Attachment A-7. MI Practitioners Focus Group Protocol

Appendix A-7. Focus Group with MI Practitioners Protocol

BEYOND BENEFITS STUDY
SOCIAL SECURITY ADMINISTRATION
Thank you for agreeing to participate in this focus group. My name is [NAME] [if have someone
else there, introduce them as well]. [I/we] work for Westat, a research organization based in
Rockville Maryland. The Social Security Administration, or SSA, has hired Westat to conduct the
Beyond Benefits Study.
During the Beyond Benefits Study, researchers will collect information about the service, medical,
and employment needs of working-age adults who used to get disability-related payment from SSA
in the past, but who stopped receiving disability-related payments due to medical improvement. This
includes the Motivational Interviewing pilot that you were a part of which aims to understand the
feasibility of using motivational interviewing with this population. This study will help SSA identify
potential interventions and inform policy recommendations to help people who are leaving disability
benefit programs and may be considering going back to work.
Today, we’d like to have a conversation about your experiences working with Exiters as part of the
Motivational Interviewing Pilot, including the challenges of providing motivational interviewing to
Exiters and the factors that help or hinder them in obtaining and maintaining employment.
We previously sent you an informed consent sheet, explaining your rights in participating in this
study. Did you have any questions about that information? [ANSWER QUESTIONS]
I just want to remind you of some of the key points about your rights.
• Your participation in this focus group is voluntary. You can choose not to answer one or
more of the questions and you can stop participating in the focus group at any time without
penalty.
•

Your answers are collected for research purposes and we will safeguard the information and
use it for limited purposes, consistent with applicable Federal law, regulations, and directives.
Your name or other identifying information will not be included in any final or published
report. We may use quotes from you or other participants but no names will be linked to any
responses.

•

A study member will lead the focus group and will instruct all participants that everything
discussed in the focus group should be kept private. However, there is some chance that
some focus group members might share what they hear in the focus group with others
outside the group.

We have planned for this focus group to last no longer than an hour and a half. You will receive a
$40 Visa gift card to thank you for your participation.
Do you have any questions? [ANSWER ALL QUESTIONS]
Finally, with your permission, I would like to record this focus group to help [me/us] recall what
was said.
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Appendix A-7. Focus Group with MI Practitioners Protocol

Are you okay with me recording? [PAUSE FOR RESPONSE]
[IF AGREES TO RECORDING]
I’d like to start the recording now. [TURN ON THE RECORDER.]
For purposes of the recording, I am going to ask you:
Are you willing to participate in the focus group? Are you willing to have the focus group recorded?
[PAUSE FOR RESPONSE.]
[IF DECLINES RECORDING]
Unfortunately, this means that you cannot participate in the focus group. Thank you for your
interest.
[PAUSE FOR RESPONSE.]
OK let’s begin.

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Appendix A-7. Focus Group with MI Practitioners Protocol

I.
Introduction
To start, I’d like to review the guidelines for this focus group and also facilitate some
introductions.
As I previously mentioned, my name is [NAME] and I work for Westat, a research company.
I’m joined by [NAME] who will act as a tech liaison during the focus group. We are gathering
information for the Social Security Administration about using motivational interviewing to help
motivate people with disabilities to become independent and specifically obtain and maintain
employment.
We want everyone to feel comfortable sharing their experiences with us in this group. As part of
that, I want to emphasize that everything that is said during this focus group should be kept
private. That means that while you can talk to people outside this group about the focus group
in general terms, no one should be talking specifically about what was said. For example, you can
tell people that you participated in a focus group about motivational interviewing, but don’t tell
people that “so-and-so said this or that.” We won’t be using any last names, and we’ve
encouraged people to use pseudonyms or nicknames if that makes them more comfortable. If
anyone has any concerns about their privacy, please let me know.
All right. Let’s start with some introductions. If we could go around, I’d like to ask everyone
what name they’d like to be called and where you are based. Let’s start with [NAME]
[NOTE: AFTER INTRODUCTIONS, CAN GUIDE THE DISCUSSION TO ANY OF THE
TOPICS BELOW, BUT DOES NOT HAVE TO BE IN ORDER]
[FOR ALL QUESTIONS, PROBE WHETHER OTHERS IN GROUP HAVE HAD
SIMILAR OR DIFFERENT EXPERIENCES/WHETHER THEY AGREE OR
DISAGREE]
II.
Overall impression of the pilot
First, I’d like to talk a little bit about your experience with the Motivational Interviewing pilot,
before moving on to specifics about the pilot structure and lessons learned.
1. Tell me about your most positive counseling experience as part of the pilot.
2. Tell me about your most negative counseling experience as part of the pilot.
3. How was your experience working with pilot participants different than you expected?
a. How was your work with Exiters different than your work with other clients?
b. How was your work with Exiters the same as your work with other clients?
4. Understanding that there’s no such thing as a “typical” trajectory of counseling, did you see
any patterns in counseling in pilot participants? How is this different or the same as the
other clients you serve?
5. How many of Exiters came to you in the pre-contemplation or contemplation stage?

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5a. How many of them finished their sessions with improvements in their motivation stage
(i.e. moving to the preparation or action stage?)? What types of facilitators and barriers did
you see pilot participants face?
6.

