The Benefits of Motivational

Interviewing and Coaching for

Improving the Practice of
Comprehensive Family Assessments
in Child Welfare
Elizabeth H. Snyder The engagement of families in child welfare
Center for Child and Family services is critical for successful outcomes
Policy, Duke University
related to safety, permanency, and child and
C. Nicole Lawrence family well-being. Motivational interviewing
Center for Child and Family (MI), an effective approach to working with
Policy, Duke University individuals struggling with alcohol and drug
addiction, has great appeal for use with fam-
Tara N. Weatherholt
Center for Child and Family
ilies involved with the child welfare system.
Policy, Duke University Consequently, many social service agencies
are beginning to integrate MI into their
Paul Nagy training curriculum. However, research has
Department of Psychiatry shown that training in MI alone is not
and Behavioral Sciences,
Duke University
enough; ongoing coaching is crucial in order
to transfer learned MI skills into practice. The
current study employs qualitative interview data from case-
workers in order to examine the implementation of MI and
long-term coaching within the child welfare system. Findings
showed that MI can be implemented successfully within the
child welfare system, and that caseworkers believed MI, sup-
ported by ongoing coaching, to be a valuable tool in engaging
families in the assessment process.

Child Welfare • Vol. 91, No. 5 9

Child Welfare Vol. 91, No. 5

n 2004, the findings from the initial federal Child and Family
I Services Review (CFSR) demonstrated a clear need for more
accurate and comprehensive assessments of the strengths and needs
of the children and families served by the child welfare system. In
response, the Administration for Children and Families (ACF)
requested that its federally funded National Resource Centers
develop “Comprehensive Family Assessment (CFA) Guidelines” to
serve as a resource for states in 2005. In a further effort to assist
state and local child welfare agencies in improving the quality of
their family assessments and the related outcomes of safety, per-
manency, and well-being, ACF funded five demonstration projects
in 2007 to use the CFA Guidelines as a framework for improving
child welfare practice.
This study is part of the process evaluation conducted for one of
the five demonstration sites: Alamance County, North Carolina.
Alamance County used the CFA Guidelines to develop and imple-
ment a comprehensive family assessment process, which is com-
pleted in partnership with families from the initial intake report
through in-home services (their demonstration currently does not
extend to foster care services). This continuous assessment process,
utilizing multiple sources, is hypothesized to facilitate the appropri-
ate and prioritized identification of needs and corresponding serv-
ices that would impact a family’s ability to care for their children.
However, in order to develop and implement a comprehensive fam-
ily assessment process, a systemic change in agency culture and prac-
tice must occur. Specifically, how the agency and its staff engage and
build relationships with families and community partners must be
at the core of this change.

Acknowledgements: This work was supported by an evaluation grant to the Center for Child and Family Policy
at Duke University from the Alamance County Department of Social Services. The “Developing, Implementing
and Evaluating a Comprehensive Family Assessment to Improve Child Welfare Outcomes” demonstration ini-
tiative was funded by the Administration on Children, Youth, and Families, U.S. Department of Health and
Human Services. Points of view or opinions in this paper are those of the authors and do not necessarily repre-
sent the official position or policy of the sponsors. The authors wish to acknowledge the important role of Steven
Frenk for his assistance in collecting the data, and the social workers who participated in the interviews.

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Snyder et al. Child Welfare

The association between family engagement and more positive

child welfare outcomes has been supported through studies of the
client-worker relationship. For example, an evaluation of a family
reunification program found a positive association between workers’
perception of a strong alliance and family permanency outcomes
( Jenson, Pine, Spath, & Kerman, 2009). In a study of the client-
worker relationship in child welfare cases, Lee and Ayón (2004)
found that better parent outcomes, such as improvement in disci-
pline and the emotional care of children, were associated with higher
parent-reported satisfaction within the client-worker relationship.
Studies such as these illustrate that a strong relationship between
families and social workers can lead to more effective intervention
by child protective services.
Although the importance of engaging families in social services
has long been advocated for and established through research, little
is known about how to truly support workers to facilitate it in prac-
tice. Additionally, there are inherent challenges in working with fam-
ilies involved in the child welfare system. Caregivers are under
scrutiny, creating feelings of anger, guilt, sadness, and frustration, all
of which add a layer of complexity to the client-caseworker relation-
ship and can undermine engagement efforts. In addition, child wel-
fare is generally not voluntary, meaning that parents often do not
recognize that a problem might exist or prepare themselves for
needed changes. Because this difficulty exists as soon as a maltreat-
ment report is received, family engagement may seem like an unrea-
sonable expectation. However, if state and county child welfare
agencies are to meet the needs identified by the CFSRs, bold efforts
to comprehensively train and support workers to engage families to
better support their motivation and efforts to change are needed.
Prochaska and DiClemente (1992) emphasized the need to view
change as a process, not an event, in their model of behavior change,
“Transtheoretical Stages of Change.” Application of this model to
work with families in child welfare could help caseworkers to engage
and partner with families at their developmental level of readiness
and motivation. Their model emphasizes the need to meet families

