Good Training Needed for Case Managers
People with complex medical needs face myriad challenges when it comes to following the “do’s and don’ts” designed to help manage their chronic conditions and avoid painful exacerbations and costly hospitalizations. A growing body of evidence suggests there may be a better way.
Multiple studies show motivational interviewing (MI) is an effective tool for eliciting behavioral change across a wide spectrum of healthcare challenges—and that good training is needed to equip care managers and other professionals with the MI skills that can help patients resolve ambivalence and achieve their goals.
Empathy and compassion are cornerstones of MI, which utilizes a series of steps to guide patients through stages of readiness. In MI, patients do most of the talking, while providers engage in reflective listening and other techniques that helps patients identify what behaviors they want to change, and how they want to do it.
MI skills are an “excellent aid to the case manager’s clinical assessment,” said Bonnie Geld, President of The Center for Case Management Inc., a Massachusetts-based consulting company that develops tools and systems for managing outcome-driven care for hospitals, health systems and other organizations. “Only through truly understanding the patient can we better identify and recognize potential challenges for the patient that will create risk for delays in discharge and/or readmissions,” she said.
Where It All Started
Motivational interviewing initially began as a therapeutic intervention for alcohol addiction and was first described by William Miller, PhD, in a landmark 1983 paper published in the British Journal of Behavioral Psychology. Within five years, another researcher—Stephen Rollnick, PhD—had begun to focus on client ambivalence and “double-sided reflections” as important areas of focus in motivational interviewing.
Miller and Rollnick soon began collaborating and in 1991 published their groundbreaking book, Motivational Interviewing: Preparing People to Change Addictive Behaviors. The pair ultimately defined MI as “a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.”
Growth and Evolving Application
In the following decades, additional research has shown MI to be a powerful tool in eliciting behavioral change across a wide range of health challenges. The studies include:
- A 2008 meta-analysis published in Research on Social Work Practice that found several studies on behavioral change among older adults with acute and chronic illness revealed significant improvement in physical activity, diet, cholesterol, blood pressure and glycemic control, and increased smoking cessation following MI.
- A 2009 study published in the Journal of Clinical Psychology that concluded that “motivational interviewing has proven effective in a variety of formats … (and) works for clients regardless of problem severity, age, or gender…”
How Motivational Interviewing Works
One of the most fundamental aspects of motivational interviewing is expressing empathy and building relationship through patient-centered conversation. The acronym OARS summarizes the steps providers utilize in MI, which are:
- Open-ended questions
Allowing patients to do the talking is what makes MI so effective, according to care management experts. “I believe that performing comprehensive clinical assessments and follow ups are the beginning of the case manager and patient relationship, in which trust is built so that the patient can feel comfortable to share their challenges and potential issues,” Geld said. That’s why MI, and good training on how to do it, is essential, she said.
The Motivational Interviewing for Case Managers course offered through Care Excellence delivers those important skills, Geld said. “This training offers a good roadmap in performing an effective interview and interventions with the patient and their family/caregiver,” she said.