The Short Motivational Programme-Revised: A new era of Motivational Interviewing in programme delivery
Programme Facilitator (East Coast), Department of Corrections
Alice Best completed a Bachelor of Counselling at Wellington Institute of Technology where she was first introduced to Motivational Interviewing (MI). She was trained by an MI practitioner who inspired her to develop a deep love of the practice and a commitment to strengthening her knowledge of the theory and her practice since. Alice has been working at the Department of Corrections since 2011 in a variety of facilitation and training roles and is currently a programme facilitator with the East Coast programmes team. Alice is part of the rainbow community and outside of Corrections offers a free counselling service to LGBTQIA+ youth.
The original Short Motivational Programme (SMP) was a five session motivational programme delivered to individual participants by Departmental programme facilitators and psychologists. The programme was initially developed because low motivation to change was an identified issue amongst the prison population (Polaschek, Anstiss, & Wilson, 2010). The aim of the programme was to support participants to develop insight into their offending and build intrinsic motivation to change unhelpful or offending behaviours. Thirteen years after being developed, the SMP has been revised and is being rolled out across the country.
Motivational Interviewing in Corrections
Motivational Interviewing (MI) is a “collaborative conversation for strengthening a person’s own motivation and commitment to change” (Miller and Rollnick, 2012). It is based upon a person-centred counselling style, addresses ambivalence about change, pays particular attention to the language of change, and evokes movement toward a goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion (Miller & Rollnick, 2012). Motivational Interviewing was first developed in the early 1980s and has been researched and developed for the past three decades. It is widely used in corrections services around the world and is useful in a variety of areas including information gathering, reducing client resistance and providing a structure for advancing behaviour change. MI is not only useful for clients; it also has the benefit of supporting Corrections staff by preventing burnout or emotional exhaustion by giving them techniques and strategies for working with high-risk, challenging or unwilling clients (Bogue and Nandi, 2012).
The history of the SMP
The SMP was originally developed and piloted by Brendan Anstiss, a Departmental Psychologist between 2001 and 2003. The outcomes of his work indicated that participants who undertook the motivational programme had increased motivation to change and took significantly longer to be reconvicted and reimprisoned than the control group (Deveraux, 2009). Antsiss observed that the programme offered a well-structured, time-limited, theory-driven approach to providing an effective intervention for incarcerated participants. He found that participants who were “pre-contemplative” (denying or not recognising any need to change) or “contemplative” (beginning to acknowledge some need to change but remaining ambivalent) prior to beginning the SMP, on average, moved to an “action” stage of change (beginning to make changes) once they had completed it (Polaschek, Anstiss and Wilson, 2010). Based on the success of this work, the SMP was developed by Dr Rob Deveraux and Dr Paula Steyn in 2006 and became a mainstream programme aimed at medium-risk, short-serving, incarcerated men. The programme was delivered by trained programme facilitators under the supervision of psychologists and in 2009 became available to the high-risk prison population when delivered by Departmental psychologists. At the time, Deveraux (2009) stated that the “SMP provides Corrections staff with a tool for attempting to motivate offenders to attend and benefit from available rehabilitation programmes and ultimately reduce their risk of re-offending”. The original SMP was a five-session programme delivered to individual participants for one hour per week. The sessions are outlined below:
Session 1 – Rehabilitative Needs Assessment
Session 2 – Offence Chain Development
Session 3 – Uncovering Positive Motivation - Costs and Benefits
Session 4 – Exploring Barriers to Change - Problem Thinking
Session 5 – Cementing Commitment to Change - Change Plan
Like all programmes in the Medium Intensity Suite, the SMP has been subject to ongoing research and evaluation. Two key pieces of research were completed by Dr Kevin Austin (Austin, 2012) and Dr Glen Kilgour (Austin, Williams & Kilgour, 2011) which indicated that the SMP was a valid intervention and suggested that intensive rehabilitation programmes were not the only effective approach to managing risk. Since 2009 the SMP has been delivered in prison and community settings by programme facilitators and Departmental psychologists. It is open to all risk bands and has maintained successful results in both reducing re-offending and motivating participants to address their rehabilitative needs.
The development of the Short Motivational Programme-Revised (SMP-R)
In March 2017, Corrections decided to review and update the SMP. Programme facilitators were consulted for their feedback on the strengths and areas for development in the current programme. The feedback indicated that while the programme was successful and supported many participants to make positive changes in their lives, the SMP needed to be updated in several areas. In particular, adjusting some of the content which involved a lot of “teaching” rather than taking a more collaborative approach, and that the programme felt inflexible as the “one size fits all” approach was not meeting the needs of many participants. For example, some sessions supported pre-contemplative participants to develop awareness into their unhelpful behaviours, but many participants already had that awareness and needed interventions to support them to deepen their awareness of their behaviours. Feedback also indicated that the SMP was not responsive to Māori or other vulnerable groups including women, Pasifika or the rainbow communities. The feedback from programme facilitators was consistent with research results from Dr Austin’s 2012 study which evidenced that the sessions where “change talk” (participant statements which lean in the direction of change) reduced were sessions which involved a lot of “teaching” content and felt educational. More recent research into programme design also indicates that treatment programmes benefit from being less prescriptive and enable the facilitator to tailor the interventions based on individual participant needs and facilitator experience (McMurran & Delight, 2012).
