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Supporting Young People is an Art

It takes a mix of curiosity, empathy, sincerity and skill to work with young people and support their health and development. And it all starts with connection and trust. Connecting and building trust with students requires good listening skills and a sincere interest in what really matters to them. Even youth who are resistant, reluctant or only considering making changes can move toward improving their situations if they feel safe, listened to and cared for.

A motivational approach elicits from a young person their own assessment of the status quo as well as their potential for change. It offers a way to raise a young person's awareness of their developing strengths. And it both encourages self-reflection and guides the student toward making positive changes.

Rather than making the youth do as we would like, the focus is on finding ways of engaging them in conversation. Instead of trying to fix or solve things in their life, emphasis is on helping them articulate and reach their goals. It is essentially steering a conversation toward possibility and action.

This resource can support

  • a school counsellor or administrator working with a student facing disciplinary action for their use of alcohol or other drugs,
  • a teacher who both senses a student is struggling with substance use and wants to help prevent a crisis situation, or
  • any school professional (or any adult) who wants to help a young person.

Using basic principles and communication skills, school professionals can help students assess themselves, explore things they may want to change, and make plans to take action.

The Basics

Empathy is about good rapport and an accepting, non-judgmental approach. It involves trying to understand the young person‘s point of view while drawing out their reflections about their situation and deciding if and what they would like to change. Without a respectful relationship it will be difficult to help a young person move toward positive changes.

Do: be accepting, understanding and encouraging, make the young person feel comfortable and at ease and use reflective listening.

Don't: judge, preach, blame or criticize, use labels such as “alcoholic” or “drug addict", or do more than 50% of the talking.

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Discrepancy is the feeling that a behaviour is out of line with a goal or value. Young people are more likely to be motivated to change a problematic behaviour when they see a difference or discrepancy between the way their life is right now—for instance, their current use of alcohol or other drugs and any related problems — and the way they‘d like their life to be.

The aim is to amplify this difference and help the young person explore the present situation in relation to what is wanted and valued, and identify their own reasons for change.

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Rolling with resistance means avoiding arguments with a student who is challenging their need for change. It means acknowledging that the youth is ultimately the one who‘ll make decisions about their health and well-being.

Showing respect for what the student thinks is more helpful than trying to force or convince them. Focus on showing interest in what they have to say, and on being non-judgmental. Express a desire to understand and accept (but not necessarily agree with) reasons for their behaviour and for their choices.

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Self-efficacy means believing in yourself and your abilities. It's about knowing or trusting that you can succeed at setting and achieving a goal.

Like adults, young people are more likely to follow through with a change in behaviour if they believe they‘ve freely chosen to make the change and can accomplish it. It‘s important to help students build confidence by remaining optimistic, reminding them of their strengths and past successes, and affirming all their efforts to make changes no matter how big or small. (more...)

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Build your skills

Open-ended questions often start with one of the 5 W’s — who, what, when, where, why — and require a student to explain something. (Closed questions, on the other hand, start with words such as “do and don’t” and ask for a yes/no response.)

Using open-ended questions can help young people think through their situations and weigh their desire to change. It's effective in pulling out detailed information because it requires them to both think more about what they’re saying and make statements that may serve as internal motivation to change.

To illustrate the difference between open-ended and closed questions, consider these examples:

“What’re some of the things you like about using drugs?” versus “Do you like using drugs?”

“What’re some of the things you dislike about drugs?” versus “Don’t drugs make you feel bad?”

“What concerns you about _______?” versus “Don’t you think ______ is a problem?”

“How do you feel about_______?” versus “Doesn’t that make you feel _________?”

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Giving affirmation involves using statements of appreciation and understanding to express confidence in the student's ability to continue positive behaviours or make positive changes. These statements can help to create a supportive atmosphere and build rapport with young people.

Recognizing a young person's strengths and efforts to change helps them build confidence. And affirming self-motivating statements encourages readiness to change. Here are some examples of affirmation:

“Thanks for coming today.”

“I appreciate your willingness to talk to me about your substance use.”