How many Exiters came to you in the Action Stage?
6a. How many of those pilot participants finished their sessions with you with a job or
working with an employment specialist? What types of facilitators and barriers did you see
pilot participants face?

III.
Pilot specifics
Now, I’d like to talk about the specific details of the pilot, and what worked and what didn’t
work for you.
7. How many sessions did most of your pilot participants attend?
a. What did participants who needed more sessions have in common? What did
participants who needed fewer sessions have in common?
8. In general, do you think that 6 sessions is the right number for working with participants
exiting Social Security disability programs? Why or why not?
9. How long did most of your MI sessions with pilot participants last?
a. What did participants who needed more time have in common? What did
participants who needed/wanted less time have in common?
10. In general, do you think 45 minute-1 hour sessions is the right amount of time per session
for participants exiting Social Security disability programs? Why or why not?
11. How frequently did you meet with most of the pilot participants?
a. What did participants who wanted to meet more frequently have in common? What
did participants who wanted to meet less frequently have in common?
12. In general, do you think that sessions every two weeks is the right frequency for participants
exiting Social Security disability programs? Why or why not?
13. Did you experience participants canceling their appointments and/or not showing up? What
were the common excuses for missing appointments? What do you suggest to make sure
people are able to keep their MI appointments?
14. About what percentage of your pilot participants did you meet with virtually (video
conferencing)?
a. Which participants opted for video sessions? Which participants opted for phone
sessions?
b. What worked well about video sessions? What didn’t work well?
c. What worked well about phone sessions? What didn’t work well?
15. How well did the Stages of Change screener work for pilot participants?
a. What worked well about the screener?
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b. What didn’t work well about the screener?
c. What changes to the screener would you recommend? This could include the
questions, when it is filled out, mode of the screener (paper, electronic), etc.
16. How well did the worksheets work for pilot participants?
a. What worked well about the worksheets?
b. What didn’t work well about the worksheets?
c. What changes to the worksheets would you recommend? This could include
questions, when they are filled out, mode of the worksheets, etc.
17. Are there other tools (worksheets, videos, etc.) that you used in your sessions that you
thought worked particularly well?
IV.

Participant Needs and Referrals
Next, I’d like to talk about the needs of pilot participants, including both employment
and non-employment needs.

18. What were some of the most common employment needs of pilot participants? E.g., resume
help, job search help, interviewing skills, etc.
19. Were participants interested in referrals for employment services? Why or why not?
20. Were you able to make referrals for employment services for your participants?
21. Were pilot participants referred to IPS supported employment? Do you know what
proportion of participants were referred?
a. What barriers did you face in making referrals for IPS supported employment
services? E.g., wait times, eligibility restrictions, etc.
b. Did you have any facilitators of IPS supported employment referrals? E.g.,
relationships with IPS supported employment agencies, etc.
c. What proportion of participants took up (or followed through on) IPS supported
employment referrals, if you know?
22. Were pilot participants referred to vocational rehabilitation or VR services? Do you know
what proportion of participants were referred?
a. What barriers did you face in making referrals for VR services? E.g., wait times,
eligibility restrictions, etc.
b. Did you have any facilitators of VR referrals? E.g., relationships with VR agencies,
etc.
c. What proportion of participants took up (or followed through on) VR referrals, if
you know?
23. What were some of the most common non-employment needs of participants?
a. Probe: Transportation; housing; food security; Internet access; medical; other
24. Were you able to make referrals for non-employment services for your participants? Were
participants interested in referrals for non-employment services? Why or why not? Do you
know what proportion of participants were referred?
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a. What barriers did you face in making referrals for non-employment services? E.g.,
lack of services, wait times, restrictions, etc.
b. Did you have any facilitators of non-employment referrals? E.g., relationships with
providers, etc.
c. What proportion of participants took up (or followed through on) referrals, if you
know?
V.

Motivational Challenges and Impact on Practice
Let’s turn to the motivational challenges of participants, and the impact of the pilot on your
own practice.

25. Why did participants in the pilot say they wanted employment?
a. How is this different than other clients you serve?
26. What types of hesitations or anxieties did participants express about employment?
a. How is this different than other clients you serve?
b. Did you feel equipped to address these hesitations or anxieties?
i. Were there additional resources you would have wanted to work more
effectively with this population?
27. Did you need to make any adjustments to your counseling (methods, policies, practices, etc.)
in order to participate in the pilot?
28. If the pilot were to be implemented on a wider scale, would you be interested in serving
more people exiting disability programs? Why or why not?
29. What types of changes (in policy or practice) would you want to see if this pilot were
implemented on a wider scale?
a. Changes in your own practice
b. Changes in broader policy, e.g., funding, availability of counselors, etc.
c. Changes in training
VI.

Reflections

30. Overall, do you think the Motivational Interviewing approach was helpful for the pilot
participants you saw? Why or why not?
31. What changes would you like to see if the pilot were implemented more widely?
32. What potential problems could you see occurring if the pilot were implemented more
widely?
a. For counselors
b. For participants
33. If money were no object, what type of programs would you design to help people exiting
Social Security disability programs?
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34. Any final comments?
Thank you for your time.

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