Case Management and
Motivational Interviewing in the
German Heroin Trial
Irmgard Vogt,
Martina Schu, Martin Schmid,
Wilfried Görgen, Hans Oliva
Fachhochschule Frankfurt am Main/ FOGS, Köln
Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M.
60318 Frankfurt a.M. Tel.: (0 69) 1533 2819
Nibelungenplatz 1
Fax: (0 69) 1533 2809
[email protected]
http://www.fh-frankfurt.de
Case Management and Motivational
Interviewing in the Heroin Trial
 Case Management and Motivational Interviewing is introduced
into the Heroin Trial as one variation of psychosocial support of
clients
 Case Management emphasises structure and an organisational
framework, networking and cooperation with other agencies;
Motivational Interviewing embraces motivational factors, style of
interaction, collaboration with clients
 The two concepts blend well as both of them have a long history
in individual counselling and are related to each other
 To facilitate comparison of results in a multicenter setting,
implementation and documentation are standardised, and
coaching of counsellors during trial is part of the standard
procedure
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Case Management: Background
 CM has a long history in individual counselling
 CM is a variation of a “client-centred” approach in a well
structured setting, designed specifically for the care of people
with complex problems
 CM is target-orientated
 CM is designed for long term interventions and geared to
solutions and sustained support in a continuum of care
 Case Managers work "in the field” making use of clients
resources as well as organisational networks; in cooperation with
clients they plan, organise and coordinate a needs-based,
comprehensive and efficient package of care, crossing
institutional and professional boundaries.
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Case Management: Techniques
 CM is well structured and organised along „stages“ or steps of
the helping process
 CM asks for networking and cooperation of (welfare) agencies
and organisations
 CM includes re-assessment and evaluation of the helping
process and of its outcome
 CM blends well with MI. However, CM underlines structure, MI
counselling style and techniques. Mixing both requires a delicate
balancing of form and content, structure and style of interaction
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Model of Case Management and Motivational
Interviewing
Admission/ First session
Assessment and Analysis of Problems
Care and treatment plan
Working along plan (and networking)
Monitoring and Re-Assessment
Evaluation and termination of counsellingt
Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M.
Case Management
 CM has been evaluated in the USA, within the framework of a
control study of drug addicts with complex problems (cf.: Ball &
Ross 1991, Mejta et al. 1997)
 Result: CM is more successful than "treatment as usual”
 CM has been implemented in Germany as well (cf. Oliva et al.
2002), but not yet in comparative studies
Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M.
Motivational Interviewing
 MI has developed out of a client-centred counselling
approach, integrating elements of motivational psychology and
cognitive behaviour therapy
 MI is based on the stages-of-change model
 MI stresses the style of interaction between counsellor and
client. Counselling techniques are tailored to facilitate the
exploration of motivational conflicts of client and to support
motivation to change
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Stages of Change
Stage 1
Precontemplation
Stage 2
Contemplation
R
E
L
Stage 3
Preparation
A
Stage 4
Action
P
Stage 5
Maintenance
S
E
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Motivational Interviewing, Stages of Change
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Motivational Interviewing: Basic Skills
 Unconditional Acceptance - the counsellor accepts the client as
a person regardless of his or her values, life-style or actual
problems; he is respectful towards the client
 Empathy - understanding another person‘s emotions and
feelings from that persons frame of reference; the counsellor is
warm, caring and interested in the client
 Enhancing Self-efficacy in clients - the counsellor fosters hope
and optimism in the clients’ capacities to change
Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M.
Motivational Interviewing: Techniques
 Showing interest in client via reflective listening and openended questions
 Developing discrepancies between client’s current situation
and hi/her hopes for the future
 Avoiding to argue, moralise, blame and label
 Avoiding interpretations - client’s statements are taken as such
and not analysed for hidden meanings
 Roll with resistance - instead of confrontation shift perspectives
and reframe statements
 Supporting self-efficacy - strengthen client‘s belief in change
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Motivational Interviewing
 MI was used and analysed in the USA in several efficacy studies,
eg. in project MATCH (1998)
 In the study, alcohol dependent clients were randomly assigned
to 3 groups of intervention methods, one of it was MI. Results
were monitored and treatment outcomes evaluated. Result: MI is
an effective intervention method
 MI is widely used in Germany, especially in counselling persons
with alcohol problems (John et al. 1996, Kremer et al. 1999) and
in short interventions
Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M.