“You’re obviously a resourceful person to have coped with those difficulties.”

“I can see that you're a really strong person.”

“That’s a good idea.”

“It’s hard to talk about _____. I really appreciate your keeping on with this.”

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Reflective listening has two purposes. It builds a connection with the student. And, it offers a way to guide the young person through the ambivalence they may be feeling about change by helping them focus on the discrepancy between their present situation and their goals and values.

Reflective listening involves truly trying to understand what the young person is saying and anticipating what they are trying to communicate. Reflecting isn’t the same as agreeing or paraphrasing. Instead, it involves selectively reflecting what was said in order to draw attention to those statements that reveal a desire to change.

Reflective listening reinforces the young person’s own positive statements about change and offers insight not by directing but by highlighting. To do this effectively, it is important to pay attention to those areas where the student expresses discrepancy between their desires and their current situation. For instance, we can focus on the positive things the student said about changing, i.e., emphasizing "change talk." 

If only negatives about changing are mentioned, we can explore what it might take for the student to consider change or why they think change is not an option.

Here are some tips for reflective listening:

  • Strip the statement down. State only the most important elements of what was said. “You’re angry” versus “So, what I’m hearing you say is that you’re angry.”
  • Continue the paragraph. Try not to parrot back what the student has said, but instead paraphrase or guess what would come next to give the conversation momentum. Consider this example:
    • Youth: I don’t know why this is such a big deal for everyone. All my friends drink like I do.
    • School professional: Others have some concerns, but it hasn’t been an issue for you.

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Summarizing is a way of gathering what a student has said and preparing them to move on. Summaries serve to remind the youth about major discussion points, their plan of action and their reasons for taking action.

If the youth slows or stops talking, summaries can act as a bridge to help them continue. They may also help to remind the youth of what they said, or point out a connection between statements.

Summaries often include these basic elements:

  • specific problems or behaviours that were discussed
  • the young person’s most important reasons for wanting to make changes
  • what their plan of action will look like, including both measures of success in completing the action and incentives or sanctions for completing or not completing the action
  • the date and time of next contact

Keep the summary short and succinct. Here’s an example of a summary:

“So, you really enjoy using alcohol and other drugs at parties, and you don’t think you use drugs any more than your friends do. On the other hand, you’ve spent a lot more money than you can afford and that really concerns you. You’re finding it difficult to pay for things you really need. Your boyfriend is angry and you really hate upsetting him. And you’ve noticed that you’re having trouble sleeping and remembering things.”

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To help a young person

Supporting positive behaviour involves raising a student's awareness of their developing strengths and the role they can play in their overall health and well-being. It means helping youth both see their strengths and how to nurture and use them to build motivation, confidence and self-efficacy for changing any problematic behaviour, including harmful use of alcohol and other drugs.

How can I be supportive?

The best way to support a young person is to help them identify their strengths. One way to do this is by asking questions that get them talking about their habits, qualities, values, skills and resources for support (e.g., family, faith, community). Here are some examples:

"How do you stay healthy?"

"What are you good at?"

"What do you do to help others?"

"Who are the important adults in your life?"

"What are your responsibilities at home? At school?"

"If I were an employer, what are all the things that would make me want to hire you?"

Tip: Try using the Strength Meter to guide the discussion.

During your discussion, listen for cues that illustrate the strengths important in making a person feel balanced and "whole." Consider using the strengths emphasized in Navajo culture: generosity, independence, mastery and belonging. For more details, see the Circle of Courage.

Here are some examples of how to do this:  

Questions to identify strengths Example response indicating strength Strength
How does your current work fit with your life goals? Well, its not really the job I want but I'm able to save money for college. Independence
What do you do for fun? I volunteer at a food bank. Generosity
What do you do when you feel sad? I usually listen to music or go for a walk. Mastery (of successful coping skills)

 

Note: Some of these questions may identify both a risk and a strength. For example, if a student says, "My boyfriend is my family," you could recognize "belonging" as a strength. Or, if a youth says, "I don’t have time for school because I work a lot," you could recognize their show of independence.

