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Introduction

Youths in the foster care system struggle with transitioning into adulthood once they become of age; it can be difficult and stressful when they are abruptly transitioned from being dependent on state-provided care to independent and experience a substantial loss of support (Miller, Paschal & Azar, 2017). There are many components and factors that affect this population when they transition out of the foster care system, for example, money management, transportation, and IADLs.

The purpose of motivational interviewing  Through the use of motivational interviewing, occupational therapy practitioners can determine which life skills this population lacks and decide ways to promote these life skills to  live independently post-foster care.

Theory

The trans-theoretical model was developed as a type of framework to discover the understanding of how individuals process change in behavior (Jahan, Shokravi, & Sanaeinasab, 2017). The transtheoretical model uses key constructs chosen from a variety of behaviors, populations and settings for the occupational therapy practitioners are able to apply and create the goals best fit for the client (Prochaska, Redding, & Evers, 2008). Hence, the practitioner can help them progress into health behavioral habits.

Evidence

Research into the use of motivational interviewing (MI) as an intervention in the area of youths in foster care is limited. However evidence shows that is an effective intervention in other areas. A randomized control trial showed the use of MI was effective in facilitating change in teenagers with type 1 diabetes leading to better control of blood glucose levels (Channon et al., 2007). A meta-analysis of 119 studies involving MI interventions showed positive outcomes in areas of substance use, health behaviors (diet, exercise), and engagement in treatment variables (Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010).

Case Study

James is a 17-year-old male, currently in the foster care system. Client is currently in the process of transitioning to the community for independent living and is interested in learning money management skills. Client states that he has never had experience with handling of money such as depositing or budgeting. Client has met with his residential supervisor who has referred to an occupational therapist to help him with money management goals.

Intervention Plan

Problem Statement

James demonstrates lack of knowledge about money management skills which limit his ability to effectively live independently.

Long Term Goals

• Client will transition from contemplation to maintenance related to money management skills  by his 18th birthday.
• Client will be able to demonstrate the skills to be able to manage his money by the transition date.

Short Terms Goals

• Client will identify two different ways in which he can save money by the next session in order to manage his money.
• Client will transition from contemplation to action in three weeks related to developing money management skills.
• Client will be able to keep track of his expenses in two weeks in order to mange his money.

Intervention Format

The intervention format would be Individual (one-to-one)

Setting

The setting of the Intervention sessions will take place in the Residential house where James resides for 30 minute sessions twice a week

Supplies

None

Agenda

• Meet with James and establish rapport (5min)
• Assess James readiness for change (2 min)
• Engaging in motivational interviewing of money management skills and techniques (18 min)
  • Potential Open-ended questions
    • “Why do you think that it is important to be able to manage your money/income?”
    • “Tell me how do spend the money that you receive weekly?”
    • “Why do you think you have difficulty saving money?”
    • “What steps do you think you can take to reduce the urge to spend?”
  • Provide Affirmations
    • “I can see that you are very motivated to learn how to save money”.
    • “You are very wise to want to save money”.
    • “You are on the right track”.
  • Provide Reflections
    • “What I am hearing is that you feel that taking your debit card rather than cash causes you to spend more”.
    • “If I am correct you think that making a list before you go to the store will help you stay on top of your spending”.
• Provide summary and debriefing of session (5 min)

Documentation

S: “I am so excited to get out of here. I can’t wait to move out on my own. This will give me a chance to actually experience the real world and make me feel more independent”.

O: Client presented for 30-minute session focusing on developing money management techniques.  Client was noted to be  enthused as he reported his excitement for learning new strategies to save enough money and feel independent. Client was able to identify 2 ways that he could improve his spending habits in order to save and manage his money. With permission, the therapist educated the client on more money management techniques.

A: Client presents in the preparation stage and has recognized that saving money is an important part of money management.

P: James will continue with motivational interviewing approach to develop money management skills. OTR will evaluate success new money management habits and acquired skills  and continue to refine and develop as needed.  OT will see client twice a week for 30 min sessions each.

References

Canadian Institutes of, Health Research, Children’s Hospital of, Eastern Ontario, The Royal Ottawa Mental, Health Centre, & Youth Services Bureau, of Ottawa. (2015). Evaluating the effectiveness of motivational interviewing and a dialectical therapy skills- based intervention for youth Centre for Addiction and  Mental Health. Retrieved from http://ezproxy.fiu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edsclt AN=edsclt.NCT01656473&site=eds-live

Channon, S. J., Huws-Thomas, M., Rollnick, S., Hood, K., Cannings-John, R., Rogers, C., & Gregory, J. W. (2007). A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes American Diabetes Association. Retrieved from http://ezproxy.fiu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.165017907&site=eds-live

Jahan, H. R., Shokravi, F. A., & Sanaeinasab, H. (2017). Relationship Between Regular Physical Activity and Transtheoretical Model Components Among Members of Municipality Councils in Selected Districts of Tehran. Asian Journal Of Sports Medicine, 8(2), 1-6.

Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137-160. Retrieved from http://ezproxy.fiu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=swh&AN=80065&site=eds-live

Miller, E. A., Paschall, K. W., & Azar, S. T. (2017). Latent classes of older foster youth: Prospective associations with outcomes and exits from the foster care system during the transition to adulthood. Children and Youth Services Review, 79,  495-505. doi:10.1016/j.childyouth.2017.06.047

Prochaska, J. O., Redding, C. A., & Evers, K. E. (2008). The Transtheoretical Model and Stages of Change. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass.