Transcript for Episode 85: How To Reach Special Populations with Motivational Interviewing
NASW Social Work Talks Podcast
Announcer:
This episode is brought to you by Pacific Oaks College: Experience That Impacts Community. Learn more at pacificoaks.edu.
Greg Wright:
Welcome to Social Work Talks. I am Greg Wright. Vaccines have proven to be the main tool we have to end the threat of COVID-19. Today, we talk to experts about how social workers can use motivational interviewing to inform clients about vaccines, and how social workers can get vaccine information to harder-to-reach special populations. Our guests are Dr. Gwen Bouie-Haynes, Executive Director of the NASW Mississippi Chapter, and Special Population Coordinator on the Connect to End COVID project. And our second guest is Dr. Mary Velasquez, a professor and director of the Health Behavior Research and Training Institute at the University of Texas at Austin Steve Hicks School of Social Work. Dr. Velasquez and Dr. Bouie-Haynes, welcome to Social Work Talks. How are you?
Mary Velasquez:
Doing well, thank you. Thank you for having us.
Gwen Bouie-Haynes:
Thank you. Doing well, Greg.
Greg Wright:
Yeah. Yes. Thank you. So before we get into our conversation about motivational interviewing and special populations, I want to talk about a Connect to End COVID initiative. It's a CDC-funded program, but Dr. Velasquez, I wanted to ask you a bit about what it is and who's involved in it.
Mary Velasquez:
Sure. Yeah. Thanks Greg. So the CDC is connecting with professional groups around the country. So NASW is actually a wonderful fit. NASW and our Health Behavior Research and Training Institute in the Steve Hicks School of Social Work in Austin have been funded by the CDC to work together on building confidence in COVID-19 vaccines. So basically what that means is helping people understand that the vaccines work, they're safe, and they're part of a trustworthy medical system. We're especially focused on vulnerable populations, which Dr. Gwen will talk about, but including children, pregnant people, immigrants, and refugees, and states with low vaccination rates.
Mary Velasquez:
As the folks listening to this podcast know, social workers are essential to this effort. Social workers are one of the largest groups of behavioral health providers that actually they are the largest group of behavioral health providers and social workers work in a broad range of settings from hospitals, mental health centers, to schools and correctional facilities. Basically we're working on a bunch of different fronts to engage social workers, and that includes training them in motivational interviewing, which we call MI often and screening and brief intervention that's known as SBIRT. So it's basically screening, brief intervention, and referral to treatment if needed.
Mary Velasquez:
Basically, Greg, key to our effort is the belief in the social work ethics of patients' rights to self-determination and autonomy. So we're not looking at forcing anyone to get vaccinated or coercing anyone to be vaccinated, but rather we want to empower social workers to have informed evidence-based conversations with clients to help them make their own decisions about COVID vaccination and motivational interviewing and the SBIRT model we felt works really well to do that.
Greg Wright:
Yeah. So there's a sentiment now that the pandemic is easing, that it isn't as bad off as it was a year back, or even two years back at this point. But is there a reason why, even though there's a sense that we're at a better place now that vaccines are still important?
Mary Velasquez:
Yeah. That's a good question. I would say we're in a phase now where many people are thinking the pandemic is over, but getting vaccinated and staying up to date on vaccines are still crucial to keep ourselves and our loved ones safe. So we may be done with the virus, but it's not done with us. There've been over a million deaths in the US due to COVID-19 and the most recent variant BA.2, I think that's what it's called is even more contagious than the Omicron variant.
Mary Velasquez:
Particularly salient for social workers, we also know that certain mental health conditions such as mood disorders, schizophrenia and substance use disorders for sure are linked to more severe COVID illnesses. So the very populations that social workers often work with are the most vulnerable to COVID. And then there's also a concern about long COVID and long COVID may affect as many as 30% of people who've gotten sick, most of whom, again, have had mild or moderate illness, but then this long COVID can cause a difference, confusion with sort of thinking, fatigue and for a subset of people, maybe even up to a third, this long COVID is problematic. Vaccination reduces the risk of getting COVID and again, of course, the risk for long COVID.
