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 need for culturally responsive and equitable practices ranked among the top five needs in the MHTTC Network's 2021 Needs Assessment Findings. Consistent with this need, the National American Indian and Alaska Native MHTTC was invited by Johns Hopkins Department of Public Health (a previous collaborator) to train their home health care workers working to address and prevent HIV / AIDS within American Indian and Alaska Native patients in Motivational Interviewing (MI). Since the main feature of MI is to promote change, the National American Indian and Alaska Native MHTTC adapts their MI training to address how historical and generational trauma experienced by Native communities must be addressed. Tailoring MI for Native communities and addressing strengths and resiliency and providing such opportunities for culturally responsive training is imperative.
This project is ongoing year round and provided on an as needed basis. Goals of this project are to enhance the provider's ability to deliver MI to Native communities by:
- Building on strength to instill hope
- Ensuring people are supported in their efforts to change their life
John Hopkins Bloomberg School of Public Health identified ~30 home health workers wanting to participate in the Intensive Technical Assistance project. The National American Indian and Alaska Native MHTC planning team determined that a small group of participants was essential to remain interactive and provided this opportunity virtually. Research Specialist, Kathy Tomlin, Ph.D. Member of the Cheyenne River Sioux Nation, who is an experience teacher/trainer in Motivational Interviewing and who has been instrumental in updating Motivational Interviewing to the 3rd Edition with cultural adaptations, led the project. Participants were Lead Managers and Supervisors for staff and staff providing services from the Department of Public Health in Arizona and 78% of participants identified as Native providers.
What We Did
Initially, the National American Indian Alaska Native MHTTC worked with an onsite supervisor to determine the level of training needs for their respective team and spent time developing a trusting relationship with the organizations and the participants and trainees. Once the organization’s needs were identified, a refresher related to their staff knowledge, skills and exposure to Motivational Interviewing was held as a best practice beforehand. Then, in collaboration with the onsite supervisors and select staff, Dr. Tomlin created a strategy for operationalizing the design of the program and determined 2 hour virtual sessions held twice a week over 5 weeks. Sessions consisted of competency training, direct supervision, coaching, and feedback.
Post training booster/feedback sessions were also provided to reinforce learnings and implementation and adoption of the MI training material. They also obtained participant feedback once training completed and offered continued consultation on a as needed basis.
- Native and rural communities often face challenges related to infrastructure such as Internet/bandwitdth which is a barrier to participation.
- Engaging Native participants is more challenging in virtual formats since relationship building and connection are essential to Native cultures.
- Native cultural ways of showing respect to people in leading positions often makes providers reserved, often thought of as shyness- a behavior that is culturally appropriate for many.
- Dr. Tomlin had to modify the training modules to adapt to a virtual format.
- Due to cultural preferences related to one's self being recorded, patients and providers are less willing to be taped for feedback and coaching sessions
- Acommodating various time zones and addressing fatigue is always an issue when conducting Intensive TA and training sessions virtually
Participants reported practice improvements and felt more confidence building.
Work with Native providers often leads to a long-term relationship and the National American Indian and Alaska Native MHTTC continues to further its rapport with behavioral health communities that serve Native people. They have also continued to assist John Hopkins University’s Native Center as they recruit candidates into their HIV/AIDS study. They will also 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.