MACRO MI NEXT STEPS: EVOKING SYSTEMS CHANGE

Kristin Dempsey and Sarah Solis

Use This Code to for Today’s Slides and Links

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CULTURAL ACKNOWLEDGMENT

Kia ora koutou katoa. Before we begin, I want to acknowledge the land on which we gather today. This land is part of the traditional territories of Ngāi Tahu, the iwi (tribe) of this region, and Ngai Tuuaahuriri, the hapū (subtribe) of the local area the MINT TNT & Forum are being held in, who have lived here for generations. I pay my respects to their elders past, present, and emerging.

I recognize and honor the deep spiritual connection that Māori people have with this land, which was cared for and nurtured long before colonization. I acknowledge the mana (authority) of Ngāi Tahu as kaitiaki (guardians) of this place and express gratitude for their ongoing stewardship of these lands and waters.

May we approach today with a spirit of respect, openness, and a willingness to learn from the rich histories and cultures of this place.

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BRONFENBRENNER’S ECOLOGICAL SYSTEMS MODEL

COMPLEXITY THEORY

• Networks-The relationship an individual has with multiple systems in GST. Eco-mapping can be a helpful assessment tool.
• Emergence-Occurs in the macro level. What the boundaries, relationships, dynamics tell you about the system. Society is made of many individuals but holds attributes distinct from the individuals. Example: people using social media to draw national attention to a local issue.
• Self-organization and social coordination-Individual agents begin to come together and complete tasks with intention. Macro MI looks to facilitate this as one possible intervention.
• Feedback sensitivity-The level of information/energy that the system allows to occur with other systems. This training aims to support with assessment of feedback sensitivity.
• Agility-Flexibility in the system to handle challenges without collapsing. There is less agility if the system is beholden to many other systems.
• Big questions: What is the emergent of this system? What is the system of this emergent?

WHAT ARE SOME EXAMPLES OF SYSTEMS WITH WHICH YOUR MI TRAINEES MIGHT INTERACT?

EXERCISE

• Please get into your groups. Think of a time during which you worked with a client to increase motivation around a change focus. You began to see some inclination to change and an openness to being referred to a supportive program (non-profit focused on employment, therapy group for folx experiencing interpersonal violence, inpatient or outpatient PTSD treatment). You attempted to help the client access the program and the client was denied (history of verbal aggression, still engaging with abusive partner, smokes marijuana) .
• Please identify the system and your intervention. How did it go? Discuss with your group members.

A SMALL DEATH

POWER

How might we work power into case formulation?

How can we access and redistribute power in our work?

POWER FOR ALL

From Battilana and Casciaro (2021)

1. Power can be learned
2. Power is not a possession; it is relative
3. Power is not just for those at the top; it’s potentially for all
• Think collective vs. individual
4. Power is not necessarily dirty; it is energy
• Keep it “clean” through humility and empathy
5. Effective change requires agitation, innovation, and orchestration
• We can different roles in different situations. We can be wise – tempered radical. We can be in community

EXERCISE

• There are three sections of large Post-it notes on the wall.
• One section is for “the system”, one is for “the practitioner” and one is for the “help seeker”.
• You will be divided into groups. Each group will start at one of these three post its.
• The job of the group is to brainstorm what kind of power each group has.
• The trainer will give you a few minutes at each pad then move you along.
• It is likely that generating the list will bring up questions, thoughts, and discussion.
• Refrain from writing every thought about the issue you are discussing but leave some key words to indicate the essence of what you are exploring – we will discuss all together.

ADVOCACY

ADVOCACY: ASK THE CLIENT WHERE YOU NEED TO WALK?�

ASSESSING SYSTEMS CHANGE READINESS USING PROCHASKA AND DICLEMENTE’S STAGES OF CHANGE

POINTS OF MOTIVATION

SYSTEMS MOTIVATION VS GATEKEEPER MOTIVATION�WHAT IS THE IMPERATIVE OF THE SYSTEM?

Gatekeeper (compliance focused)

• Mandates
• Mission Statements
• Outcomes/funding streams
• Gatekeeper anxiety/rule bound/low flexibility

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Gatekeeper (personal belief focused)

• Personal beliefs/values
• Community/culture beliefs

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SYSTEM MANDATE MOTIVATION

EXAMPLES OF MANDATES

EXERCISE

• Please get into your groups. Think about a challenging system interaction. What is that system’s mandate? How is different from your mandate?

ASSESSMENT OF COMMITMENT TO MANDATE

To what degree has the individual or treatment team internalized their agency’s mandate?

If the service provider holds the mandate as important, what programmatic outcome measure would be meaningful to them?

When is the outcome due?

