—by Paul M. Kubek
The scientific method has provided the profession of social work what it has provided so many other professions that utilize the rigors of research to produce new knowledge. It has made social work more informed about contemporary problems and more precise about its responses.
There are now specializations and sub-specializations that are equipped with highly nuanced, expert approaches to policies and practices that improve quality of life for specific populations and communities in need. Bring this up with Sharon Milligan, PhD, associate dean for academic affairs and chair of the master’s program at the Mandel School of Applied Social Sciences, and she will quickly agree. Yet, she also integrates this observation about contemporary social work with its historical roots. She explains that there is a unifying principle at the core of all social work specializations which has withstood the test of time.
"It does not matter if our students, alumni, faculty, and staff work with individuals, families, groups, or communities," she says. "Ultimately, every social worker is an advocate for and an agent of change.”
MOTIVATION TO CHANGE
Milligan is eager to discuss a recent addition to the Mandel School curriculum that explores in depth the process of change and innovation. It's a new elective course on Motivational Interviewing (MI), an evidence-based practice that is one of the best available to help individuals, families, groups, and organizations identify and move beyond their own ambivalence to change. MI was introduced as an elective in the summer of 2011. Thirty-eight students completed that first course. In the spring and summer of 2012, an additional 48 students completed the class.
"It's a wildly popular elective," Milligan says. "Students obviously understand the utility of motivational interviewing across social-work practice."
FROM COMMUNITY TO CLASSROOM
Milligan credits senior faculty member Lenore A. Kola, PhD, associate professor of social work and co-director of the School's Center for Evidence-Based Practices for proposing the course. Kola saw it as an opportunity to bring the Center's work from the community into the classroom. The Center provides consultation, training, and evaluation services to health and behavioral healthcare organizations that are implementing evidence-based practices and other service innovations that improve outcomes for people with serious mental illness and co-occurring substance use disorders. The Center's consultants and trainers teach MI to organizations implementing new models of care as a way to improve clinical services and to facilitate the organizational change that is necessary to support the new practices.
Kola and two other faculty (see sidebar) have been teaching Motivational Interviewing in practice courses about alcohol and other drug addiction since the 1990s. Kola explains that MI is essentially a way of framing conversations to help people discover their own interests in making a positive change in their lives and to express it in their own words. Research shows that people are more likely to take action when they talk about their own desires and plans. MI helps people through personal changes, such as diet; exercise; reducing and eliminating the use of alcohol, tobacco, and other drugs; managing symptoms of mental illness and chronic physical conditions such as heart disease, diabetes, and obesity, among others. It also helps with organizational change, such as building consensus for a new vision, revising budgets to support a new mission, or redefining the skills needed from staff members.
"You cannot force people to change," Kola says. "If you tell them what you think they should do, they resist and nothing positive gets done. However, if you help them hear their own inner desire to improve some aspect of their lives or work and help them express that in their own words, they are more likely to make plans and do it."
MI was developed by Stephen Rollnick, PhD, of Cardiff University, and his colleague William R. Miller, PhD, from the University of New Mexico. Since 2009, the Center has been teaching MI to behavioral healthcare organizations that are integrating substance abuse services with mental health services. The Center works with over 60 organizations in Ohio and has been invited to consult in 24 other states and in the Netherlands. Over the past several years, requests for consulting and training about MI have come from a wide variety of organizations that provide employment services, housing, tobacco cessation, and primary healthcare, including hospitals.
Milligan explains that the positive feedback about MI among social work students inspired the Mandel School to incorporate it into a required non-credit seminar being taught to first-year students at Case Western Reserve University as a multidisciplinary collaboration among four professional schools: medicine, dentistry, nursing, and social work. The seminar was created, in part, as a response to the Inter-professional Education Collaboration and the World Health Organization’s call for a collaborative practice-ready workforce.
The goal of the seminar is to examine primary health problems from the perspective of all four schools that are participating in the collaborative. In Spring 2012, the seminar explored the effects of and approaches to patient obesity. Milligan invited staff from the Center for Evidence-Based Practices to teach Motivational Interviewing to over 500 students in the seminar.
"Our contribution to this seminar has been significant," Milligan says. "We have demonstrated how communication from professionals can hinder or facilitate behavior change and influence outcomes."
FOUNDATION FOR CHANGE
Milligan sees a future for Motivational Interviewing at the Mandel School. She thinks it could become part of the foundations curriculum in which all new students are required to take the class, including those in the community development specialization.
"If students learn the strategies of motivational interviewing and its emphasis on change-talk in the context of organizational change and systems change," Milligan says, "it will be a very powerful change tool. No one changes communities by themselves without changing organizations that serve the neighborhoods."