Greg Wright:
Thank you. Dr. Bouie-Haynes, what is a special population exactly? And I want you also to talk about you are in a Southern state that has a vaccination rate that's lower than, I guess the national average is. So if you could address what a special population is and how that's playing out down in Mississippi.
Gwen Bouie-Haynes:
Thank you for that question. I'd like to define a special population as a group of people, perhaps that have to overcome barriers to accessing certain resources that might be aligned with this project. So in essence, special populations can be defined as groups of people, such as those that Mary has already mentioned. And those include children, adolescents, or young adults, pregnant persons, people who are unhoused, rural communities, and marginalized groups of people.
Gwen Bouie-Haynes:
So with special populations, you sort of think of special populations from the same vantage point that you might be thinking about some systemic issue, some issue that people have a barrier or a challenge to accessing. And one such issue might be compared to that of systemic racism, for example. So special populations in this instance would be the pandemic, in terms of COVID-19, people having difficulties accessing resources within their own individual communities.
Gwen Bouie-Haynes:
In the State of Mississippi in the early height of the COVID-19 pandemic, Mississippi was at the top of the scale in terms of the state with a low vaccine uptake. And currently, now, Mississippi is looking a little better at about 40%, however, and it's going between 40 to 50 depend on the community of people that you're looking at. For example, in the State of Mississippi, we have a Native American community of people where there is a very high, low vaccine uptake within that community. We have rural communities that have a low vaccine uptake within those communities as well.
Gwen Bouie-Haynes:
So those are just some examples. And needless to say, even with the homeless community of people that are unhoused across communities of Mississippi, they're also one of the groups of people that's still being impacted by the pandemic. And I think it's significant in that this is such an important training for states like Mississippi and other Southern states, particularly from the vantage point that we are giving people that opportunity, especially social workers to reach out to those individuals, families, those groups, organizations, communities, to help with informed decision making, which is essentially the crux of this particular initiative. And so I think it's been very impactful in Mississippi in terms of the training. However, with the pandemic itself, we are still in a very high risk area because not all of our people in our state have been vaccinated. And I think it's still a lot of work yet for social workers in the state.
Greg Wright:
What I wanted to ask both of you are, what are the reasons why a person is hesitant to take a vaccine? Now I want to tell you a story. I was looking at a property to buy and the real estate agent was a college-educated black man. He was around 40. He had on a mask. So I asked him, "Are you vaccinating?" And he said, "No, because I don't want them to put poison into my body." So it really surprised me that a college-educated person in a state of where like I am, where our vaccination is over 75% that there's still hesitancy out there. So I wanted to ask both of you, what are you hearing from folks? Mary, if you want to go first.
Mary Velasquez:
Sorry about that. Yeah, I think there's a lot of misinformation out there and also what we would call disinformation. And obviously people need to make their own choices. Some of the things, I mean, we've heard everything from a COVID vaccine could put a chip into your body to women won't be able to get pregnant or it affects a man's fertility. That's not factual, but it certainly is out there. So the conversations that we're encouraging social workers to have with clients is to really try to dispel some of those myths. As Dr. Gwen and I know, to be honest, there's some social workers out there that sort of have the same beliefs. So our task, when we talk with them using motivational interviewing and SBIRT is just to really listen well, provide them with factual information, and then let them make their own decision about whether or not to be vaccinated. I don't know, Dr. Gwen, you may have another-
Gwen Bouie-Haynes:
Yeah. I agree with the misinformation, Mary. I think it's very important that we continue to educate communities and particularly people that social workers work with across communities, because there are so many things out there regarding the vaccination causing birth defects. And so it's a lot of miscommunication regarding that pregnant population of people that we want to certainly distill and make sure that people understand that's not exactly the truth behind the vaccination.
