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Introduction: Implementing the Paradigms for Improved Outcomes

Posted on October 27, 2017

Connecting Paradigms: A Trauma-Informed & Neurobiological Framework for Motivational Interviewing Implement begins with the following statement:

Connecting Paradigms is written to fill a void in the social-work, psychology, educational, and public-health literature. It is a void that I felt all too powerfully when I left the halls of academia and entered the helping professions. This void, stated simply, is that I had no idea why my clients struggled the way they did or what my clients needed from me as a counselor, educator, case manager, or therapist to help them change behaviors that kept them trapped in cycles of violence, addiction, and extreme poverty. Connecting Paradigms ambitiously seeks a comprehensive answer to the who, what, and how of helping others live the best life possible.

In the hundreds of pages that follow, Connecting Paradigms, brings together knowledge on trauma and neurobiology with the practical application of Motivational Interviewing (MI) and other complementary approaches. With the questions of “who, what, and how of helping others” answered, we want to pull back from the focus on direct care presented in the book. Here we explore how the concepts presented in Connecting Paradigms: A Trauma-Informed & Neurobiological Framework for Motivational Interviewing Implement realize their full potential when implemented across programs, organizations, and entire systems.

Just as the paradigms of trauma-informed care, neurobiology, MI, mindfulness, and stages of change shift how we view work with clients, they also challenge how we conceptualize our programs, organizations, and systems. One therapist, outreach worker, medical professional, teacher, or helper with this knowledge affects the life outcomes of their clients, patients, and students with whom this work. Integrating Connecting Paradigms on a larger scale provides a common language, learning environment, outcome measures, and support that maximizes the effectiveness of entire systems of care. Correctly positioned, the paradigms, approaches, and concepts put forth in the book provide leaders and staff with opportunities to structure effective quality improvement processes, implement supportive and high-performance staff supervision, and help clients and staff achieve the outcomes they value.

The book takes considerable effort to demonstrate the challenges that clients face when making difficult life changes. It is easy at times to look at systems change as easy compared to a client trying to stop an addiction, leave an abusive partner, or change how they view themselves and world. All meaningful change is complicated and fraught with potential pitfalls and obstacles. While effective MI implementation might seem easy compared to the challenges facing our clients, the implementation of new ways of thinking and acting across groups of people adds a level of complexity that usually does not exist with an individual trying to make a life change.

In this series of posts, we take on some challenging but significant challenges. First, how does a program, organization, or system integrate knowledge and principles of trauma and neurobiology into their conceptualization of the people they serve. Second, based on this understanding, how do we help staff build competency in the skills and practices required to effectively assist clients to make difficult life changes and heal from trauma. Note: we will focus our attention here on the approaches presented in the book, however; the same implementation strategies are effective for the implementation of other skills or best practices. Third, how do we measure the outcomes of our efforts and utilize these outcomes to continuously improve the quality of services we deliver.

Next is a brief introduction to each paradigm that we will explore in detail throughout this series of post. Please note this series is designed to build upon the material presented in Connecting Paradigms: A Trauma-Informed & Neurobiological Framework for Motivational Interviewing Implement. We highly suggest that you keep the book close by for easy reference as you work through these posts. We will reference specific chapters and sections of the book throughout to keep our focus here are concise as possible.

Trauma-Informed Paradigm

In recent years, our knowledge of the effects of stress and trauma on human development, psychological and cognitive functioning, and behavior has increased dramatically. These scientific advancements call into question many of the traditional theories that have guided psychology, public policy, education, and healthcare. The trauma-informed paradigm will inform every aspect of the approaches presented throughout this series.

Motivational Interviewing

As with the book, Motivational Interviewing (abbreviated as MI) serves as the best practice model utilized throughout these posts. MI provides a set of skills, philosophies, and focus areas shown to be proven in a diverse range of settings regardless of the professional training of the helper implementing it. As demonstrated in the book, MI provides a structure to help clients heal from past trauma and make crucial life changes.

William Miller and Stephen Rollnick are the founders of Motivational Interviewing and have spent the last several decades developing it into the intervention presented here. The definition of MI has evolved over the years. In the most recent edition, Miller and Rollnick (2012) state:

Motivational interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.

Neurobiology

Neurobiology to provide a deeper understanding of the neurological processes that facilitate change and growth. In the book, the change focused on the clients. In this series, our knowledge of the brain will focus on how staff and system change the way they think and act.

Implementation Science

Implementation science is the study of processes that facilitate quality implementation of evidence based and research informed practices and programs. Implementation science began in the medical field and is now an evidence based practice itself, prolifically used and studied in early childhood education, social sciences, prevention, and criminal justice fields, to name a few. There are many different implementation frameworks and paradigms, and research is plentiful. You can find additional links about implementation science at the end of the post and in future posts in this series.

Quality Improvement

The quality movement started in the manufacturing world and has spread to other industries including the helping professions. I have written a series of past post on this subject and will include those links at the end of this post. For an introduction, quality improvement is the planning, implementation, and assessment cycles used to determine if services are successful, finding areas for improvement, and taking actions to realize those opportunities.

Supporting Paradigms

Like the book, our primary focus here concerns the implementation of trauma-informed care and MI. We will mention some of the other approaches that played a critical supporting role in the book. The stages of change model provides a context for understanding both the process and neurobiology of change and how we can position our change efforts to maximize system effectiveness. Harm reduction offers a philosophic foundation supporting the application of MI skills and approaches, which also align with trauma-informed principles. Finally, mindfulness presents as a set of skills that heal the neurobiological damage of trauma and establish the focus necessary for realizing difficult changes.

Implementational Science Links:

https://implementationscience.biomedcentral.com

https://globalimplementation.org/

http://www.coloradoimplementation.com/

http://implementation.fpg.unc.edu/

http://www.episcenter.psu.edu/

https://militaryfamilies.psu.edu/

http://www.blueprintsprograms.com/

http://cfirguide.org/constructs.html

http://www.effectiveservices.org/work

http://implementationleadership.com/measures.html

https://www.rand.org/health/projects/getting-to-outcomes/documents.html