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Community & Behavioral Health | Recovery | Social Change

Motivational Interviewing 12: Joy Crawford

An episode of “Changing the Conversation” podcast

Joy Crawford and Ali Hall share strategies for supporting people experiencing trauma during COVID-19 through remote services and Motivational Interviewing practices with host Jeff Olivet.

March 22, 2021

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Jeff Olivet, Host: [0:05] This is Jeff Olivet with Changing the Conversation. Today, the next in our series of conversations around motivational interviewing, and I’m thrilled to be joined by Joy Crawford and Ali Hall. Joy is executive director of Eve for Life. She’s a MINT member, and a master trainer, and facilitator. Joy is also a motivational interviewing trainer and a clinical supervisor. Joy calling in from the beautiful Island of Jamaica today, it’s great to have you.

Joy Crawford, Guest: [00:31] Thank you so much. And great to be here.

Jeff: [00:34] And Ali Hall is an independent trainer consultant and coach on motivational interviewing. She’s a member and a board member of the Motivational Interviewing Network of Trainers, calling in from San Francisco, California. Ali, it’s great to have you again.

Ali Hall, Guest: [00:48] Thank you Jeff. Good to be with both you and Joy.

Jeff: [00:50] And our topic today Joy is the question of serving the most vulnerable during the era of pandemic. All over the globe over the last now 12 months or more, communities, individuals have faced the tragedy of the Corona virus pandemic of COVID-19 both on the physical and mental health of individuals and families, certainly the tremendous loss of life. And also the economic impact that has affected so many people around the globe. Tell us about your work with people who are already vulnerable before the pandemic and now that’s compounded by the impact of COVID-19.

Joy: [1:35] You are correct. COVID-19 is a pandemic I think that really has overshadowed or released the issues that have been happening to other pandemics in my area. So for example, I consider what’s happening to the adolescent girl in our country and in the world as a vulnerable person who experienced gender based violence and family violence, and other ills that happen to our girls with trafficking and all the issues around abuse.

Joy: [2:10] And so with COVID, it really has exasperated and made the issues so much more larger, eh? But those things are already there and really never got enough attention. So what I have noticed is that COVID has been a challenge, but has also been an opportunity. And in particular, in the organization that I work and I serve, we have seen an increase in the social ills where our government for example, had a number of responses to give financial aid.

Joy: [2:50] And I think most countries have tried to do that. But when you have criteria for financial aid, such as documents, identifications, national registration numbers, or even employment confirmation, it rules out the group of persons who have none of those things. So the adolescent mother who is not yet in the formal workforce, and or the young woman who doesn’t have education to be a part of any of that she’s an, what we call in Jamaica hustler or someone who really just do work that doesn’t require any kind of academic stuff.

Joy: [3:35] And she was left out, she wasn’t able. She doesn’t have a bank account to receive the grants. Things like that. We also saw where, as a result of COVID the whole issue of mental health that was mentioned that before COVID a lot of the young women who are facing these issues were already at a disadvantage in terms of managing emotional disorders. A girl for example, who is a survivor of incest in her family and is going through counseling and can no longer access through a therapist because of where she may have been living.

Joy: [4:13] And she doesn’t have a device to go online. She doesn’t have data in her community to continue her care, finds herself again at greater risk. So we saw a number of issues around, and also because of increased violence, schools are out. Schools were out and kids were sent home to do online schooling. But if you think about a household that may have three kids and have one computer. Then of course there’s challenge there.

Joy: [4:42] Just quickly on one opportunity though is, I think the whole world recognize that there were some populations who would have been at higher risk either for the infection and or for the social ills. And so people have been trying to put in place to increase food bank, security. We have here in Jamaica, a number of kids benefited by getting gifts of tablets to go online from our government. We never had tablets before. So I think there were opportunities as much as challenges

Jeff: [5:17] You’re hitting on so many complicated and interconnected issues. I hear you talk about sexual exploitation and sexual violence, the issue of access to technology and to internet, which is so critical in even basic educational access in the time of COVID. You’re talking about hunger, these issues are so deeply entwined. And as you said in the earlier part of your comments, the current pandemic has sort of peeled back the cover on a hundred other pandemics.

