Motivational Interviewing Resources

Motivational interviewing (MI) is an evidence-based approach that health care providers and home visitors can use to help individuals make meaningful behavior changes to support their overall health. The concept of MI dates back to work in the early 1980s by Dr. William Miller. This work began in the substance use field with the treatment of individuals or patients who experienced problems with alcohol use. Dr. Miller and his colleague, Dr. Stephen Rollnick, expanded this work in 1991. As research and practitioner interest in MI continued to grow, so did its application to a variety of health care issues and behaviors in addition to the treatment of addictions. MI has been linked to increased engagement in treatment and improved outcomes across a range of self-management behaviors including adult and pediatric weight management, smoking cessation, and medication compliance.

The central premise of MI is that most people generally experience ambivalence or conflicting feelings about making changes, even when they know the change is good for them. Defined by Miller and Rollnick as a "collaborative conversation for strengthening a person's own motivation and commitment to change" [1], MI can help mothers or family members identify and openly express ambivalence about and resistance to changing their behavior. Home visitors can strengthen and support family members' commitment to achieve the desired change through facilitated discussions designed to help them clarify their motivation to make a healthier choice.

Four principles are central to MI as applied to a mother who is enrolled in a home visiting program:

  • Expressing empathy for a mother's point of view
  • Supporting self-efficacy by highlighting a mother's previous ability to successfully solve problems
  • Rolling with resistance by helping a mother to define a problem and develop her own solution(s)
  • Developing discrepancy by helping a mother to consider the difference between her current behavior and her future goals for herself and her family

We know that the more people talk about change, the more likely they are to make it happen. A home visitor can assess where a person is in the stages of change (Prochaska, DiClemente, & Norcross, 1992) and elicit "change talk" to evoke a commitment to change. Examples of MI communication strategies (also known as OARS) that home visitors can use to engage families in change talk include:

  • Asking Open-ended Questions: "We always ask mothers in our program what they do when they are feeling stressed or overwhelmed as it is natural for every mother to feel this way sometimes. Would it be okay to talk about this with you [asking permission to have this conversation first]? Can you tell me what you do when you feel this way?"
  • Providing Affirmations: "You built in five minutes for yourself each day this week! You really thought about what we talked about at our last visit. That's a great start!"
  • Reflecting (or Reflective Listening): "You are relieved that you haven't had a drink this week, but you are worried that you will drink again, even though you know that it is not good for your baby."  
  • Summarizing Next Steps: "Today we talked about some healthy things to do when you are feeling stressed. You will choose one of the ideas you suggested and try it out before we meet again next week." 

Recipients (grantees) can consider developing a plan to provide state wide professional development on MI. They can also assist LIAs that express interest in learning about MI to provide ongoing professional development; both initial training for home visitors and supervisors, and ongoing opportunities for coaching are needed for home visitors to be able to successfully apply MI techniques on a daily basis. The resources below can support recipients and LIAs as they plan to implement professional development:

  • The HRSA-SAMHSA Center for Integrated Health Solutions includes links to multiple resources to learn more about MI.
  • The National Center on Early Childhood Health and Wellness has developed a Motivational Interviewing Suite that includes videos, debriefs, and an accompanying video guide, one of which features a home visitor talking to a parent about a positive depression screening. Although the materials were developed for an Early Head Start/Head Start audience, they provide examples of how to use MI strategies in everyday conversations with families.
  • The Motivational Interviewing Network of Trainers (MINT) website provides information about the latest MI research and upcoming trainings and events in the United States and abroad.
  • The Center for Evidence-based Practices at Case Western Reserve University offers information about MI consulting and training to support organizations that want to implement an MI program. The Center also provides free PDF resources that can be downloaded:
    • The MI Reminder Card (Am I Doing This Right?) is a helpful visual aide with questions to support practitioners' awareness of their attitudes, thoughts, and communication style.
    • The Readiness Ruler is a tool to help people evaluate their desire to change their behavior and their confidence in making this happen.  

[1]Miller, W. R., & Rollnick, S. (2013). The Method of Motivational Interviewing. Motivational interviewing: helping people change (3rd ed.). New York, NY: Guilford Press.