What can I say to show my support?

Here are some examples of ways to respond when you recognize a trait worthy of praise or see that a student needs some cheering on: 

Strength Strength is present Strength is absent
Generosity Your willingness to care for others is inspiring. It shows generosity and that's a very important skill to develop. I'd like you to think about sharing your obvious athletic skill with others. What do you think about showing the ropes to some younger kids?
Independence I'm very impressed with your decision to stop hanging out with the friends you were telling me about. I know it must have been difficult. I'm wondering if there's something we can do to help you start finding your own way and developing your independence.
Mastery You should feel really good about finishing this school year. I know it took a lot of hard work but you did it! Getting really good at something can help you feel good about yourself. Let's think about how you might be able to develop mastery in something. Tell me something that you really like to do with your time.
Belonging You have a lot of strong relationships in your life. I know this sense of belonging must be a lot of help when times get tough. It's important to develop relationships that help you feel happy and safe during this stage of your life. Can we think of some people you might be able to rely on when you need it?

 

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Supporting change means openly recognizing the ways in which a student is making good choices (e.g., choosing not to smoke cigarettes) while giving them strategies and information on ways to reduce their risk of harm (e.g., low-risk drinking guidelines). It also involves drawing out the student's thoughts about both the possibility of change and potential ways to change.

An overall framework

It's important to understand what exactly we're trying to do, where our responsibilities lie, where our influence is, and how we can help young people make healthy decisions and encourage positive change. The following framework involves movement that leads to increased motivation on the part of the student.

  • Engagement and safety: Showing empathy and respect toward young people (being curious and skillful at asking questions to understand their interests and concerns) is a good way to start.
  • Self-awareness: An emotionally safe environment encourages youth to develop
    self-awareness and to critically assess their current situation.
  • Discrepancy: Exploring the possibility of change or maintaining current patterns can uncover discrepancy between goals and values and current actions.
  • Motivation: Greater awareness of discrepancy and greater belief in their own ability leads to greater motivation to change.

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A simple process for supporting change

Key Tasks

  • Engage: Create rapport and a sense of safety by showing empathy and respect.
  • Raise doubt: Explore student's perspective of risks and problems with their current behaviours (status quo).

There is no “one way” to start because each student presents with a different combination of circumstances. For instance, a student may be facing disciplinary action due to their use of alcohol or other drugs. Or a teacher may sense substance use may be causing problems and therefore wants to reach out to a student before a crisis takes place.

Whether a problem has emerged or is anticipated, it's important to get beyond any initial emotional reaction the youth may be feeling and begin to build a connection. Both engaging the student and creating a respectful and emotionally safe environment will encourage them to reflect and assess the status quo (the way their life is now and the reality of their situation).

Being sincerely curious and skilful at asking questions can help us understand and assist the student in thinking through their situation. The following worksheets may be helpful in guiding the conversations.

  • Decisional Balance: To help us understand why a student is doing what they're doing, we need to ask open-ended questions about their situation, concerns and problems. The Decisional Balance grid provides a frame for asking these questions. (Without a framework for asking and recording responses, this task could easily get muddled and complicated.) And by viewing these questions and the responses in a grid format, we can better understand the student's rationale for their choices and behaviour, especially when he or she is ambivalent about change.
  • Screening: Introducing screening during a discussion can help deepen the connection with the student. It offers an opportunity to (1) provide feedback about their use of alcohol and other drugs, (2) encourage the student to reflect on any problems they're having related to their drug use, and (3) draw out ways to make some positive changes (even if they choose not to do them now or feel they may never do them). Screening can also be used to reinforce positive behaviours and encourage low risk use of alcohol and other drugs.

For some students, completing a screening questionnaire may seem intimidating or threatening. A casual approach can make it feel less so. Setting an informal tone will not only add value to the relationship but also make it easier to communicate and share information. The student may even learn a few things about themselves that they were unaware of. After all, they may not have talked so openly about their use of alcohol or other drugs with an adult before.

