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Friday, 14 October 2011

Where goes Motivational Interviewing After 'Payment By Results"?

I've had a fascinating three days working with some of the pilot Drug & Alcohol Services for Payment By Results (PbR). This is the government initiative designed to shift UK drugs services towards tying funding to an abstinence/recovery model accompanied by evidencing documentation - or in the words of the organisational mantra I came across "No TOPs, no clients, no job!". TOPs (Treatment Outcome Profiles) is the evidencing paperwork. Leaving aside the rights and wrongs of this policy switch within the drugs field, I'm particularly interested in it's implications for Motivational Interviewing training ( )

Most managers I talked to were worried that Motivational Interviewing (MI) would be swept aside by the new recovery model. It would be seen as irrelevant in the face of increased compulsion to abstain. I disagreed. PbR is interested in abstinence outcomes and on this basis MI is one of the few games in town.Few other approaches match it's researched outcomes. Plus in the current financial climate it's important to recognise that "a sprinkling" of MI is often sufficient to effect significant changes in outcome with moderate effect sizes. The issue becomes instead whether there is a sufficient MI lobby in the UK to argue it's undoubted virtues and it's invaluable contribution to outcome or whether MI is seen as an expensive extra ignored in a race to the bottom in terms of costs.

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