adoption of the MI training material, obtained participant feedback once training completed, and offered continued consultation on a as needed basis, because starting to work with Native providers often leads to a long-term relationship
- Internet band width, depending upon the location of the participants
- Engaging Native participants more challenging when not in person, because in-person interactions are always preferable to virtual communication
- Native cultural ways of showing respect to people in leading positions often makes providers a little reserved (sometimes people think this is shyness), a behavior that is culturally appropriate for many. Participating in a zoom meeting or use another virtual platform, can be a challenge.
- Dr. Tomlin modified the training modules to adapt to the virtual format
- Challenging to get patients to be willing to be taped for feedback and coaching sessions for the counselor
- Different time zones, and computer fatigue is a real issue when we conduct Intensive TA and training sessions
Participants reported practice improvements and felt more confidence building
The National American Indian and Alaska Native MHTTC continues to assist John Hopkins University’s Native Center as they are in the process of recruiting people into their HIV/AIDS study and will provide 1 on 1 feedback to Behavioral Health workers using Motivational Interviewing.
This training program has been updated to meet the content of Motivational Interviewing 3rd Edition and further adapted. After the COVID-19 pandemic hit the country, this curriculum was further developed and adapted to a virtual platform and offered over a series of sessions. This series is part of a 10-hour Motivational Interviewing program that was held in 2-hour sessions on a weekly basis for 5 weeks. Training objectives for family home visiting staff included learning how to help families increase motivation related to their goals and identify barriers to growth, gaining helpful tools that can guide participants to reach their goals, introduction to Motivational Interviewing concepts such as: focusing on growing opportunities, recognizing change talk, and feeling out of balance (ambivalence), adjusting to resistance, and supporting confidence and hope. The goals of this training event were to assist participants to support blending cultural practices with the concepts of Motivational Interviewing, (MI); an evidenced based, experience-based/knowledge based culturally informed behavior change practice. When offering this virtually, we changed the title for a few organizations to be called: Motivational Interviewing within Cultural Practices where participants would gain knowledge of key concepts of MI, identifying and practicing culturally specific practices that blend well with MI, adapting MI and learning how to enhance cultural practices to encourage healthy behavioral changes and be open to attend post training MI mentoring to become better helpers. The goals are to maximize healthy and holistic behavior change within their unique tribal and community life. This is one of our more sought-after trainings, so we have offered this virtually several times during the pandemic. We continue to deliver this to providers virtually until a FTF training can be held.
Be patient with virtual classes, constantly review engagement of participants, continuously ask during sessions how people are doing with the material, keep modules and feedback short in time and increase practice and discussion times, evaluate the effects of the efforts made to implement material, incorporate feedback along the way (don’t wait to evaluate), be aware of computer fatigue. Participant engagement always increases when we focus on supporting the participants in implementing MI with cultural adaptations.
The National American Indian and Alaska Native MHTTC, funded by the Substance Abuse and Mental Health Services Administration, is housed in the Native Center for Behavioral Health at the University of Iowa, College of Public Health. The National American Indian and Alaska Native MHTTC works with organizations and treatment practitioners involved in the delivery of mental health services to American Indian and Alaska Native individuals, families, and tribal and urban Indian communities to strengthen their capacity to deliver effective evidence-based and experience-based practices. This includes the full continuum of services spanning mental illness prevention, treatment, and recovery support.