PRACTITIONER ANXIETY MANAGEMENT 101:�TEACH PROCESS AND OUTCOME

• Is a way to address anxiety that gets in the way of doing MI (or any other person-driven work)
• Addresses control: You want to fix it. You can’t. It’s OK.
• Here is what you can do: You can have good process as good process typically leads to good outcome.
• Try to teach this to the supervisors and managers in addition to line practitioners.

TEACHING PROCESS AND OUTCOME

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• What if we started to advocate for good process being The Outcome?
• Start to shift culture to recognize the importance of engagement and retention as outcomes
• Is there a way to identify where we can re-evaluate what we are trying to capture and re-write contracts or agency evaluations to be more involve in capturing more of how the work is done vs. only specific quantifiable outcomes?

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SYSTEM REPRESENTATIVE VALUES MOTIVATION

EXERCISE

• Please get into groups. Feel free to review the Values Cards Set. Now, think of a challenge you have faced with a system. What possible value did the representative of that system hold in relation to the challenge? Discuss with your group members.

DEVELOPING AMBIVALENCE

THE SPIRIT OF MI APPLIED TO THE SYSTEM

SYSTEM SUSTAIN TALK�

EXERCISE

• What are some examples of system sustain talk that you or your trainees hear?

SYSTEMS CHANGE TALK

EXERCISE

• What are some examples of system change talk that you or your trainees hear?

ATTEMPTING TO “FIX” A SYSTEM

OPEN ENDED QUESTIONS TO BETTER UNDERSTAND A PROVIDER’S MOTIVATION��

What would the client’s life look like if she/he continued on this path?

EXERCISE

• Please get into your groups. Identify 3 open-ended questions you could use when experiencing a challenge with a systems representative.

AFFIRMATIONS

• Remember that the system gatekeepers are people with values, goals, ambitions, or intentions.
• Think about some gatekeepers or systems representatives with whom you have worked.
• Bonus challenge: Think about a gatekeeper that you might have had, let’s say, challenges.
• What are some strengths that some of these individuals have? We need to find a strength that is a real strength and not something we are going to challenge. For instance, “You really care a lot about sticking to the rules at all times.”
• Now create an affirmation based on the strength:
• “I see that you are someone who really cares about individuals doing what they can to build better lives for themselves.”
• “I notice that you care a lot about the children the department seeks to support.”

REFLECTIONS

• When interacting with a system, we are shifting focus from individual help seeker to systems representative.
• Like help seekers, systems reps need to be engaged and they might come to a meeting particularly sensitive or defensive.
• Use active listening to create safety for the systems rep so the can have increased access to the psychological safety they need for increased behavioral flexibility:
• “You have been told these guidelines are important to follow, so everyone is treated the same.” (reflection on sustain talk)
• Like work with individuals in our care, we want to eventually evoke and reinforce change talk.

HOW WOULD YOU REFLECT?�SEE ANY LITTLE PIECES OF CHANGE TALK? �

• We have the same rules for everyone in this program. I know Rosie. She is someone who knows how to game the system.
• I try to help everyone I can get into these housing programs. We just have a lot of lists and housing requirements. It will take a couple of years for anyone to get an apartment.
• I am not sure what happened to his paperwork. You will have to resubmit it.
• I do not think their probation officer will make any changes to their probation plan. I know they have been working hard in their program, but I just do not seem him being that flexible.
• I will let my manage know that you want a re-assessment. I can’t make any promises, because she doesn’t usually do this, but I will send her a message.

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SUMMARIES

• For systems work, summaries service a similar function to help organize and focus conversations.
• Systems workers are often overworked and likely get flooded with requests.
• Summaries help us be efficient with systems staff, which can also potentially help create more opportunities for productive conversations with less chance of banter back and forth.

SUMMARIES

Example: “The client has met 2 of 4 requirements needed to successfully complete your program, you are regularly assessing the client’s progress completing the last two items, and you have concerns. I am wondering if we can talk about possible supports the client may need to achieve the last two requirements”.

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REVIEW AND DISCUSS

• Macro MI, as we are using it here to address systems issues, has potentially to build on and expand important advocacy work with do with individual help seekers.
• Every component of standard MI can be adapted to work with systems gatekeepers or representatives as well as with individual help seekers contemplating or engaging in systems change.
• It is helpful to remember that systems are large and powerful abstractions created and operated by people. Those people can also be engaged in conversations about change and growth.
• Among other things, assess your own and your help seekers’ power. Consider how power might be used to engage the systems

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QUESTIONS, DISCUSSION, &�NEXT STEPS

REFERENCES

Battilana, J., & Casciaro, T. (2021). Power, for all: How it really works and why it's everyone's business. Simon and Schuster.

Johnstone, L., & Boyle, M. (2018). The power threat meaning framework: An alternative nondiagnostic conceptual system. Journal of Humanistic Psychology, 0022167818793289.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow. Guilford press.