Gwen Bouie-Haynes:
One of the things that I know social workers are hearing is they're hearing some things that there are social determinants out there, those things regarding housing, income, educational levels, those kinds of things that might be impacting whether people make a decision or not. Geographical locations might be one of those other social determinants of help that people sort of have in their mind. Social media is a big issue out there, because there's a lot of information that's put out there without any evidence-based backing behind the information. So I think the trainings that are being provided as part of this initiative, and Mary is one of the lead trainers with the initiative, that it's absolutely impactful and imperative for educating communities.
Greg Wright:
I want to get into the issue of motivational interviewing now, Dr. Velasquez. And I wanted to ask you, what is it? And you're also using a term called SBIRT. If you could get more into that.
Mary Velasquez:
Sure. Yeah.
Greg Wright:
What that means.
Mary Velasquez:
One way that social workers can educate clients about COVID is through using motivational interviewing. Basically motivational interviewing is a collaborative conversation style. It started out as a counseling strategy, and again, it's still a counseling strategy, very evidence based, but the idea of motivational interviewing is it strengthens a person's own motivation and commitment to change. So again, it has a very strong evidence base. Most social workers know about motivational interviewing and hopefully have some training in it because most of our schools are integrating it. I teach two sections of it each year and it fills quickly. The master students really, I think enjoy it. And when they get out, they practice it.
Mary Velasquez:
Basically, it works on exploring and resolving a person's ambivalence by evoking their own reasons, desires, and their ability to change. So it was first developed as sort of a way to talk with clients about substance use behaviors. And as the evidence grew to its effectiveness, MI began to be used to address a variety of health behaviors and the evidence base, again, for its use in these situations continues to grow. It's used sort of worldwide and it's very congruent and fits beautifully with social work and social work ethics because it recognizes the true power for change rests within the client.
Mary Velasquez:
So by working collaboratively, the social worker, the provider helps guide the person to consider how a change might fit within their own values and what they want for themselves. So basically it emphasizes client autonomy, which is why we think it's such an effective approach for us in talking with folks about the COVID vaccine, because we know no one wants to be pushed or coerced or argued with around their own decisions around health. So motivational interviewing is the foundation of the model that we're sharing with social workers on how to conduct conversations around the COVID vaccine and because we're so sensitive to the demands that social workers face. Especially with the impact of the pandemic on ourselves and the clients we serve, we wanted to provide a model that could be easily incorporated into typical client interactions because, let's face it, social workers have been on the front lines of this pandemic for the longest time.
Mary Velasquez:
So we adapted the motivational-based screening and brief intervention and referral to treatment. So the SBIRT model, which again, has a lot of evidence behind it, particularly around conversations in healthcare settings with patients. So it has a lot of evidence and it was originally designed for busy healthcare providers in medical settings to use sort of as a guide. So it can be even a seven to nine-minute interaction, yet it's a highly effective conversation with patients around behavior change.
Greg Wright:
Yeah. So if I'm a patient and I come in and there is a social worker in that healthcare facility, how would the social worker interact with me to have a conversation about vaccines that would be empowering to me?
Mary Velasquez:
Yeah. Basically, initially there's a screening question. So the social worker is provided with some information about whether you've been vaccinated, whether you have thoughts about being vaccinated. So we sort of assess a person's stage of readiness to change. And then because motivational interviewing is focused on resolving ambivalence, the social workers, they use that to discuss maybe the challenges the clients have around, like you said, some of the myths or the fears around it. They discuss maybe referral and participation to another either a place to get the vaccine. But basically, there's five steps to it. So it's sort of starting the conversation. It's looking at decisional balance.
Mary Velasquez:
So Greg, and obviously this is made up, but on the one hand, you've told me that you have some concerns about becoming vaccinated. Your partner is really sort of fearful about the vaccine. So those are some of the concerns you have. And on the other hand, you told me that you want to keep your parents safe. You've got elderly parents. You don't want to lose time at work. And so there's sort of this decisional balance. So in motivational interviewing you really, you look at both sides of what we call the decisional balance and it elicits what we call change talk. And so you sort of listen for any reasons for change, and that's what you reflect back to the person. So it's really very skill based and it does require a pretty fair amount of training. Like for example, with Dr. Gwen's group, we did, I think seven hours of training around this.