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where they are in the change process, rather than where others might
expect them to be for optimal results. Altman (2008) found that both
workers and parents reported that motivation to change was a chal-
lenging but necessary component to engagement. However, a study
by Pecora (1989) found that the single greatest skill deficit identified
by caseworkers was “knowing techniques for motivating a client to
change.” Thus, while it clearly is acknowledged that motivation to
change is essential, the knowledge of how to best support child wel-
fare workers to facilitate it is largely absent. In addition, it is impor-
tant to note that this is often in stark contrast to the demands of child
welfare work, where state policies and timelines dictate that change
on the part of families must often occur very quickly.
One therapeutic method that has shown major success in target-
ing the change process in the treatment of substance abuse (Bien,
Miller, & Boroughs, 1993; Brown & Miller, 1993), smoking cessa-
tion (Colby et al., 2005), and weight loss (Carels et al., 2007) is
Motivational Interviewing (MI). MI is defined as “a client-centered,
directive method for enhancing intrinsic motivation to change by
exploring and resolving ambivalence” (Miller & Rollnick, 2002, p.
25). Through the development of an empathic and collaborative rela-
tionship with the client, the interventionist seeks to increase “change
talk” while emphasizing client autonomy. The goal is to evoke the
client’s own motivation to change (Miller & Rollnick, 2009).
The use of MI practices by social workers with families involved
with a child maltreatment report is a logical extension given the high
rate of substance abuse in child welfare caseloads (Hohman, 1998).
Recently, MI has been applied to work with families involved in the
child welfare system or who are at risk of entering the child welfare
system. Damashek, Doughty, Ware, and Silovsky (2011) examined
enrollment and retention rates of families at risk for child maltreat-
ment in two home-based intervention programs, SafeCare (SC+),
and Services as Usual (SAU). The two programs differed on several
program and provider level variables, including the addition of MI
in SC+. Findings showed that families randomly assigned to receive
SC+ were more likely to both enroll in and complete services than

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Snyder et al. Child Welfare

families in the SAU program. While the authors were unable to sta-
tistically attribute the difference to individual components of SC+,
they did conjecture that the use of MI may have enhanced service
completion. A recent pilot study examining caregiver engagement in
a parenting program found that parents who received brief MI were
more likely to attend at least one workshop program than parents
who did not receive brief MI (Sterrett, Jones, Zalot, & Shook, 2010).
Nock and Kazdin (2005) developed a Participation Enhancement
Intervention (PEI), composed of motivational interviewing tech-
niques and components to use with parents of children with diag-
nosed behavior problems. Comparisons between the use of PEI and
a widely used treatment, Parent Management Training (PMT), found
that PEI was associated with significantly greater treatment adher-
ence and parental motivation to change parenting practices. Studies
conducted by Chaffin and colleagues (2009, 2010) found that MI
combined with a parenting program, improved retention and
decreased recidivism with a group of parents who had prior child wel-
fare referrals and whose starting level of motivation was low to mod-
erate. However, Mullins, Suarez, Ondersma, and Page (2004) did not
find improved retention rates in a MI intervention among substance
abusing mothers involved with child protective services. It is impor-
tant to note that this body of research has focused on programs and
service agencies working with families referred by CPS, not on the
child welfare social workers working directly with these families to
assess reports of maltreatment and develop a case plan.
In order for MI to be successfully implemented, caseworkers must
be effectively trained in MI techniques and provided with ongoing
support to utilize these newly acquired skills in their daily practice
(Fixsen et al., 2005). The traditional training for MI is a one- or two-
day workshop, as reported by Miller and Mount (2001). In their study
of the effectiveness of such training, the skillfulness attained and
maintained by clinicians was examined. The results showed that
immediate post-training gains through self-report were acquired,
whereas an observational method concluded more modest gains in
MI skills and little reduction in MI-inconsistent behaviors. Moreover,

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the gains in MI skills that were seen post-training were not main-
tained at a four-month follow up. While other research has also
shown that training alone is not sufficient enough for the successful
transfer of skills into actual continuous practice, combining initial
training with ongoing support or coaching significantly enhances the
implementation of the skills learned during training (Henry, Strupp,
Butler, Schacht, & Binder, 1993; Joyce & Showers, 2002; Sanders,
Prinz, & Shapiro, 2009).
The addition of coaching provides learners with opportunities to
discuss issues and problems that occur during real-life implementa-
tion. The provision of feedback and modeling from a coach enables
learners to readjust and improve their practice. Joyce and Showers
(2002) conducted a meta-analysis of the effects of training and coach-
ing on teacher’s implementation of newly learned skills in the class-
room. Results from their analysis showed that the training
components of theory and discussion and demonstration of skills in
training did not result in the later demonstration of new skills in the
classroom by participants (0%). The training component of practice
and feedback in training led to later use of new skills in the classroom
by 5% of training participants. However, when coaching in the class-
room was provided after the training, 95% of participants demon-
strated later use of new skills in the classroom.
Forrester and colleagues (Forrester, McCambridge, Waissbein,
Emlyn-Jones, & Rollnick, 2008) evaluated the effectiveness of a two-
day MI training to add skills and change the practice of social work-
ers in working with parents showing alcohol misuse. In addition to
the two-day workshop, post-workshop supervision for three months
was offered to some participants in the form of three individual tele-
phone sessions and group consultations. The findings from this study
indicated that the added supervision did not increase MI skills com-
pared to the social workers in the workshop-only group, although the
three participants with the highest overall MI skill scores were in the
workshop-plus-supervision group. The authors noted that participa-
tion in the supervisory sessions was very low, and was reportedly due
to the difficulty of focusing on phone sessions in the office and lack

