1. ENGAGEMENT TRAINING
FOR CASE MANAGEMENT:
MOTIVATIONAL
INTERVIEWING
Mary M. Cain, MPH
July 8, 2011

2. Mary
I am a part of all that I have met – Tennyson
 Institute for the Future > role of consumers &
technology
 LifeMasters > application of activation and
motivational interviewing in disease
management call centers decreased HC
utilization by 11%
 StayWell > health coaches have an advantage
in engaging members

3. Improving Member
Engagement
From Case Management Team:
 We need to improve engagement with members
 Case Managers don’t like “selling” themselves
 We want to improve member’s health by ensuring
access to the services available
 The value of case management not clear to the
member or to case managers
 Current results:
 Short interactions
 Missed opportunities
 No connection made with the member

4. How to improve CM results
 Revisit the value of case management from
the case manager’s perspective
 Introduce Motivational Interviewing
 Meet the member where they are
 Learn how to listen, collaborate and connect with
the member

5. Objectives for training
 Describe the core skills of motivational interviewing
and the concept of engagement as they apply it to
the case management process
 Demonstrate basic motivational interviewing
techniques and an understanding of how to engage
members in assessment, goal setting and achieving
plan of care
 Practice specific techniques to increase member
engagement to facilitate assessment, goal setting
and achieving plan of care
 Demonstrate skills to utilize effective responses
designed to reduce member resistance, allowing
facilitation of goal setting and continued member
engagement with the plan of care

6. Process for developing and
conducting training
 Learn about the context for case management
 How are staff trained?
 What are they measured on?
 What do they think works and why?
 Develop customized training
 Provide training
 Train-the-trainer
 Clinical: 3 modules trained in August
 2 virtual 2-hour trainings over 2 weeks, 1 onsite 4-hour
training
 Non-clinical: 2 modules trained in September
 2 virtual 2-hour trainings over 2 weeks
 Post-training evaluation

7. Success Metrics
 CM staff’s ability to articulate an understanding of the
case management program
 CM staff’s comfort with ability to engage members as
measured by pre- and post-training assessments
 Effective communication with members as measured
by member surveys
 Efficient process for staff that doesn’t increase
perception of workload burden as measured by pre-
and post-training assessments (i.e. revisiting the
process, not just piling more on top)
 Long-term measures of success
 Fewer “one and done” cases, fewer incidences of “lost
contact”
 Greater member satisfaction with case management
services

8. Context of Case
Management
 Why do people choose to be case managers?
 What helps them connect with their members?
 What are the barriers to connecting?

9. Motivational Interviewing
 Collaborative, person-centered form of guiding
to elicit and strengthen a person’s motivation
for change – Bill Miller
 Goal: give the staff tools to draw the member
out and support the member’s own motivation
for change in the context of an appropriate
care plan

10. Spirit of MI
 Collaborative > a partnership, not top down
 Evocative > the member has the resources
within herself to make a change
 Honors autonomy > Case Manager can’t make
choices for the member

11. Principles of MI
 Support self-efficacy
 Express empathy
 Roll with resistance
 Develop discrepancy

12. MI Techniques
 OARS
 Open-ended questions
 Affirmative statements
 Reflective statements
 Summary statements
 Listening for change talk
 Desire: Why would you want to make this change?
 Ability: How would you do it if you decided?
 Reason: What are the three best reasons?
 Need: How important is it? and why?
 Commitment: What do you think you’ll do?

13. MI works

14. Keys to success
 Training is the first step in a journey
 Evidence supports ongoing coaching and
management support will make or break the
sustainability of the change
 Supporting infrastructure is key
 Performance evaluation and measurement must
adjust to continue staff growth in skills

15. MI is a big change
 Change is hard
 Congratulations on taking this first step
 This is a marathon, not a sprint

16. Value
 To member: greater self-efficacy, help when
they need it and ultimately better quality of life
 To staff: job satisfaction, more efficient process
and time well spent
 To Corporation: more appropriate use of
services, improvement in the health of the
member population

17. Thank You
 Mary M. Cain, MPH
 mcain@ht3.com
 415-656-6788