Mary Velasquez:
Then we provide information, but we always ask, would it be okay if we give you some information about the COVID vaccine? So we provide information and then we ask them, so what do you make of that? How does that fit for you? And then if they're ready to make a change plan, we help them make a change plan and help refer them or direct them to a place to go, to get the vaccine. If they say they don't want the vaccine, we say, thank you for talking to us. If you change your mind, or you'd like to have more information or more conversation, please feel free to come back to us. Because what that does is it plants a seed. Even if someone says they're not ready, you're kind of planting that seed and you're giving them factual information because as we all know, change often happens between sessions or after a session.
Announcer:
More than ever social workers are needed to support children and families as they address the challenges of everyday life. You can help by pursuing a career in social work at Pacific Oaks College online. Our bachelor and master of social work programs, combine online training with hands-on field experience in your local community. Pacific Oaks College, Experience That Impacts Community. Learn more at pacificoaks.edu.
Greg Wright:
Social work is like so nuanced because I'm looking at it as a laymen and I'm looking at the news, I'm like, take it, take the vaccine, but you can't do that. You have to be caring, patient. And that's a lot of training learning that, seven hours. Quite a bit.
Gwen Bouie-Haynes:
I want to jump in here, Mary, and just maybe offer an additional comment to what you've mentioned about social workers, this being really a good intervention to use with clients. And it is an excellent intervention to use with clients because essentially it fits the framework of meeting the client where he or she is, essentially allowing the client to process and identify solutions to their own decision, rather than someone coming in to tell the client what to do.
Gwen Bouie-Haynes:
And you're exactly right, Greg, it does require a lot of skill and a lot of work to get adjusted to using motivational interviewing because you are helping to guide that decision. And you're not really telling the client how to make that decision, but the essential framework here is that it supports what social work focuses on. And that's the generalist intervention model of assessing, allowing the client to assess, intervening with the client, then providing some level of support through intervention and evaluation. I think that's absolutely essential here. Our training was really done well, and Mary was the leader with that training, but it does take a lot of skill to do MI and also SBIRT.
Greg Wright:
Where is this training available? I mean, is it online, is it at a Connect to End COVID website, or is it on a university level? Do I have to take a course in other words, in order to do it?
Mary Velasquez:
The CDC has funded NASW, which in turn funded Chapter. So the chapters had to apply for the training and get accepted. And I think, Dr. Gwen, you were the first group to be trained, I think. And so we're doing it that way. I'm really grateful to the CDC. It's almost like they're just staying one step ahead of the science too, right? This whole COVID thing is new to us. So the CDC, I think, was very smart to reach out to social workers, because again, you are the biggest group of mental health and behavioral health providers. We did a webinar, so there's a webinar that's available through NASW. It's about, I think, an hour long. So social workers can take advantage of that. There are also courses in SBIRT that are sort of, you could maybe even Google it and get a little brief introduction to SBIRT, but to really do it and do it well, you really want to incorporate the motivational interviewing and that does take some real skill. So NASW has been wonderful about offering these trainings to the various chapters.
Greg Wright:
Dr. Bouie-Haynes, I want ask you another question about a special population. You've actually said that it includes women who are pregnant, people who are unhoused, people who are living with a mental illness. So when you are reaching out to them, are you having to develop strategies for each one? In other words, it's not like a one-size-fits-all thing at all.
Gwen Bouie-Haynes:
Right.
Greg Wright:
I was wondering if you could speak on that for us.
Gwen Bouie-Haynes:
Good question. One of the things that chapters did across the state, there is a five-step tool process where they start to look at their own individual community. Where are those environments where social workers work? And so we know that social workers are in essentially just about every community where people are being served, whether it's in some of the nursing homes or skilled care facilities, or whether it's childcare, domestic violence, any number of settings, social workers are located. So we wanted to find out from there, then based on those populations of individuals, what might your state be saying about special population in terms of the data? How does the data support what we are saying regarding special populations?