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of time for group sessions. This study highlights the importance of

the design of the supervisory or coaching component used in com-
bination with MI for social workers. Utilizing a randomized con-
trolled trial (RCT) with substance abuse professionals, Miller and
colleagues (2004) examined the individual and collective impact of
feedback and coaching on MI skill acquisition and found that both
of these supports significantly improved their skills.
Given the promising findings regarding the use of MI with par-
ents involved in the child welfare system, Alamance County chose to
utilize MI as part of their CFA process to serve as the vehicle to
increase family engagement in order to obtain a truly comprehensive
assessment. In addition, the studies regarding “spray and pray” train-
ing methods make clear that in order to achieve beneficial outcomes
for both clients and caseworkers, implementation requires a longer-
term, multilevel approach. As such, an integral part of the Alamance
County CFA model included the hiring of a full-time clinical coach
to ensure that caseworkers’ newly acquired MI skills would actually
be translated into practice. In addition to Alamance County, other
jurisdictions have also begun to utilize full-time coaches. For exam-
ple, the state of Washington has utilized coaching to help implement
solution-focused case planning on a statewide level (Marcenko,
Newby, Lee, Courtney, & Brennan, 2009). Utilizing 12 full-time
coaches, their model also involved initial trainings proceeded by long-
term ongoing coaching.
To date, few studies have examined MI training with the addi-
tion of coaching, and none have explored this method for use by
social workers to engage families in child welfare cases (Barwick et
al., 2012). Maxwell and colleagues (2012) conducted a qualitative
study of father engagement training in child welfare, of which MI
was a component. However, the training was only two days long
and did not involve ongoing coaching. Furthermore, interviews with
participating social workers were conducted only three weeks after
the brief training; thus, information regarding implementation over
time was not obtained. The current study is the first to examine the
implementation of MI training combined with long-term, on-site

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coaching in order to prepare and continuously support casework-

ers to use MI with families involved in child welfare services.
Typically, studies conducted within the context of child protec-
tive services focus on measuring family and child outcomes associ-
ated with the implementation of new programs to affect change.
However, a critical first step of these evaluations is the examination
of the process of incorporating new methods from the perspective of
those implementing it. Findings from this process-oriented evalua-
tion allow for the identification of successful implementation of MI
and ongoing coaching within child welfare. Moreover, this formative
evaluation allows for the identification of challenges and issues fac-
ing caseworkers so they can be addressed for a more effective inter-
vention. Consequently, the purpose of the current study is to utilize
qualitative interview data from the caseworkers’ perspective to exam-
ine how MI and coaching have been implemented to improve the
practice of conducting comprehensive family assessments.

MI Training and Coaching Model in Alamance County

As part of the CFA grant, participating caseworkers were required to
first attend intensive multi-day training sessions on substance abuse
and motivational interviewing. These trainings were led by the
Director of Substance Abuse Clinical Training and Consultation of
the Duke Addictions Program in the Department of Psychiatry and
Behavioral Sciences. With more than 25 years of experience, the
trainer is a Licensed Clinical Addictions Specialist and a Certified
Clinical Supervisor in the substance-abuse field, as well as a Licensed
Professional Counselor, and is a member of the Motivational
Interviewing Network of Trainers (MINT). The substance-abuse
training focused heavily on the biological underpinnings of substance
abuse, and served as a foundation for the introductory MI trainings.
The areas of focus for the utilization of MI within child welfare
included all issues caseworkers might encounter, including, but not
limited to, substance abuse (e.g., child neglect related to unsafe hous-
ing conditions, inappropriate discipline, improper supervision,

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Snyder et al. Child Welfare

domestic violence, etc.). As part of the CFA grant, MI principles and

practices were interwoven into the total CPS assessment process—
from intake, the first phone call to families, and all interactions with
clients through case closure in in-home services.
The trainer continued to meet with staff once a month as one large
group that included caseworkers, their supervisors, the child welfare
program manager, and the CFA clinical coach. These sessions lasted
two hours and served as ongoing coaching to ensure ongoing skill-
building around MI. These sessions involved many experiential activ-
ities, including discussions, practice, and role-plays that could include
existing clients and difficult situations, as well as everyday issues that
caseworkers might face in working with families. Often, processing
cases with the trainer occurred in order to obtain coaching and guid-
ance as to how to implement MI with a particular client or situation.

Coaching
A full-time clinical coach has been an integral part of the Alamance
County CFA program. The coach was a clinician with a background
in community mental health and substance abuse counseling. She is
also a member of the Motivational Interviewing Network of Trainers
(MINT). The purpose of the coach is to help ensure that newly
learned skills are translated into practice for caseworkers. The coach
holds monthly trainings that build upon the MI sessions held by the
trainer. In addition, the coach accompanied caseworkers on a mini-
mum of two home visits per month with families. During these home
visits, the coach was able to assess and guide the caseworker in using
MI to facilitate the comprehensive family assessment process, as well
as to provide feedback and suggestions on areas in need of improve-
ment and areas where it was utilized well. Workers can also receive
mentoring and coaching through office visits, attendance at Child
and Family Team meetings, and attendance at weekly individual
supervision meetings.

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Methods
Sample
This study was approved by the Institutional Review Board of Duke
University. All participating caseworkers gave written informed con-
sent. Six personal interviews were conducted with caseworkers
employed by the Alamance County Department of Social Services
(ACDSS) during August and September of 2010. Depending on the
CPS team to which the workers were assigned, this interview time-
frame was one to two years after the initial training and coaching
began (CFA was piloted with one team in 2008, and subsequently
implemented with a randomly selected intervention team in 2009).
Participants were selected utilizing a stratified sampling strategy to
ensure representation across key job functions including
assessors/investigators and in-home workers. Two in-home case-
workers (out of three possible) and four assessors/investigators (out
of six possible) were randomly selected to participate. This selection
process was utilized to protect the anonymity of the workers as not
all caseworkers were interviewed, and staff were instructed not to
share with others that they were interviewed for this study. The sam-
ple was comprised of five females and one male. Two were African
American and four were white. Those interviewed had an average of
four years of professional experience as social workers either in
Alamance County or elsewhere (range = 9 months to 9 years).
Education levels of those workers interviewed is not presented in
order to protect confidentiality, but on average, most workers inter-
viewed were not degreed social workers (i.e., BSW or MSW).