Jeff: [5:52] Whether we’re talking about homelessness, or mental health crisis, or suicide, or domestic violence. Let’s talk a little bit more about girls at risk for sexual violation, sexual violence, sexual exploitation. That’s a lot of the work that you all do. And I’m curious how you engage in that work when we’re in this time of sort of social distancing when this work is so relational. What have you done to adapt to the current realities?

Joy: [6:22] One of the things for Eve for Life, is that we always said at the beginning of the pandemic here in Jamaica, which would be about a year ago, February, March is that we would have come out on the right side of the pandemic. I think we were one of the more favorite organization because prior to the pandemic, our strategy was already youth centered. So for example, we were already using WhatsApp groups to communicate with our clients because they are young.

Joy: [6:55] We’d do like a social media engagement. They were all on our Instagram page, and they’re on our Facebook page. So even though I’m a co-founder, and I may be up there in years, our target audience are young people. So the work that we’re doing, we’re already driven in that way. We have what we call our mentors, which are young women, all of them would have been on the age 30, who were survivors themselves. And our mentorship program would see where we have one of the mentor being like a big sister to two or three other young girls. That’s the model.

Joy: [7:31] And she already had 24 hour relationship with these young women. They could have called her any time throughout their day, their life, their triggers. So before the pandemic as an organization, the way we delivered service and the way we deliver care was heavily remote, heavily client centered, targeted to each client based on her particular needs. So from that perspective we had our process in place. What we didn’t have was the tools for infrastructure. So we may have before COVID had one computer in rural Jamaica, we recognized we needed more than that.

Joy: [8:15] Our partners like our psychologists who used to come into the office and provide her service, she was stuck probably three hours away, and we needed to connect her with the client. So even was simple thing like a Zoom license, you know without the Zoom license you have, I think 40 minutes or 30 minutes before the call cuts off. We recognize that we had to go purchase a Zoom license. So if someone needed to talk for more than 40 minutes, then they weren’t cut off. So we had to look to see how we increase the quality of our service and put better infrastructure in place.

Joy: [8:55] We were kind of fortunate because prior to that we were already doing a lot of more handholding, 24 hour engagement, reaching our clients. What we faced was the client though, not being able to access even what we would have done. And in particular around sexual violence. This is a scenario, the perpetrator, if it’s a male in most instances who would engage in physical violence, sexual violence with his partner or with a girl who is just someone who is in the community, would carry out the act and then go away.

Joy: [9:37] They were now stuck at home. So the household that may have the perpetrator in the home. You would find that if rather than the girl being sexually violated once a month or once a week, you are now talking about daily experiences. You were talking about girls who would be able to leave home for support. We had lock down in communities, the government had curfews, so she couldn’t leave and go visit a friend or leave and go to the police station, or leave and go to the health center as she would have been able to do prior to COVID.

Joy: [10:15] So her ability to seek safety, and security, and psychosocial support was reduced in COVID. And so we had to get a lot more creative. We had a lot more home visits. When I think that we’re able to do is to lobby that we become a part of the essential services. So where a movement has taken place from the formal essential service, even though the mentors and Eve for Life is not a health facility, we recognize that we were essential services. And so we were able to move around with some amount of privilege to go in and bring food, or go in and reach the girls. So, those are some of the situations that we noticed.