Gwen Bouie-Haynes:
So you use various means to get that data, whether it's your local health department, CDC has just a wealth of resources there as well. And then you start to look at that data and you're teasing out from there, okay, I see maybe that we have racial and ethnic groups of people in Northeast, Mississippi. And so then you start looking for those social workers that work with communities of people, whether it's black African-Americans, whether it's Native Americans. You're looking at people of color within that community. Are there social workers? Are there licensed social workers at facilities? And then you are intentional about your outreach and what you do to reach those social workers in those communities.
Gwen Bouie-Haynes:
Is it necessary to say, oh, we want to do motivational interviewing and SBIRT training? No, that's not exactly what we do. We're saying to them that NASW Foundation and also the Steve Hicks School of Social Work is involved in an initiative that we would love for you to be a part of. And it helps to support social workers, making informed decision making, and also encouraging their clients to make informed decision making. This is what it looks like. It involves. So we actually give the information in that way to support people, wanting to be a part of the actual training. And I think thus far, it has worked very well with us going from different states and using that five-step process, very simple to identify where do you get your social workers? Where do you find people? And then how do you get them to these trainings across communities is really, really essential in how we identify these special populations.
Greg Wright:
Thank you. So a final question, and it's actually been a wonderful conversation. I am aware of the grant, but it's a different thing hearing it from all of you. So a year from now in our pandemic, what is your hope, Dr. Velasquez and Dr. Bouie-Haynes, where we should be in another year? Because I'm really tired of being at home. I want to get out. I want to live. So your thoughts please.
Mary Velasquez:
We all do. We sure do. I just wanted to add just related to your last point. We have been doing these trainings on Zoom. Initially, we planned to do them in person. There's not anything that substitutes for personal interaction in training, but it's actually worked quite well on Zoom because of the connections we have with the chapters and with the chapter leads like Dr. Gwen.
Mary Velasquez:
So what do we hope we'll achieve as we continue into this, I guess we're the third year of COVID-19? I think we hope that everyone stays up to date on their COVID vaccines. So that means sort of getting all the recommended doses in the primary series and getting your booster when you're eligible to do that. We do know that the science is showing us that the vaccines are safe for everyone aged five and over, and hopefully very soon children under five as well.
Mary Velasquez:
So I kind of think the bottom line is that the vaccines are the best tool we have to prevent hospitalization and death. We've had over a million deaths now. Vaccinated and boosted people are 41 times less likely to die of COVID than unvaccinated individuals. And staying up to date will help protect us sort of against and treat COVID. And I have to say, I don't know about you all, but I've had COVID and it was quite a surprise that I had it, but I was vaccinated and boosted, and it was actually very, very mild. And so I'm a strong proponent, we are strong proponents for those vaccines and boosters.
Greg Wright:
Thank you. Dr. Bouie-Haynes, your hopes.
Gwen Bouie-Haynes:
Yeah. I'd like to just add to what Mary has said. I think it's really important as we enter into this third year that we not lose the momentum that we have already gained, and that momentum is essentially being sure that we keep social workers at the forefront of this whole initiative that we are doing now. But more importantly, across this country that we ensure that we are continuing the safeguards in terms of hand washing, hygiene, the vaccination, being sure that we keep those things out there, and also being sure that we get boosted. I have not had COVID and none of my family members. And so we are trying to be really safe and cautious. Everyone is vaccinated and we are fully boosted as well, but I know that the pandemic is not over and it's going to take each of us ensuring that we reach across where we are normally not very comfortable, that we continue to reach across communities to ensure that no one is left behind.
Greg Wright:
Thank you, Dr. Velasquez.
Mary Velasquez:
Very good points. Very good.
Greg Wright:
Yes. Yes. Excellent ones. Dr. Velasquez and Dr. Bouie-Haynes, thank you for being our guests on NASW's Social Work Talks. Thank you so much.
Announcer:
You have been listening to NASW Social Work Talks, a production of the National Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development of our members to create and maintain professional standards and to advance sound social policies. You can learn more at www.socialworkers.org. Don't forget to subscribe to NASW Social Work Talks wherever you get your podcasts. Thanks again for joining us. We look forward to seeing you next episode.