Data Collection Procedure

Researchers from CCFP contacted selected caseworkers by phone to
explain the purpose of the evaluation study and to schedule individ-
ual meetings to conduct the interviews. The mean length of the inter-
views was 48 minutes. One researcher facilitated all of the personal
interviews with the assistance of a graduate student who took field

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Snyder et al. Child Welfare

notes, digitally recorded the interviews and later transcribed them. The
interviewer had experience in conducting research within North
Carolina’s child welfare system and was familiar with CFA overall, but
had no previous involvement with the evaluation. A semi-structured
interview protocol was developed as a guide to ensure that specific
topic areas or typologies were explored, but also allowed the flexibil-
ity to probe additional concepts that emerged during the ensuing con-
versation. Interviews were conducted at various locations throughout
Alamance County depending on worker preference and in the inter-
est of making the process as convenient as possible for participants.
One interview was conducted at a local coffee shop, two at the
Alamance County Human Services Building (on a different floor than
DSS), and the remaining three at a centrally located community
resource center. All subjects were provided with a $25 gift card as a
token of appreciation for participating. The participants seemed will-
ing, and, in most cases, happy to share their opinions about their work
within the Comprehensive Family Assessment project.

Data Analysis
Data analysis for this study was conducted using typological analy-
sis. Hatch (2002) described the typological model as dividing the col-
lected data into groups based on predetermined categories developed
from sources such as theories, common sense/intuition, and overall
research objectives. Hatch noted that studies relying on interviews as
the sole source of data were often focused around a set of guiding
questions with the overarching goal being to gain the perspectives of
individuals related to a particular topic or aspect of a topic. The devel-
opment of the interview protocol provided the foundational typolo-
gies used in analysis.
Hatch (2002) outlined nine steps for researchers conducting typo-
logical analysis, including: (1) identify typologies to be analyzed; (2)
read the data and mark entries as they may relate to one or more of
the established typologies; (3) read entries by typology and develop
main ideas or summaries; (4) identify patterns, relationships, and

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Child Welfare Vol. 91, No. 5

themes within typologies; (5) read data and code entries according
to identified patterns; (6) determine if patterns are supported by the
data and search for non-examples of patterns;( 7) look for relation-
ships among the patterns identified; (8) write your patterns as brief
generalizations; and (9) select quotes from the data that support those
generalizations.
Utilizing the typological approach and Atlas.ti qualitative soft-
ware, a team comprised of two researchers and one graduate student
assistant reviewed one transcript independently and developed a list
of codes thought to capture key areas of interest within the framework
of the previously established typologies. The team met and reviewed
their codes collectively, made changes to the code list and reached con-
sensus on the 36 codes used in analysis. The team then reviewed two
additional transcripts independently and coded them utilizing the
agreed upon coding structure. Again, the team met and reviewed the
transcripts and codes reaching consensus on how key statements were
coded. The final three transcripts were coded by the graduate student
assistant and later reviewed and approved by the researchers. While
the 36 codes covered a number of typologies useful for continuous
quality improvement in program implementation, only seven codes
were specific to the typologies categorized respectively as MI and
coaching for family engagement. These seven codes are the focus of
the current study and are highlighted in Table 1. The table also includes
the frequency of statements by code across the six interviews.

Results

Motivational Interviewing
Training on Substance Abuse and MI
Caseworkers were asked about the ongoing coaching and skill build-
ing they received for MI, and most indicated that it helped them deal
with difficult issues they encountered, changed long-held perspectives,
and provided a new approach to working with families. The following
quotes highlight some of the comments made by caseworkers.

20
Snyder et al. Child Welfare

“My favorite part was Table 1

learning from [MI Frequency of Statements by Code
trainer] about the sub-
Code Name Frequency
stance abuse…I used Value of MI 12
to have a real black Application of MI 15
Frequency of MI Use 10
and white picture of Training on MI 10
substance abuse and Value of Coaching 13
people who use sub- Applications of Coaching 4
Challenges Associated with Coaching 11
stances, and I think
that my line of think-
ing was more in line with law enforcement and that it’s a
choice, and you should be able to stop it and make the choice
because that’s your kid and just quit. So when I had the train-
ing and learned about the medical piece of it, a whole new
door was opened for me. The training completely changed
everything I thought about it, and I just don’t view it that way
anymore. The biggest piece that I’ve enjoyed in the process is
I’ve found out that when you really do go back and you get
their history it does not justify anything they’re doing, but it
certainly explains the behaviors; so I’ve learned a lot.”

“The substance-abuse training I thought was awesome,

because it opened up a new door to me and now I’m more
eager to work with the moms, make the referrals to Horizons
or ADS [local substance abuse service providers], understand
they might relapse, work with them again, and stick with the
cases a little bit longer and with the family. So, that was huge
for me. I did not see it as an excuse anymore coming from the
moms. If it had not been for [MI trainer] teaching us that
piece of it, I would never have had this belief.”

“The biggest part of CFA for me was learning the motivational

interviewing and the open-ended questions, and going back
and getting their history; and being a bit more family-friendly
and nonjudgmental.”

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Child Welfare Vol. 91, No. 5

“Initially, the monthly sessions on MI were very useful, when

it was new. We learned how to engage families in a different
way. I am seeing a big difference in my work with fami-
lies…This was the kind of thing that [MI Trainer] helped us
with because you may have gotten into a situation and you
didn’t know how to word things or a client said something
that you were not expecting and you weren’t sure how to han-
dle it. We were trying to change how we do things and that
was when he would say, ‘Well you could have said this or you
could have said that.’ With our clients we tend to see the same
issues so it is the same thing over and over again so now we
know how to handle it.”