Case Management and Motivational
Interviewing
Steps to Standardization
 Development of guidelines to Case Management and
Motivational Interviewing - Manual for counsellors
 Development of questionnaires and fact sheets to facilitate
assessment, treatment planning, minutes etc.
 Training’s of Case Managers in the trial in methods, techniques
and use of questionnaires
 Re-training’s of Case Managers 3 and 6 months after start of the
trial
 Coaching of Case Managers at work place
Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M.
Case Management and Motivational
Interviewing
Steps to Standardization
 Development of questionnaires and fact sheets
 General information sheet for clients regarding Case Management
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
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and Motivational Interviewing
contract to collaboration while in trial
Client files and documents
Documentation of daily work schedule of Case Managers
Questionnaire of Generalised Competence Expectation
Final evaluation assessment sheet
Institut für Suchtforschung i.Gr. an der Fachhochschule Frankfurt a.M.
Case Management und Motivational
Interviewing
Steps to Standardization
 Client files and documents
 Structured assessment forms regarding: patterns of drug use and
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abuse, general aspects of health, relationship to family members and
friends, education and employment, actual income and debts,
problems with the police and the judicial system, self-reported
problems
Checklist of regional support system (e.g. counselling organisations
and welfare agencies) and establishing a network according to the
needs of the client
Forms for treatment plans and for conferences to discuss treatment
plans
Re-assessment forms
Final evaluation form
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Case Management und Motivational
Interviewing
Summary
 The blending of CM and MI is suitable and offers a wide range of
methods and techniques to psychosocial care for substance
dependents
 The combination of CM and MI is tailored to care for people with
longstanding and complex problems including clients with dual
diagnosis
 Steps to standardise the helping process allow for a control of
the number and type of interventions in multicenter settings
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Case Management and Motivational
Interviewing
Content
Admission and first session,
explanation of the concept,
establishing collaboration
and agreement to work together
Assessment, start to network
with counselling and other
related agencies in the region
and with personal resources of
client
Motivational
stage
Precontemplation
Techniques
Reflective listening, open-ended questions,
explore and support clients needs,
provide information of study, regional
support system etc.
Contemplation Reflective listening, open-ended questions,
evoke and work with discrepancies, affirm,
give feedback, summarise.
First assessment of clients‘ motivational
stage in different areas of interest;
mapping of counselling and welfare
agencies in the region; if appropriate,
introduce diagnostic results (triangulation);
visit client at home.
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Case Management and Motivational
Interviewing
Content
Assessment and definition of
target problems. Outlining a
treatment plan
Working along treatment plan
Motivational
stage
Techniques
Contemplation Reflective listening, open-ended questions,
Preparation
evoke and work with discrepancies, elicit
self-motivational statements, affirm, give
feedback, summarise, planning of next
step, reframe, explore alternatives and
choices, support self-efficacy. If
appropriate, organise conference on
treatment plan with colleges of related
agencies
Preparation
Action
Reflective listening, open-ended questions,
affirm, elicit self-motivational statements,
reframe, advocacy, feedback, summarise.
Introduce relapse prevention
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Case Management and Motivational
Interviewing
Content
Motivational
stage
Techniques
First preliminary evaluation of
results.If necessary, ReAssessment and rearrangement of treatment plan.
Strengthening collaboration with
colleges of related agencies,
networking with new actors
Contemplation,
Praparation,
Action
Reflective listening, open-ended questions,
affirm, elicit self-motivational statements,
give feedback, reframe, explore
alternatives and choices, support selfefficacy, intensify cooperation with other
institutions
Working along treatment plan.
Process evaluation
Action
Maintenance
Reflective listening, open-ended questions,
affirm, elicit self-motivational statements,
give feedback, explore alternatives and
choices, support self-efficacy, increase
level of clients self management
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Case Management and Motivational
Interviewing
Content
Outcome evaluation and
termination of counselling
Motivational
stage
Maintenance
Termination
Techniques
Reflective listening, open-ended questions,
affirm, feedback, summarise, support selfefficacy, increase level of clients self
management, prepare to finish counselling
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Case Management and Motivational
Interviewing
Content
Relapse prevention
Motivational
stage
Relapse
Techniques
Relapse prevention package, crisis
intervention, reflective listening, openended questions, provide information,
planning of next step
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