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Key Tasks

  • Tip the balance: Evoke (as opposed to suggest) reasons to change and risks of not changing.
  • Enhance discrepancy: Amplify the difference between the status quo and the way the student would like their life to be.
  • Recognize readiness: Listen for cues of readiness to change, and be ready to shift to a support role.

Rather than telling students what to do, or trying to fix or solve things for them, focus instead on steering the conversation toward possibility. Talking to them about continuing on the way they are now (status quo), and in particular on its impact on their goals and values, is one way to try to uncover and enhance discrepancy between what they say they want and what they are currently doing. The greater the discrepancy, the more motivated a young person will be to consider making some changes.

The goal is to understand the student's motivation for change and what they ultimately want to do or become. Using open-ended questions requires the student to think more about what they are saying and make statements that may help access their internal motivation to change. Questions like the following may help clarify motivation:

  • Why would you want to make this change?
  • How would you go about it? What would be the best way to succeed?
  • What are the top three reasons for you to make this change?
  • How important is it for you to make this change (0-10), and why?

Worksheets such as the following may help to guide the discussion.

  • Decisional Balance: If a student seems to be wavering back and forth between thinking about changing and not changing, try using the Decisional Balance grid to help them weigh the pros and cons. Talking through their concerns about both the issue and the benefits of changing may help tip the balance.
  • Readiness to Change: The Readiness to Change scale can be used to start a discussion on why the student thinks change might be necessary, their degree of confidence in making the change, and their readiness to take action.

The shift from motivating change to supporting action for change is like a window of opportunity, so it is important to recognize when the window is open. Here are some signs of a student's readiness to change:

  • Decreased resistance
  • Decreased discussion about the problem
  • Resolve (ambivalence is absent)
  • Change talk (direct change statements)
  • Increased questions about change
  • Envisioning and experimenting†

Working with ambivalence

Ambivalence is a normal part of the change process. Helping students resolve it, therefore, is key to change. When helping, however, it's important not to take one side over the other. Here are some other things to keep in mind:

  • Each youth’s ambivalence is unique, so go at his or her pace.
  • Ambivalence is not always rational – use empathetic and reflective listening strategies to stay attuned to the youth’s feelings, values and beliefs.
  • Help the student move through their ambivalence by evoking reasons for change and risks of not changing.

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†From Miller, W.R. & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd edition). New York: Guildford.

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Key Tasks

  • Sort options and arrive at a plan: Help the youth both determine the best course of action and develop a plan.
  • Elicit commitment: Have the young person reaffirm commitment to their plan.

If a youth is preparing or attempting to make changes, for a variety of reasons they may be vulnerable to ambivalence or a weakening of commitment and may be be at risk of not following through. It is important to enhance their confidence in their ability to change, and help them make a realistic change plan.

Taking the Next Steps

We can use open-ended questions, reflective listening and summarizing to get youth thinking and talking about the next steps.

Some mobilizing open-ended questions might be:

  • What do you think you will do?
  • What are you ready or willing to do?
  • What have you already done, even if just a small thing?

A summary should begin with a statement that is an attempt to draw together everything that has been discussed and look at what they are ready or willing to do next. It should include the following elements:

  • the youth’s perception of the problem
  • the youth’s ambivalence
  • objective evidence of risks that are present
  • re-statement of any indication of wanting, planning or intending to change
  • our own assessment, especially where it agrees with the youth's own concerns

In supporting action for change:

  • Provide positive feedback and restate the young person’s commitment to change.
  • Discuss the young person’s level of confidence and ways they can obtain support.
  • Emphasize self-efficacy and provide the youth with self-help resources.

A worksheet such as the following may help to guide the discussion.

  • Change Plan: A practical way to support a young person in following through with their plans is to help them choose one or two things to change and assist them in making an action plan. Try using a worksheet such as My Change Plan to help the young person think through their next steps.

Avoiding Pitfalls

Helping youth move to action can involve hazards such as being overly eager or trying to make the youth do as we would like. We need to continue with the same care and style used when motivating change, which means emphasizing personal responsibility and choice. At the same time, not answering the youth’s request for direction can lead to floundering. It may be best to answer with alternatives.