“I can bounce things off him when we are doing that, so he

gives me a different way to look at things. Plus, I have been
able to implement some of the things he has recommended.”

“We focus on the strengths of the family, even if the parent

just woke up and got the kid dressed in the morning. [MI
Trainer] talks about how to do this and how to focus on these
positive details…[MI Trainer] has helped me find these
strengths and talked about how to find commonality with
families…”

“Over time this [the MI training sessions] has helped me to

be more conscious of it and make sure I practice and use it.”

However, while all reported that these sessions were very helpful
initially, many indicated that the monthly training/coaching sessions
had ultimately reached a plateau with respect to building their MI skills.

“From the very beginning, the trainings seemed to be really

useful and helpful, and then somewhere along the road, the
focus shifted to sitting through every training and talking
about everyone’s cases, which is not as useful.”

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Snyder et al. Child Welfare

“I mean when you staff cases you still learn, I’m not saying that
he doesn’t teach through that.”

“Now we just sit in a circle and talk about people’s cases. I do

not want to hear about other people’s cases. I wish he would
go back to teaching more.”

“He is great and has helped us with our skills, but now every-
one is starting to feel like he is doing staffing not training.”

Value of MI
All six caseworkers discussed the importance of motivational inter-
viewing and how it positively affected their assessment practice with
families. This is exemplified below as articulated by two caseworkers.

“Motivational interviewing has changed the way we work with

all families and not just with the tough cases. Before, we would
come in and say this is DSS and this is what you have to do,
and this is how it is going to happen. Now, we listen to fam-
ilies and recognize that they are the experts on their family.
Our whole approach is different and motivational interview-
ing has taught us how to ask... questions to engage families. It
is all about partnerships now.”

“MI definitely helps you focus on what you’re saying to the

client. I was actively listening with clients before CFA, but it
wasn’t really defined as anything I should do. Now I realize
what I’m doing and why I should do it. For example, one of
the things MI teaches is to restate the words of the client to
show them you’re listening and hearing what they’re saying.”

Caseworkers also reported that their attitudes and behaviors,

including monitoring their own body language, changed toward care-
givers as a result of having motivational interviewing training.
Specifically, the training created more self-awareness around their

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own behaviors when interacting with families and a realization that

these factors may impact family engagement.

“I listen, that is what it was for me. I was black and white and
when parents would talk to me, I could only hear it as excuses,
but now I listen and hear what they say and I watch body lan-
guage and I really look for the red flags. It’s taught me to pay
attention and to listen and to hear them when they are talking.”

“Now we listen to the family and recognize that they are the
experts on their family. Our whole approach is different and
MI has really taught us how to ask open-ended questions in
engaging families. It is all about partnership now.”

“The more I learn about it, the more I use it. One thing that
has changed since I have learned about motivational inter-
viewing is my body language. I am more conscious that I usu-
ally sit with my arms crossed and that can come across as being
standoffish and not open. I have also started to act like a
chameleon and conform to whatever situation I am in.”

Caseworkers reported that they have seen positive effects in their

interactions with families through the use of MI techniques.
However, others acknowledged that not all interactions are positive
indicating that some families are not ready to make needed change.

“Sometimes people are in denial and you get stuck. When

that happens, you do not want to do anything with them.”

“For some people, you can sit there and MI them to death and
it [change] is not going to happen.”

Application of MI
Caseworkers were asked to provide some examples of how they actu-
ally implement MI with families. The comments below indicate that

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Snyder et al. Child Welfare

in applying MI, workers tended to ask questions rather than making

assumptions, and in some instances reserved judgments as they
worked to engage families and build trust.

“It is amazing to notice how much families appreciate you ask-

ing them permission. For example, I say to a family, ‘I have
some ideas about parenting techniques that you could try,
would you like to hear them?’ Their reaction to me, given the
choice, is much different than the old way where I would say,
‘there is a parenting class starting Monday, and I am signing
you up for it.’ ”

“For example, a mom and dad occasionally smoke marijuana,

because they are under stress and cannot afford their medica-
tions. I then empathize with them without necessarily agree-
ing with them by telling them what they told me in a different
way. They feel like they are being heard and not just being con-
demned for smoking marijuana.”

“From my perspective, MI involves trying to work with par-

ents as partners instead of going into the household and just
telling them what to do, so I can close my case out. I am try-
ing to make the parents identify what they need to do for their
own household and family so they will not go through the sys-
tem again.”

Frequency of MI Use
Caseworkers were asked about how often they utilize their acquired
MI skills. The majority of the caseworkers reported that they use MI
frequently with their families, especially as they refine and further
develop these skills.

“I use it pretty much every time.”

“Yes, it starts to come naturally to you.”

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“The more I learn about it, the more I use it.”

One caseworker indicated that she used MI with some families

but not with others.

“There are those cases where I don’t use it. I may not use it ini-
tially, but I’ll go back and use it on some of them. It is a pretty
valuable tool.”

All six caseworkers reported that there was definite value in moti-
vational interviewing.

“The motivational interviewing has helped a lot, and we have

been using that to our advantage. I would give the usefulness
a 9 [out of 10].“

Coaching
Value of Coaching
Five out of six caseworkers provided positive comments about the
mentoring and support they have received from the CFA coach. Four
caseworkers said that they appreciated her presence at meetings with
families that were somewhat confrontational or difficult to engage.
Examples of supporting comments included:

“We have walked into situations that I am not prepared for,

and she is pretty quick on her feet and can help things.”

