NASW Social Work Talks - EP85: How To Reach Special Populations with Motivational Interviewing | Connect to End COVID-19

Episode Date: May 26, 2022

In this episode, we talk about how social workers can talk to harder-to-reach special populations about vaccines and use motivational interviewing to inform people about vaccines.  Our guests are NASW Mississippi Chapter Executive Director and Special Populations Coordinator Gwen Bouie Haynes and Mary Velasquez, professor and director of the Health Behavior Research and Training Institute at the University of Texas at Austin.  NASW and the NASW Foundation are partnering with the Health Behavior Research and Training Institute at The University of Texas at Austin Steve Hicks School of Social Work on Connect to End COVID-19, a Centers for Disease Control and Prevention (CDC) funded initiative to support social workers and their clients in informed vaccine decision-making.  

This episode is brought to you by Pacific Oaks College, experience that impacts community. Learn more at pacificoaks.edu. 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 Bowie-Haynes, Executive Director of the NASW Mississippi Chapter

and Special Population Coordinator on the Connect2End 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. Bowie Haynes, welcome to Social Work Talks. How are you? Doing well, thank you. Thank you for having us. Thank you. Doing well, Greg. Yeah, yes, thank you. So before we get into our conversation about motivational interviewing and special populations, I want to talk about a Connected in 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. Sure. Yeah. Thanks, Greg. So the CDC was, is connecting with professional groups around the country. So NASW is actually a wonderful fit. So NASW and our Institute, Health Behavior Research

and Training Institute in the School of Social Work, 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. So we're especially focused on vulnerable populations, which Dr. Gwynn will talk about, but including children, pregnant people, immigrants and refugees, and states with low vaccination rates. So 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. 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. So 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. So 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. yes so um there's um a sentiment now that the pandemic is like easing that it isn't as like bad off as it was um a year back or even uh two years back at this point but um is there um a reason why even though there's um a sense that like we're at um a better place now that vaccines are still important? 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 have been over a million deaths in the U.S. due to COVID-19. And the most recent variant, VA2, I think that's what it's called, is even more contagious than the Omicron variant. Particularly salient for social workers, we also know that certain mental health conditions, such as mood disorders and 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, you know, difference, confusion with sort of thinking, fatigue. And for a subset of people, maybe even up to a third, this long COVID is problematic. So vaccination reduces the risk of getting COVID. And again, of course, the risk for long COVID. Thank you. Dr. Bowie Haynes, what is a special population exactly? And I want you also to kind of like talk about, you are in a Southern state that like 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 like playing out down in Mississippi. 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. So with special populations, you sort of think of special populations from the same vantage point that you might be thinking about some systemic issues, 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. 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.

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. I wanted to ask both of you, 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 like 40. Um, he had on a mask. So, um, I asked him, are you, um, vaccinated? And he said like, no, because I don't want them to put poison into my, uh, body. So it really like surprised me that, um, a college, um, educated white person in, um, a state of where like I am, where, um, our vaccination is over like 75 percent that there is um like still um hesitancy out there so um i wanted to like ask both of you what are you like hearing from folks um mary um if you want to go

first sorry about that um yeah i think there's a lot of misinformation out there and also what what we would call disinformation. So, you know, and obviously people need to make their own choices. You know, some of the things, I mean, we've heard everything from a COVID vaccine could put a chip into your body to, you know, women won't be able to get pregnant or it affects a man's fertility. And, you know, 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. And, you know, 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. So I don't know, Dr. Gwen, you may have another.

Yeah, you know, 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. 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. 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 ESPRIT. ESPRIT, if you could kind of get more into that, what that means. So one way that social workers can educate clients about COVID is through using motivational interviewing. So 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 have hopefully have some training in it because most of our our schools are integrating it I teach it to some are two sections of it each year in the and it fills quickly. The master students really, I think, enjoy it. And when they get out, they practice it. But 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 recognizes very, 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. 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 sort of 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, you know, let's face it, social workers have been on the front lines of this pandemic for the longest time.

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. Yes. So if I'm a patient and I come in and like there is a social worker in that health care facility, how would the like social worker interact with me to have a conversation about vaccines that would be empowering to me? Yeah, so basically, the social worker would 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 change, stage of readiness to change.

And then because motivational interviewing is focused on resolving ambivalence, the social workers um they they use that to discuss maybe the challenges the clients have around like you said um some of the the myths or the fears around it um they discuss maybe a referral and participation um to another you know either a place to get the vaccine um but basically it's very um there's a there's five steps to it. So, uh, it's sort of starting the conversation. It's, um, looking at decisional balance. So Greg, on the one hand, um, what you've told me, 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. Um, so, um, those are some of the,

some of the concerns you have. And on the other hand, you told me that you want to keep, you know, you want to keep your parents safe, you've got elderly parents, you don't want to lose time at work. And so you know, there's sort of this decision, 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. Gwynn's group, you know, we did, I think, seven hours of training around this. And then we, so we 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, you know, 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. 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 social work is like so like nuanced because i'm looking at it as um a layman and um i'm looking

at the news i'm like take it take the vaccine but you can't like do that you like have to be um caring um like patient and that's a lot of training learning that seven hours quite a bit you know and and i want to jump in uh here mary and just maybe offer an additional comment to what you've mentioned about uh social workers uh this being really um 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. 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 But the essential framework here is that it supports what social work focuses on, and that's the generalist intervention model of, you know, assessing, allowing the client to assess, intervening with the client, then providing some level of support through intervention and evaluation. And I think that's absolutely essential here. Our training was really well done well. And Mary was the leader with that training. But it does take a lot of skill to do MI and also SBIRT. Where is this training available? I mean, is it online? Is it at a Connect2End COVID website or is it on a university level? do i have to take take on a course in other words in order to do it um there are um so the cdc has funded nesw which in turn um funded chapters so the chapters had to apply um for the training

and get accepted um and i think dr glenn you were the first group to be trained i think um and so we're doing it that way. I'm really grateful to the CDC. And they, you know, it's almost like they're just staying one step ahead of the science too, right? So, you know, 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 have, 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 in that. That does take some real skill. So NASW has been wonderful about offering these trainings to the various chapters. Dr. Bowie-Haynes, I want to 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. I was wondering if you could kind of speak on that for us. Good, 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 child care, 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? 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. OK, 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. Is it necessary to say, oh, we want to do motivational interviewing and expert training? No, that's not exactly what we do. We are saying to them that NASW, NASW Foundation, and also the Stephen 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 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. 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, like hearing it from all of you. So a year from now in our

pandemic, what is your hope on Dr. Velasquez and Dr. Bowie 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 we all do we sure do um and 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 and training but it's actually worked quite well on zoom um because of the connections we we we have with the chapters and with the chapter leads, like Dr. Gwynn. So what do we hope that 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. So I kind of think the bottom line is that the vaccines are the best tool we have to prevent hospitalization and death. And you know, 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 I,

you know, 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. Thank you. Dr. Bowie-Haynes, your hopes? 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're 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're trying to be really safe and cautious. Everyone is vaccinated and we're 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.

Thank you. Yes, excellent ones. Dr. Velasquez and Dr. Bowie Haynes, thank you for being our guest on NASW's Social Work Talks. Thank you so much. 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.