Implementing Motivational Interviewing in TPP Project Settings

This resource provides information about Motivational Interviewing (MI) and how Teen Pregnancy Prevention (TPP) projects can implement MI in a way that meets program expectations. Watch the case study video to hear from a TPP project with MI experience, then scroll down for frequently asked questions about MI.

Video Chapters

• Intro & Objectives
• How does MI fit into the Health Mentor Model? (00:49)
• What is MI? (2:00)
• How do you use MI? (4:43)
• How are your MI practitioners trained? (8:20)

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* Click on a chapter block on the playback bar above or use the chapter menu (the third icon from the right) to jump directly to a section.

What is MI?

MI is an evidence-based communication approach to behavior change that can strengthen someone’s internal motivation for and commitment to a specific goal. This approach is rooted in a respectful and curious way of being with people that honors a person’s autonomy and leverages their desire and capacity for change. 

MI is particularly useful for helping people reflect when they have:

• Mixed feelings about changing
• Low confidence about their ability to change
• Uncertainty about their goals for change
• Clarity about their goals but questions about the next steps to take

While MI does not have a defined curriculum or script, there are MI principles, processes, and skills that facilitators can learn and follow.

What is the spirit of MI?

MI is characterized by:

• Partnership. MI is a collaborative relationship in which the MI facilitator recognizes that the participant is the expert of their own life.
• Evocation. To bring about change, the MI facilitator draws out the resources the participant already has within themselves.
• Acceptance. The MI facilitator allows the participant to lead the conversation and focus on the issues and solutions they want to address without judgment.
• Compassion. The MI facilitator prioritizes the participant’s well-being and safety.

What does an MI session entail?

MI facilitators typically focus on four fundamental processes (though they may move back and forth among them): 

• Engaging: Establishing a relationship with the participant. It also includes explaining the facilitator’s role in MI and sharing information about confidentiality and mandated reporting.
• Focusing: Identifying the participant’s question, concern, or need and coming to a shared understanding of change goals.
• Evoking: Drawing out the reasons why the participant might want to change.
• Planning: Exploring how the participant might go about changing. It may also include setting up additional sessions, referring for other services, or sharing resources.

During sessions, many MI facilitators use the OARS communication model to foster an interactive dialogue. OARS stands for: open-ended, affirming, reflective listening, summarizing. Check out this OARS resource to learn more.

Depending on their organization or project, MI facilitators may also need to gather consent for data collection or document the session. 

This guide from SAMHSA, though focused on applying MI to substance use, has more information on the fundamental processes of MI.

What is the evidence for using MI with adolescents?

Among adolescents, MI either alone or as part of a curriculum has been associated with increased uptake of HIV testing (Miller, 2021), condoms (Miller, 2021) (Tucker, 2021), and long-acting reversible contraception (Tomlin, 2017) (Stevens, 2017). 

Adolescent populations studied include males (Bassett, 2022), females (Miller, 2021) (Tucker, 2021) (Tomlin, 2017) (Stevens, 2017), unhoused adolescents (Tucker 2021), and pregnant adolescents (Tomlin, 2017) (Stevens, 2017).  

How can I use MI in my TPP project?

Your TPP project can use MI to integrate behavior change into your work with youth. 

You can implement MI in a variety of ways:

1. As a standalone intervention (MI). For example, as a one-on-one health education session in a congregate care setting.
2. As a supplement to an evidence-based program (EBP). For example, delivering an EBP to a group of participants and offering an additional one-on-one MI session for interested participants.
3. As part of an EBP that includes MI as a program component.

Review your curriculum and talk to your Project Officer about how MI may fit into your TPP project’s work.

What resources does my TPP project need to implement MI?

• Private space. MI requires a room with a closed door for confidential one-on-one conversations.
• Sufficient time for each session. There is no set session length, but it’s important to allow enough time for a meaningful conversation. If conducting multiple sessions, plan on at least 45 minutes for the first. Once the facilitator and participant have built rapport over a few sessions, they may need less time for each one.
• Commitment to the spirit of MI. Your project leadership and staff should embrace MI’s spirit of partnership, evocation, acceptance, and compassion.
• Trained staff. It’s important for MI facilitators to know and have practice implementing the fundamentals of MI, including the MI processes and the OARS model. Once your Project Officer approves your MI implementation plan, you can find an MI trainer through your RHNTC grantee liaison or the TPP grantee listserv.
• Access to referral resources. MI is not therapy. Facilitators should be prepared to connect youth to therapy and other adolescent-friendly behavioral health, reproductive health, and other services as appropriate. Also, MI training should educate facilitators on the distinction between MI and therapy and how to hold this boundary. 

How many sessions should a facilitator conduct with each MI participant?

There is no set number of sessions for each MI participant. 

MI tends to be most effective when a participant has multiple sessions so the facilitator can build rapport and uncover the participant’s goals and challenges. However, to avoid an ongoing therapeutic relationship, your project will need to set a limit on the number of MI sessions per participant (and indicate this limit in your MI implementation plan). Consider available space and other resources when determining this limit. 

It is possible to implement MI in one session. If your project is considering this approach, make sure the participant feels connected to the organization or facilitator delivering the MI and/or receives resources and referrals to support them in reaching their goals.