“For some clients, she can just say one phrase and the client
will start opening up, which is a really good thing.”

“It [coaching] is helpful because I see her do it and I think

why didn’t I do that? On the ride back, we talk about how she
thought it out, or why didn’t I say that, and she’ll say to me
‘next time you can re-word it like this,’ that kind of thing.”

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Snyder et al. Child Welfare

The CFA coach’s interaction with families also allowed her to

model motivational interviewing, which the social workers indicated
that they found useful in improving their own practice.

“The coach can deescalate a situation. She is a lot more skilled

at motivational interviewing, so she can get clients to open up
better than I could. She comes up with questions a lot faster
than I do.”

“We tend to want her there when we have a unique situation.

I think she added a lot to the process in the beginning because
she was there listening to what you were saying to families and
then you would have sessions with her in the car on the way
back….I would say the meetings with families that she went
along on were better or at least the next one was better given
her feedback. I would ask her, ‘how could I have asked that
question better or avoided closed-ended questions?’ She really,
really helped us with that stuff.”

Only one worker reported negative feelings about the role of

coaching suggesting that the coach was viewed as an unnecessary
resource.

“I don’t want to be super harsh, but I really don’t need her.”

Applications of Coaching
The coach also provided useful feedback to social workers after meet-
ings with families. Caseworkers suggested the rides back from the
office provided meaningful training opportunities.

“We talk about the meeting on the ride back, and she will ask
if I noticed something she noticed, or she will tell me things
she learned while talking to a child or another family mem-
ber when I was talking to a parent.”

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“We had sessions in the car on the ride back to the office. She
would discuss what I said to the families and suggest other
ways I could have said this or that. The instant feedback was
very helpful.”

Other social workers indicated that they have consulted with the
coach about substance abuse cases and also cases that involved men-
tal health issues.

“There are things that she picks up on that we did not….She

helps a lot with substance abuse issues, because we might not
know the signs.”

“She’s been very helpful in some of my biggest cases. I get

some pretty far out cases, and for some of them, I am not sure
what I would have done without her—especially when deal-
ing with mental health issues. When I feel like I am up against
the wall, I will look over to her, and she knows I am stuck and
she reopens the door with more questions.”

Challenges Associated with Coaching

Some social workers indicated scheduling challenges associated with
having the coach accompany them, given that there was only one per-
son serving in this role with multiple caseworkers vying for time.

“I would send her emails and try to schedule visits with her, but
the times when I was free would conflict with her schedule.”

“It can be a headache to schedule her visits.”

One caseworker indicated some possible issues with the coach

participating in individual supervision sessions.

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Snyder et al. Child Welfare

“Occasionally the supervisors ignore the coach even though

she has a valid point. I think the supervisors sometimes feel
like they are being undercut.”

Summary and Implications

The Alamance County Department of Social Services implemented
the comprehensive family assessment (CFA) process, most notably
the use of motivational interviewing and ongoing coaching, in order
to help caseworkers more effectively engage families in the assess-
ment process and thus improve outcomes related to safety, perma-
nency and child and family well-being. The purpose of this study was
to better understand the process of how MI and ongoing coaching
can be implemented within child welfare to improve the assessment
process by gaining the perspective of the caseworkers who are utiliz-
ing the new methodologies. Findings from the interviews could then
be used to evaluate successful implementation of MI and coaching,
and to identify challenges and barriers in order to improve the inter-
vention. Interviews were conducted with six caseworkers from the
CFA project and then coded using qualitative research software.
All caseworkers reported that the substance abuse and MI train-
ings and ongoing skill building sessions improved their assessment
practice with families involved in the child welfare system. Workers
reported that they utilized acquired MI techniques frequently and
felt they improved their MI skills as they gained more experience.
Caseworkers also found that they changed their behavior and atti-
tudes toward the families as a function of learning motivational inter-
viewing. These findings indicate that MI helped to reach the
overarching programmatic goal of implementing systemic change in
the way caseworkers engage families.
Overall, the content of the interviews showed positive effects from
the trainings and ongoing coaching of motivational interviewing.
Caseworkers were able to provide tangible examples of how they
employed core MI skills. These included active listening, such as pos-
itive nonverbal communication, empathic listening, including the

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importance of ascertaining historical events that may have led to the

maltreatment report, utilizing open-ended questions, affirmation of
strengths and the use of reflections. Caseworkers, however, did not
provide examples of implementing higher-level MI skills such as
developing discrepancy, rolling with resistance and having a strategic
objective for client change. A strategic objective in MI is resolving
ambivalence and having a plan that can be adapted to reaching a goal
when barriers to change are encountered (Forrester et al., 2012). These
MI skills can be very difficult to master and implement consistently.
This was most often attributed to a lack of readiness or change on the
part of families and was associated with more serious contributing
factors or risk, such as substance abuse, domestic violence, and inter-
generational poverty. This finding is not surprising given that such
risk factors often present great barriers to successful engagement and
case plan completion. Consequently, caseworkers cited the CFA
coach as being the most helpful with decreasing family resistance.
When caseworkers got “stuck” or frustrated, they reported that the
coach was able to model various ways of implementing MI with fam-
ilies, and thus increase their motivation for change.
All but one caseworker reported that their experiences receiving
support on the use of MI techniques from a coach were positive, espe-
cially regarding the home visits with families. Caseworkers reported
that the coach effectively modeled MI techniques during home vis-
its with families, providing a real-time application of MI.
Caseworkers found the immediate feedback after the home visits to
be valuable, as well. Findings from this study show that the use of a
full-time coach, in addition to ongoing skill-building with the MI
trainer, supports critical adult learning principles including opportu-
nities for practice, modeling, and the provision of feedback and coach-
ing over time (Barwick et al., 2012). Moreover, the use of ongoing
coaching can be especially critical when limited baseline counseling
skills and low motivation to learn MI are present (Mitcheson et al.,
2009). Given that the participating workers in this study did not have
advanced social work degrees and did not volunteer to be early
adopters of this initiative, the use of a full-time coach and ongoing

30
Snyder et al. Child Welfare

skill-building sessions were likely instrumental in integrating MI into

workers’ daily practice.
Many caseworkers reported growing dissatisfaction with the
monthly skill-building and coaching sessions with the MI trainer that
occurred after the initial training sessions. Workers reported that talk-
ing about their cases in a large group setting was no longer meeting
their MI skill-building needs. Based upon the findings reported here,
the training sessions were revised to include three small groups of
four workers each, for one hour per month. Similar to clinical super-
visions in mental health, workers now bring audio recordings of their
MI sessions with clients to get immediate feedback on what was done
well, possible areas of improvement, and strategies to use in subse-
quent visits with clients. In an effort to coach workers on the higher-
level MI skills described above (developing discrepancy, rolling with
resistance, and having a strategic plan for client change) the coach
now utilizes the Motivational Interviewing Training Integrity code
(MITI; Moyers et al., 2005), an established objective measure of
behavioral change, on home visits with workers. The MITI provides
workers with immediate and detailed feedback regarding their pro-
ficiency in all MI skills.

Limitations
Although these findings suggest positive impacts associated with the
utilization of MI and coaching within the child welfare system, it is
important to note the limitations of the study. First, the sample size
for the interviews was small, and may not be completely reflective
of all project staff. Widespread use of MI throughout Alamance
County DSS would provide an opportunity for a larger sample size
and would likely provide greater variation in successes, challenges,
and strategies used when implementing MI and coaching in child
welfare. In addition, these qualitative data are only representative of
social workers, and not the families they are working with. Future
evaluation will include interviews and surveys with families to obtain
their perspective on engagement with social services. Comparisons
with families working with non-CFA social workers will provide

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additional clarity regarding the successful implementation and value

of MI and coaching. Findings from this study, however, indicate that
MI and coaching appear to have been successfully implemented.
Moreover, challenges identified through these interviews have been
successfully addressed, leading to more individualized and structured
skill-building and coaching.

Implications for Future Studies

The CFSRs have added mounting pressure on child welfare agencies
to improve outcomes related to child safety, permanency and family
well-being. Methods to better engage families and foster motivation
to change are increasingly being viewed as a means to that end.
Consequently, there has been growing interest in the use of
Motivational Interviewing with families involved in child welfare, as
many face challenging issues such as substance abuse, domestic vio-
lence and intergenerational poverty. Many families are often not
aware that a problem related to child safety exists and thus exhibit a
high level of resistance, even when they are at risk of losing custody
of their children. These confounding factors present social workers
with a unique and difficult challenge; to engage families and encour-
age positive change, but to do so within the context of strict CPS
timelines and policies.
Findings from this study indicate that MI can be implemented
successfully by CPS workers. However, as has been found in previous
studies (Barwick et al., 2012; Forrester et al., 2008; Joyce & Showers,
2002; Miller & Mount, 2001), successful implementation appears to
be highly dependent upon the presence of ongoing coaching after ini-
tial trainings. Specifically, having a trainer continue to conduct regu-
lar skill-building sessions after the standard initial 1-2 day training
session, and providing opportunities for workers to receive live feed-
back and modeling as they continue to develop and improve their skills
is imperative. Findings from this study would indicate that provisions
for these supports to workers take a minimum of one year, if not longer.
This is especially important given the high rate of staff turnover in
child welfare. As other jurisdictions are exploring or beginning to

32
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implement coaching and MI, these findings provide important infor-

mation regarding how this process can be successfully implemented,
and possible challenges and successes to be expected. An important
finding from this study related to coaching was the difficulty many
workers reported with scheduling home visits with the coach. When
fully staffed, the coach to social worker ratio for this project is 12:1.
In addition to a minimum of two home visits per month with each
worker, the CFA coach also attended weekly individual supervision
sessions. Based on the feedback from caseworkers, this ratio may be
somewhat high for such an intensive skill building model. However,
given the current economic climate, most states and counties do not
have the financial resources to support full-time coaches. As such, uti-
lizing and training supervisors to serve as coaches may be a cost neu-
tral alternative and more sustainable option.

References
Altman, J. C. (2008). Engaging families in child welfare services: Worker versus client per-
spectives. Child Welfare, 87(3), 41–61.

Barwick, M.A., Bennett, L.M., Johnson, S.N., McGowan, J., & Moore, J.E. (2012). Training
health and mental health professionals in motivational interviewing: A systematic review.
Children and Youth Services Review, 34(9), 1786–1795.

Bien, T. H., Miller, W. R., & Boroughs, J. M. (1993). Motivational interviewing with alcohol
outpatients. Behavioural and Cognitive Psychotherapy, 21(4), 347–356.

Brown, J. M., & Miller, W. R. (1993). Impact of motivational interviewing on participation

and outcome in residential alcoholism treatment. Psychology of Addictive Behaviors, 7(4),
211–218.

Carels, R. A., Darby, L., Cacciapaglia, H. M., Konrad, K., Coit, C., Harper, J., Kaplar, M. E.,
Young, K., Baylen, C. A., & Versland, A. (2007). Using motivational interviewing as a
supplement to obesity treatment: A stepped-care approach. Health Psychology, 26(3), 369–
374.