Jeff: [10:59] It’s really profound and deeply sad. What you’re talking about, that people who may have been able to escape violence, escape rape, and incest, and all of the other emotional and physical and long-term fallout from that now have no escape. And it strikes me that these stories are not being told at least enough in the mass media, if our listeners want to know more about Joy and her organization, they can visit the website at Eve for Life, eveforlife.org and learn more about the work. Joy, I’m curious how motivational interviewing plays into all of this. You’re a very seasoned practitioner, and trainer, and clinical supervisor. What have you seen around the role of motivational interviewing training and skills as your team and other organizations have tried to operate in this very difficult context?

Joy: [11:56] I’m a motivational interviewing advocate, not just a trainer or a practitioner, but I’m an activist for it because the very essence, the heart of MI that embraces autonomy, the collaboration, the partnership, the empathy, those attributes are perfect for the way that we do. Is the non-judgmental attitude that is required, where listening to somebody’s story about their own pain or experiences, and whether they had power or not had power or display power, or not, not to be able to judge it, but to really to be able to walk with that person.

Joy: [12:38] And then to have a kind of conversation that creates the respect and allow them the room to make their decision. So even in making, for example, a gender-based violence safety plan, a safety plan as to where the woman or the girl is at requires a particular attitude from the counselor or from the practitioner. And MI does that. So shortly after I was mentored in 2016, I mean, once I came home, one of my first thing was to make sure that all my mentors and all my staff were trained in MI and got coaching.

Joy: [13:17] And I had the opportunity to work with Jessie Barb, who was my mentor when I just got mentored, was to ensure that we were giving them the best support. My trainers, Sylvie and Maurice, they were there to ensure that the coaching went on. So again, I believe for me, the quality of work that Eve for Life has been able to put out and sustain is a direct benefit from my being exposed to MI and being a trainer in MI. That conversation is so key. I think the other thing for MI I think, and how it has helped us is — autonomy is something that I really appreciate.

Joy: [14:04] We’re in a culture, I don’t know about the rest of the world, but we like to tell people things. We like to dictate people’s lives, and we have an opinion about everything. I mean, once you say something, if something comes on and immediate I tell you man, if you put something on Instagram or Facebook and you look at those comments, everybody has a comment, and everybody has all authority on the situation. What MI has done for us is to allow my team to remember that it really is not about us. It really is about, and if there’s one group of people who need to be validated, is someone with an experience as their own as extremely traumatic.

Joy: [14:48] So I think that’s the other real big benefit that MI has provided for us as an organization. And in Jamaica, we really have become the go-to around this issue. How do you care for girls and women who have had this experience. We actually are the only NGO that’s focused primarily on this population. I mean, I have friends who are psychologists who say, we don’t want to touch it. We struggle, it’s hard. It’s difficult for us to listen to a girl who is raped by her father, and then she gets pregnant. So the issues that happen in this population, they’re so emotional. They’re so emotive that if the practitioner, I mean, in our case, if myself or my team is already grounded in a skill that allow us to step back and to do our own self care, but to just work with the client, then we would have been in trouble. So we were really grateful that we have been exposed to MI.

Jeff: [15:51] Well, thank you Joy first of all for the work that you all do, it’s really incredible to hear you talk about it. And around MI loved your phrase. You’re not just a practitioner or a trainer. You’re an advocate. You’re an activist for MI. You’re not the only activist for MI on this call. We’ve got Ali Hall with us, and I’d like to invite you into the conversation. What are you hearing and what are you thinking about in Joy’s descriptions of how this all plays out. The things that are already endemic in our society that people don’t want to talk about. And now the pandemic of Coronavirus has ripped back the cover. What do you make of all this?

Ali: [16:32] I’m just so moved by the heart and thoughtfulness and creativity that Joy is bringing to this vital work. And thank you for that Joy. I think that at least as a trainer and supporter of those who provide direct services in these times, access to treatment inclusion, that may involve availability of treatment generally, but also internet and other resources that people simply may not have. And as Joy said, when people cannot access resources outside their home, or may not be aware, there’s really compelled organizations to be pretty creative and coming up with ways to reach out low cost in other ways.