Designing the SMP-R
The redesign of the programme began in April 2017 and focused on two tasks: The first involved reviewing all of the written documents relating to the SMP (such as facilitator manuals, programme resources, research papers) and conducting a focus group with programme facilitators experienced in delivering and/or supervising or training others in the SMP. From the review, a number of strengths of the programme were identified such as the therapeutic approach to working with participants, the focus on assisting participants to make changes, and the process of encouraging participants to identify their rehabilitative needs. The target area to focus on for the rewrite of the programme was to focus on MI as a theory, because MI had been updated by Miller and Rollnick in 2012 and the changes to the practice were not reflected in the current programme or training package. The second step involved running focus groups with programme facilitators where the programme content was reviewed and the programme was redeveloped. When researching and updating the practice of MI, Miller and Rollnick identified four overlapping phases which occur during treatment: engaging (developing the therapeutic alliance), focusing (developing a goal and agenda to work on), evoking (eliciting the participant’s motivation to change) and planning (committing to change and a plan of action). These four processes guide the flow of MI, and emerge in this order. However, they are not linear; a participant may move backwards and forwards through the phases. During the rewrite of the programme, these four processes guided the content of the sessions and interventions used to support participants to move through the four processes, exploring and hopefully resolving their ambivalence to addressing their rehabilitative needs before developing a change plan.
Piloting the SMP-R
In September 2017 the first version of the SMP-R was completed with changes including using more strength-based language (such as replacing “offender” with “participants”), providing a more flexible approach to the content based on each participant’s level of readiness to change, and a greater focus on the relationship between the participant and programme facilitator. The programme was piloted by five programme facilitators in Central, Northern and Lower North regions. Based on the feedback and observations from delivering the revised programme, it was apparent that some amendments were needed. A review of the content was undertaken and the session outlines were redeveloped. The key areas of focus at this stage in the rewrite were:
- Providing structure within the sessions while allowing programme facilitators flexibility with the interventions they chose
- Developing a culturally responsive approach to the programme for both participants and programme facilitators to draw on their own backgrounds, knowledge and expertise
- Using the research outcomes from Dr Austin and Dr Provan’s 2012 (Austin, 2012; Provan, 2012) studies on the SMP to identify which content needed to be removed from the programme (particularly the content which reduced “change talk”).
At this stage, the SMP-R was “deconstructed” and the session content was moved around to match the “process” stage of the programme. The programme content that was successful in the old programme remained and new interventions were added. Lower North, Central and Northern Region cultural supervisors and programme facilitators provided support and feedback on developing a culturally responsive approach to the programme, reviewing all aspects of the programme ranging from the facilitator manual and resources to the training packages. The SMP-R was also adjusted to align more closely to other programmes in the Corrections suite, changing the rehabilitative needs to match the focus areas in MIRP/ SRP/ Kowhiritanga and Saili Matagi programmes. By changing the rehabilitative needs, participants can transition more smoothly from the SMP-R to a Departmental rehabilitation programme with goals which are more programme specific. The training packages were updated and redesigned following the first pilot, using the outcomes from the 2012 study on the SMP to inform both the programme content and the training packages for programme facilitators. The key practice focus change in the updated SMP-R training focused on the therapeutic alliance and how crucial this is to the practice, rather than a series of interventions and strategies.
After the second rewrite, the SMP-R was ready to pilot again.. The programme dosage remains at one hour per week for five sessions and is delivered to individual participants. The programme is open to all risk bands (although delivered by Departmental psychologists for participants deemed at high risk of re-offending), the entire spectrum of genders, and has no age limit. Participants with convictions for sexual offending are not eligible for the programme as facilitated by a programme facilitator without an approved over-ride. Participants are potentially eligible for the SMP-R if they are denying their offending, but this would be assessed on a case-by-case basis. The programme contains a framework on how to approach each session when working with someone denying their offending, to support them to develop insight into the circumstances and high-risk factors surrounding their convictions.
The SMP-R five session outline is:
Session 1 – Whakawhānaungatanga, Engagement and Rehabilitative Needs Assessment.
This session is part of the “engaging” process and gives the programme facilitator and participant time to connect and establish rapport before the programme facilitator supports the participant to self-assess the factors which they believe contributed to their offending. When the participant has assessed these factors they spend time exploring how each impacts on their behaviour and the choices they made.
Session 2 – Finding a Focus –Offence Mapping.
Session 2 involves the participant completing an offence map focusing on their index offence. Following completion of the offence map, the participant reflects on the factors they identified in session 1 and links these needs to points on the offence map to gain further insight into how they drive their offending. Session 2 is part of the “focusing” stage of MI as the content is focused on problem recognition and establishes the offence focus of the programme.