33
Child Welfare Vol. 91, No. 5

Chaffin, M., Funderburk, B., Bard, D., Valle, L.A., & Gurwitch, R. (2010). A combined moti-
vation and parent-child interaction therapy package reduces child welfare recidivism in a
randomized dismantling field trial. Journal of Consulting and Clinical Psychology, 79(1),
84–95.

Chaffin, M., Valle, L. A., Funderburk, B., Gurwitch, R., Silovsky, J., Bard, D., McCoy, C., &
Kees, M. (2009). A motivational intervention can improve retention in PCIT for low-
motivation child welfare clients. Child Maltreatment, 14(4), 356–368.

Colby, S. M., Monti, P. M., Tevyaw, T. O., Barnett, N. P., Spirito, A., Rohsenow, D. J., Riggs,
S., & Lewander, W. (2005). Brief motivational intervention for adolescent smokers in
medical settings. Addictive Behaviors, 30(5), 865–874.

Damashek, A., Doughty, D., Ware, L. and Silovsky, J. (2011). Predictors of client engagement
and attrition in home-based child maltreatment prevention services. Child Maltreatment,
16(1), 9–20.

Fixsen, D.L., Naoom, S.F., Blasé, K.A., Friedman, R.M., & Wallace, F. (2005). Implementation
research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la
Parte Florida Mental Health Institute, The National Implementation Research Network
(FMHI Publication #231).

Forrester, D., McCambridge, J., Waissbein, C., Emlyn-Jones, R., & Rollnick, S. (2008). Child
risk and parental resistance: Can motivational interviewing improve the practice of child
and family social workers in working with parental alcohol misuse? British Journal of Social
Work, 38(7), 1302–1319.

Hatch, J. A., (2002). Doing qualitative research in education settings. Albany: State University
of New York.

Henry, W. P., Strupp, H. H., Butler, S. F., Schacht, T. E., & Binder, J. L. (1993). Effects of
training in time-limited dynamic psychotherapy: Changes in therapist behavior. Journal
of Consulting and Clinical Psychology, 61(3), 434–440.

Hohman, M.M. (1998). Motivational interviewing: An intervention tool for child welfare
case workers working with substance-abusing parents. Child Welfare, 77(3), 275–289.

Joyce, B., & Showers, B. (2002). Student achievement through staff development (3rd ed.).
Alexandria, VA: Association for Supervision and Curriculum Development.

Lee, C. D., and Ayón, C. (2004). Is the client-worker relationship associated with better out-
comes in mandated child abuse cases? Research on Social Work Practice, 14(5), 351–357.

34
Snyder et al. Child Welfare

Marcenko, M., Newby, M., Lee, J., Courtney, M., & Brennan, K. (2009). Evaluation of
Washington’s Solution Based Casework Practice Model. Retrieved January 31, 2013, from
http://partnersforourchildren.org/pocweb/userfiles/PFOC_ParentSurvey_report.pdf.

Maxwell, N., Scourfield, J., Holland, S., Featherstone, B., & Lee, J. (2012). The benefits and
challenges of training child protection social workers in father engagement. Child Abuse
Review, 21(4), 299–310.

Mitcheson, L., Bhavsar, K., & McCambridge, J. (2009). Randomized trial of training and
supervision in motivational interviewing with adolescent drug treatment practitioners.
Journal of Substance Abuse Treatment, 37(1), 73–78.

Miller, W. R., & Mount, K. A. (2001). A small study of training in motivational interview-
ing: Does one workshop change clinician and client behavior? Behavioural and Cognitive
Psychotherapy, 29(4), 457–471.

Miller, W.R., & Rollnick, S. (2009). Ten things that motivational interviewing is not.
Behavioral and Cognitive Psychotherapy, 37(2), 129–140.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change.
New York: Guilford Press.

Miller, W.R., Yahne, C.E., Moyers, T.B., Martinez, J., & Pirritano, M. (2004). A randomized
trial of methods to help clinicians learn motivation interviewing. Journal of Consulting and
Clinical Psychology, 72(6), 1050–1062.

Moyers, T.B., Martin, T., Manuel, J.K., Hendrickson, S.M.L., & Miller, W.R. (2005).
Assessing competence in the use of motivational interviewing. Journal of Substance Abuse
Treatment, 28(1), 19–26.

Mullins, S. M., Suarez, M., Ondersma, S. J., & Page, M. C. (2004). The impact of motiva-
tional interviewing on substance abuse treatment retention: A randomized control trial
of women involved with child welfare. Journal of Substance Abuse Treatment, 27(1), 51–58.

Nock, M. K., and Kazdin, A. E. (2005). Randomized controlled trial of a brief intervention
for increasing participation in parent management training. Journal of Consulting and
Clinical Psychology, 73(5), 872–879.

Pecora, P. J. (1989). Improving the quality of child welfare services: Needs assessment for staff
training. Child Welfare, 68(4), 403–419.

35
Child Welfare Vol. 91, No. 5

Prochaska, J. O., & DiClemente, C. C. (1992). The transtheoretical approach. In J. C. Norcross

and M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 300-334). New
York: Basic Books.

Sanders, M. R., Prinz, R. J., & Shapiro, C. J. (2009). Predicting utilization of evidence-based
parenting interventions with organizational, service-provider and client variables.
Administration and Policy in Mental Health, 36(2), 133–143.

Sterrett, E., Jones, D. J., Zalot, A., & Shook, S. (2010). A pilot study of a brief motivational
intervention to enhance parental engagement: A brief report. Journal of Child and Family
Studies, 19(6), 697–701.

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