What topics can my TPP project address with MI?

Any topic that aligns with your TPP project goals and goals of the TPP grant program, which is to reduce teen pregnancy and sexually transmitted infections (STIs). For example: healthy relationships, abstinence, birth control methods, pregnancy, and STI prevention, testing, and treatment.

Which TPP project settings are appropriate for MI?

Any setting is appropriate for MI as long as your TPP project has the necessary resources (see above) and buy-in from the implementation partner. 

When thinking about whether MI is right for a given setting, consider all the angles. For example, it may be difficult to secure confidential space in a juvenile justice setting. However, the transient nature of juvenile justice settings may make MI a particularly good fit because MI does not require a specific number of sessions.

Do TPP projects implementing MI need to conduct fidelity monitoring?

Yes. Any TPP project implementing an EBP or evidence-based approach, including MI, needs to conduct fidelity monitoring. 

OPA defines fidelity as the degree to which a program is implemented with adherence to its core components (the key ingredients related to achieving the outcomes associated with the program model). By monitoring how closely your program sticks to the core components of MI, you can assess if MI is a good fit for your program and the extent to which MI is helping you achieve your project goals.

What does fidelity monitoring look like for MI?

To conduct fidelity monitoring of MI, your TPP project will need to collect the following information:

• MI session attendance
• Fidelity to the MI approach
• Overall quality of MI implementation

Observation is a necessary part of fidelity monitoring, so it is important to plan ahead and determine how your TPP project will approach MI observations. Direct observation of one-on-one MI sessions is possible but can be challenging given the confidential nature of the sessions. 

To avoid making participants feel uncomfortable, your project can consider observation through:

• Reviewing recorded MI sessions
• Watching mock MI sessions 

Mock sessions include an actual MI facilitator and either a staff member or adolescent role-playing as the MI participant. (Including adolescents in role-play may be an opportunity to enhance youth engagement in the program.) It’s recommended that observers assess whether the mock MI sessions reflect the spirit of MI, four MI fundamental processes, and OARS model.

For more information about fidelity monitoring, check out the Introduction to Fidelity eLearning. 

How can my TPP project ensure our MI is trauma-informed, age appropriate, medically accurate, and culturally responsive?

Make sure your staff participate in MI training that emphasizes these principles and focuses on implementing MI with youth. It’s also important for staff training to include skills practice on flipping concerns to goals, evoking change talk, and scaling questions. 

Creating a sense of safety, which aligns with trauma-informed practice, is part of the spirit of MI.

My TPP project wants to implement MI. What should we do next?

First, talk with your Project Officer to discuss how MI fits into your TPP project work. You will then need to follow the following steps:

1. Develop an MI implementation plan (including logic model) for your TPP project. Planning can help you understand and assess the resources needed to implement MI and move forward thoughtfully.
2. Set up training and fidelity monitoring plans.
3. Formally submit your request to implement MI to your Project Officer for approval. For submission requirements, please see OPA’s Evidence-based Teen Pregnancy Prevention Program Approval Guidance on Connect.gov.
4. Conduct MI training.
5. Pilot MI and make adjustments, as needed.
6. Implement MI with fidelity.

References

1. Bassett, S. S., Delaney, D. J., Moore, A. M., Clair-Michaud, M., Clarke, J. G., & Stein, L. A. R. (2022). Motivational interviewing to reduce risky sexual behaviors among at-risk male youth: A randomized controlled pilot study. Psychological Services, 19(1), 167–175. http://doi.org/10.1037/ser0000498
2. Miller, M. K., Catley, D., Adams, A., Staggs, V. S., Dowd, M. D., Stancil, S. L., Miller, E., Satterwhite, C. L., Bauermeister, J., & Goggin, K. (2021). Brief Motivational Intervention to Improve Adolescent Sexual Health Service Uptake: A Pilot Randomized Controlled Trial in the Emergency Department. The Journal of Pediatrics, 237, 250–257.e2. http://doi.org/10.1016/j.jpeds.2021.06.007
3. Motivational Interviewing Network of Trainers. (2021). Understanding Motivational Interviewing. http://motivationalinterviewing.org/understanding-motivational-interviewing
4. Tomlin, K., Bambulas, T., Sutton, M., Pazdernik, V., & Coonrod, D. V. (2017). Motivational Interviewing to Promote Long-Acting Reversible Contraception in Postpartum Teenagers. Journal of Pediatric and Adolescent Gynecology, 30(3), 383–388. http://doi.org/10.1016/j.jpag.2016.11.001
5. Tucker, J. S., D'Amico, E. J., Ewing, B. A., Miles, J. N., & Pedersen, E. R. (2017). A group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among homeless young adults. Journal of Substance Abuse Treatment, 76, 20–27. http://doi.org/10.1016/j.jsat.2017.02.008
6. Stevens, J., Lutz, R., Osuagwu, N., Rotz, D., & Goesling, B. (2017). A randomized trial of motivational interviewing and facilitated contraceptive access to prevent rapid repeat pregnancy among adolescent mothers. American Journal of Obstetrics and Gynecology, 217(4), 423.e1–423.e9. http://doi.org/10.1016/j.ajog.2017.06.010