Session 3 – Evoking Motivation to Change – Consequences, Values and Needs.
This session moves into the ‘evoking’ stage of the programme as the participant is provided the opportunity to reflect on the consequences of their offending, to examine whether their offending is misaligned with their values systems and how offending can impact on their basic needs. Programme facilitators choose two of three interventions to use in this session, providing flexibility based on the participant’s current level of motivation.
Session 4 – Strengthening Commitment to Change – Time Projection.
This session is still part of the “evoking” stage in the four processes of MI. The participant is asked to project forward 5-10 years in the future and describe their preferred life. The programme facilitator writes down details of this life, encouraging the participant to describe all areas of their preferred life including areas outlined in their rehabilitative needs. Following this, the participant is asked to project forward 5-10 years and describe their life if they do not make any changes. They are asked to consider all areas outlined in their preferred life and following this, view both futures side-by-side and identify which is their preferred future. Following this they complete “importance” and “confidence” rulers where they consider how important change is to them at this time and how confident they feel about the changes they need to make.
Session 5 – Planning for Change.
Session 5 moves to the “planning” stage and participants complete and share a “change plan” outlining the goals and action plan to address their rehabilitative needs. At the end of the session there is the opportunity for them to invite key support people in to share their plans with them. This will enable probation officers, case managers and case officers to complete programme referrals and provide ongoing support for participants as they move to the next phase of their rehabilitation journey.
The second pilot
Three programme facilitators based in Central and Lower North regions who had been involved in the project and the first pilot undertook a further pilot of the programme. Feedback from the programme facilitators who delivered the second pilot indicated that the programme was responsive, enabled participants to reflect meaningfully on their offending and past choices and that the programme engaged participants more effectively through the use of colourful and engaging resources. Following the second pilot, no further adjustments were required and the programme was ready to be rolled out.
All programme facilitators require specific MI and SMP-R training before they can deliver the programme. Part of the rewrite involved updating the training packages to reflect the changes to MI. The research conducted by Dr Austin and Dr Provan in 2012 significantly informed the rewrite of the training package. Through their research they had identified some of the key areas where programme facilitator practice could and did impact on a participant’s motivation to change. From this research, sessions within the training package were included to explore participant ambivalence (wanting and not wanting something at the same time) and programme facilitator responses to ambivalence, the “righting reflex” (the urge to “fix” problems and take a more “directive” approach instead of using MI skills) and responding to discord within the therapeutic relationship.
Due to the updates of both the programme and the theoretical foundation of the programme, all programme facilitators were required to undertake a one-day training event. Key objectives of this one-day training were to update facilitators on the changes to the content, changes to MI and spend time learning the “spirit” of MI and working effectively with ambivalence, recognising the righting reflex and responding to discord within the therapeutic alliance.
The way forward for the SMP-R
Retraining programme facilitators across Corrections in New Zealand began in February 2019. Experienced programme facilitators from each region were nominated to attend “train the trainer” training and following this, returned to their teams to provide the one-day training package. Feedback from the training has been positive and programme facilitators have reported that they are looking forward to delivering the new programme. The training was completed at the end of March 2019, when the SMP was retired and a new era of MI in programme delivery began. It is anticipated that an evaluation of the SMP-R will be carried out in March 2020.
Austin, K., Williams, M W., Kilgour, G. (2011) The effectiveness of Motivational Interviewing with Offenders: An outcome evaluation. New Zealand Journal of Psychology, Vol. 40, No. 1, 2011
Austin, K. (2012) The Process of Motivational Interviewing with Offenders. (Doctoral Dissertation, Massey University) Retrieved from https://mro.massey.ac.nz/bitstream/handle/10179/4173/02_whole.pdf
Bogue, B. & Nandi, A. (2012) Motivational Interviewing in Corrections. Washington: National Institute of Corrections
Deveraux, R. (2009) Motivating offenders to attend (and benefit from) rehabilitative programmes: The development of a Short Motivational Programme within New Zealand’s Department of Corrections. Journal of New Zealand Clinical Psychologists, Spring, 6-14
McMurran, M., & Delight. S. (2012) Revising manualised treatment programmes: incorporating practitioners' feedback. The British Journal of Forensic Practice, Vol. 14 Issue: 3, pp.157-167
Miller, W., & Rollnick, S. (2012) Motivational Interviewing 3rd Edition. New York: The Guilford Press.
Polaschek, D.L.L., Antsiss, B. & Wilson, B. (2010) The assessment of offending-related stage of change in in offenders: Psychometric validation of the URICA in male prisoners. Psychology, Crime and Law l-21 DOI:10.1080/10683160802698766
Provan, H. (2012) Therapist relational skills and client resistance in a short motivational programme for offenders.(Doctoral Dissertation, Massey University) Retrieved from https://mro.massey.ac.nz/bitstream/handle/10179/5616/02_whole.pdf?sequence=3&isAllowed=y