Child Risk and Parental Resistance: Can Motivational Interviewing Improve the Practice of Child and Family Social Workers in Working with Parental Alcohol Misuse?

Note: This report was funded and/or written by our predecessor organisation, the Alcohol Education Research Council (AERC).

Local authority social workers for children and their families deal with large num­bers of parents who have alcohol problems. Research shows that they have par­ticular difficulties when trying to work with parents who deny or minimise the amount they drink. Motivational interviewing is a counselling method developed for working with people who have a drink or drugs problem. A particular focus of motivational interviewing is on working with “denial”, so it seems likely to be helpful for social workers in their work with parents who misuse alcohol.

However, there are challenges involved in training social workers motivational interviewing. Firstly, we do not know much about the process of training social workers in such skills. Thus, there are questions about the starting level of their skills, the best format for improving their practice and the relative impact of training and follow-up input such as consultations or supervision. Secondly, while motivational interviewing is of proven effectiveness in a range of settings, there are particular challenges in child protection social work that make using counsel­ling skills difficult. For instance, how can motivational interviewing skills be used to when one is telling a parent that one believes a child should be removed or assessing whether their drinking is harming their child’s welfare? There is remark­ably little research on how these difficult conversations can be managed, and we therefore can not be confident about how motivational interviewing might be used in such situations.

The study explores these areas. It is interested in three main questions:

1. Does input around motivational interviewing make a difference to social workers’ skills?
2. What helps and what hinders skill development?
3. What is the impact of using motivational interviewing skills in practice?

The study provided a Z-day training workshop for 35 social workers and 5 manag­ers from seven London local authorities. Before and 3 months after the training participants’ skills and attitudes were measured through:

• Asking participants how they would respond to various casework situations and rating the answers.
• Standardised measures of attitudes to working with alcohol misuse.
• Social workers’ descriptions of the cases that they were currently working with.
• Qualitative descriptions of current work and the impact (if any) of the train­ing.
• In addition, after the training we recorded a session with a “simulated cli­ent” (i.e. someone acting as a parent with an alcohol problem) and rated participants for skill in motivational interviewing. This was undertaken for 34 social workers.

We were also interested in the contribution of additional supervision and/or group discussions in promoting skills development, as previous studies have found this to be particularly important. We therefore randomly assigned half of the group to receive extra input; the others received no support between the workshop and the follow-up interview.

• Improving the communication skills of social workers in working with pa­rental alcohol misuse is an urgent priority. The poor listening skills and high levels of confrontation demonstrated by most participants prior to training were a surprising and striking finding.
• The confrontational style identified pre-training points to the possibility that social workers may inadvertently be contributing to the resistance that they describe as such a problem in their work with this client group. It is always likely to be difficult to talk to someone about the impact of their al­cohol problem on their child; if workers have not been taught how to listen empathically it is likely to make the discussion even more fraught.
• A 2-day workshop in motivational interviewing had a significant positive impact on the practice, knowledge and confidence of participants. This is an important positive finding. Some significant improvements in listening skills and reductions in confrontation can be achieved through even a brief training intervention.
• The lack of support for skills development in workplaces was surprising. In particular the lack of involvement of line managers in developing the skills of practitioners was of concern, as this group appear key in supporting the transfer of skills learnt in training into practice.
• The provision of telephone supervision and group consultations was not ef­fective, and participation was poor. Further work on what might help so­cial workers in transferring skills from training into practice is needed. A programme of follow-up days and/or training for supervisors are possible approaches to this issue.
• The study provided evidence that USing listening skills improved social work­ers’ relationships with clients and their satisfaction with their work. This did not need to be as high level a skill as “motivational interviewing”: for many participants it was relatively simple skills, such as using open ques­tions or reflections, that seemed to help improve relationships.
• There was nonetheless some encouraging evidence for the potential contri­bution that motivational interviewing might make as a method to be used by child and family social workers. However, more research is required on how participants can achieve skilfulness, on how skilful practitioners negotiate practice dilemmas and on whether outcomes for parents and children are improved.