Motivational interviewing: An intervention tool for child welfare case workers working with substance-abusing parents.

Child welfare case workers have long known that abuse of alcohol and drugs is a major problem with many parents on their caseloads. This article discusses motivational interviewing, an intervention technique used with substance abusers. Motivational interviewing, which is based on the principles of motivational psychology, postulates that motivation is created in an interaction between the client and worker. Principles of motivational interviewing are discussed and illustrated in a case example. Child welfare case workers have long known that abuse of alcohol and other drugs is a major problem with many of the parents on their caseloads. Estimates of the rate of substance abuse in child welfare populations vary from 30% to almost half to over 80% of parents [Jones et al. 1992]. Reed [1991] found that over 50% of parents in child sexual abuse cases had addiction problems. In a review of 190 court cases, Famularo et al. [1992] found associations between alcohol abuse and physical abuse, and between cocaine abuse and sexual maltreatment. Research has also found that substance-abusing parents tend to be particularly problematic for case workers. These parents are likely to reject court-ordered services and make service delivery difficult, and, therefore, are likely to have their children removed permanently [Curtis & McCullough 1993; Tracy & Farkas 1994; Murphy et al. 1991]. Substance-abusing families move frequently, and parents in such families may be highly involved in the "drug community," making recovery difficult [Johnson 1995]. Case workers are also concerned about the possibility of violence, particularly if illegal activities are occurring in the home, such as the operation of a methamphetamine lab. Not only does substance abuse add a difficult dimension to working with neglectful or abusive families, most case workers have had little training in identifying substance abuse [Gregoire 1994], and even less training regarding intervention techniques. This article reviews and applies in a case study an intervention technique, developed by Miller and Rollnick [1991] for alcoholism/ substance abuse, called motivational interviewing. This technique has been used successfully by therapists and social workers without a background in addictions treatment [Rollnick & Bell 1991], and has been used with involuntary clients in other settings [Miller & Rollnick 1991; Garland & Dougher 1991]. Motivational interviewing can be used by child welfare workers and other social workers because many of its principles are based on traditional social work values such as client self-determination, respect and dignity, and empowerment. Traditionally, substance abuse counselors were trained in a model of intervention that included direct confrontation to break down the client's denial of his or her addiction, because the client's defense mechanisms were so firmly entrenched. Research has found, however, that this type of confrontation does not help the client [Miller 1995]. Rather, it tends to increase denial and resistance; not all clients are in the stage of change where they are willing to think about change. Prochaska et al. [1992], researchers in the field of addictions (particularly with respect to alcoholism and tobacco), have developed a five-stage model of change. They have found that people tend to re-cycle through these stages. Case workers or therapists who want to use motivational interviewing should assess the client's readiness to change and the stage of change. Stages of Change The first two stages in the change process are precontemplation and contemplation. Most of the substance-abusing clients whom workers see are in one of these two stages [Barber 1995]. Precontemplators are not even aware that they have a problem, or they may have a vague awareness of their problem, but have no intention of changing. They are defensive or angry when questioned about drug or alcohol involvement, and tend to deny or minimize their substance use and its associated problems. …