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Solidifying changes involves helping students build their capacity for, and commitment to, change. This means helping them develop skills and supportive networks to continue their healthy behaviours while avoiding lapsing back into their old patterns of harmful behaviour.

Applying a health lens

Helping young people continue to make positive changes is not just about addressing individual behaviours (e.g., those related to personal choices about substance use). Students' choices and behaviours are often the result of what they see, hear and experience in the world around them. Therefore, it is crucial that we try to identify and influence opportunities at both the school and community level to build healthier environments in which to grow and learn.

Creating a school that enhances the health and well-being of students requires that a health lens be applied to all of the school’s structures, policies and programs. For instance, when developing a new policy, these two core questions deserve consideration:

  • What impact will the policy have on the healthy development of students?
  • Will this policy increase or decrease school connectedness?

Connectedness and building bridges

Connections with family, school and community are significant protective factors for harms related to using alcohol and other drugs. The more protective factors young people have in their lives, the more resilient they will be in the face of obstacles or challenging circumstances.

This is especially important for students returning to school from a service or program in the community. Relationships with friends, teachers and family members may have been negatively affected by the student's previous behaviour. Therefore, bringing the student back into a normal classroom situation will of course involve helping them restore relationships and build connections within the school and community.

Some ways to support a student's return to school include

  • engaging with parents or guardians around how the school and home might work together to support the student, and
  • facilitating discussions with teachers about ways to ease the student's integration back into the classroom.

Preventing relapse

Students who are trying to maintain positive behavioural changes need affirmation that they’re doing a good job. They also need encouragement to stay on track, even if they lose their way sometimes. We can do this by checking in with them about their progress and praising them for the changes they’ve maintained (or for their continuing to stay connected to us despite not sticking to their goals such as reducing their use of alcohol or other drugs). 

Since preventing relapse is a routine part of the relationship, it’s best not to think of the process in terms of linear steps. Nonetheless, the following elements are involved.

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One way to do this is to help the young person create a list of benefits and suggest they carry it around as a reminder and motivator. For example, this may involve reviewing the costs associated with using alcohol and other drugs, and the benefits of change. Another way is to encourage them to acknowledge everyday at least one good thing that happened because of the positive changes they made.

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A high-risk situation is when a student finds it particularly difficult to stay on track with the changes they are making because of one or more of these factors: emotions, thoughts, places, events, or people. Self-monitoring is one way for a young person to identify times when they’re particularly prone to lapse into old patterns (e.g., harmful use of drugs). Other options include simply asking them about situations that have caused them difficulties in the past, or using a worksheet such as Identifying and Managing High Risk Situations to help guide the conversation.

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During the early stages of change, young people may find it easiest to simply avoid high-risk situations. But it’s not always possible to steer clear of risky situations. For this reason, they may need help in developing a plan to cope with situations if/when they arise. This could involve introducing various problem-solving techniques and practising them through role-playing. Or it could involve introducing them to harm reduction strategies.

Harm reduction strategies are also useful when dealing with youth who are using drugs alone because of shame or fear of detection. (Note: These situations put young people at higher risk of overdose, intoxication and assault, so it’s crucial to address them as safety issues.)

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When a young person has a relapse, they should not be made to feel guilty. Instead, they should be encouraged to brush it off and try again. Remind them that relapse is a normal part of the change process for many people. And repeat the techniques used to get them on track in the first place.

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About Art of Motivation

This resource offers a way for school professionals to implement the promising practice related to brief intervention and referral. It helps school professionals help students explore making positive changes to their behaviour, including their use of alcohol and other drugs. Grounded in a motivational approach, the aim is to support students in examining their situations and deciding if and what they would like to change.

For further information about the tool and discussion on how a motivational approach has been implemented in some school districts in BC, you can view this webinar. Because we were still unfamiliar with the technology, the web tour part of the webinar is less than ideal. Please be aware that as the features of the web tool are being described, you can navigate around the site as you would in a normal browser.

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Worksheets

Self-Help Resources