Ali: [17:11] But for example, brings up an urban and rural divide, access to resources and so on. And even we would think in urban environments where people might have greater access to internet services and so on, not if you can’t get out of the house and not if your home doesn’t offer. And if you’re there. So I know that in some urban places, providers have been very clever and creative to bring their treatment materials say to laundromats and coffee shops where people might be able to get out and see that help is available.

Ali: [17:49] Maybe to be able to access that kind of help. And also workshops frequently in increasing inclusion and access for those in these times. And just, we can think about great, if you have an opportunity to get out of the house and see a provider. And of course the issue of wearing masks and physical distancing brings up a whole another set of traumas for some people. So finding a way, whether it’s by cell phone, or whether it’s by tablets, or whether it’s the person prefers to be able to get away and meet at a treatment center or something like that, it’s all to be figured out with the greatest compassion. But it really has compelled our providers to be very creative, not only in finding people who need help, but making sure that those services are delivered in a trauma-responsive way.

Jeff: [18:36] And this is, I think for both of you, the question of how, not only do you do service provision in a remote environment, but how do you do training in a remote environment around a practice that is deeply relational and very much about human contact. I’m curious what both of you have learned over the last year around service provision from a remote point of view. And Joy, you said you all were already doing a lot of remote service provision. I’m curious how you all have also learned about and thought about training for new MI practitioners. Joy, go ahead.

Joy: [19:12] I listened to Ali talk about just creative ways to ensure that this service continues to be done in a way that serve the client. I thought about the issue of confidentiality, because before COVID and especially you’re seeing someone face-to-face, it’s very easy to go into a room and you lock the door and you create this privacy. And we felt not very early through one particular case, where when I call the young lady, I got a report that she was in need of a call and support because there was some traits for violence around her.

Joy: [19:50] So I remember calling her, and she answered the phone and I was like, “Okay, are you able to talk?” She said, “Yes. I’m able to talk.” They call me Auntie Joy sometimes. And I’m like, so I said, okay. My next question was, “Can you speak privately?” And said, “Yeah, man, I can talk. Go ahead and talk.” I said, then I asked, “Is there anyone else there with you?” “Oh, yes, my brother and my cousin.” And then she listed a couple of people who was with her. And then I asked, is there somewhere in the house that you could go that you’re alone? And then my next question is in the house best or should you go outside? Can you find an outside area with a tree.

Joy: [20:36] And I went through a number of asks just to make sure that she was actually in a space that was private and confidential. Before COVID and before being alerted as to how urgent this need for the environment to be, I probably would have started the conversation, the moment I called and she says, “Hi, I’m glad you called.” But I was not aware of that, what privacy looks like to me may not be the same for that person and their understanding of it. And not recognizing that the conversation that we may engage in as practitioner or a therapist really is not for the brother and the uncle and the cousin who she says, “Oh, they’re okay. They’re fine.”

Joy: [21:27] So just establishing in a remote way, what privacy and confidentiality looks like, really is a different thing. And we were able to pick that up very early. And so we really helped the person on the other end of the phone to ensure that what they understand privacy to be really is private. So I just wanted to share that because I found that to be very interesting as we have navigated COVID. How do we make the space really private and confidential. And we have done training. There’s one entity here. There is a group, it’s the United Theology College of the West Indies. And it’s an institution that trains ministers of religion here in Jamaica and the Caribbean.

Joy: [22:19] And they have a very strong program to train the ministers in voluntary, counseling and testing for HIV. And they wanted to get their training done online. So I was engaged to look at the curriculum which I had helped develop. And how do we create components of the curriculum and turn what used to be a five day training into an online training. And so we got very creative. So rather than having full days, we recognize that you can’t really engage for more than three hours at a time when you’re online. And so I do train, and I may do the same group or in the morning from 8:00 to like 11:00, and then we take a break and then we come back in the evening and we might do 4:00 to 7:00.

Joy: [23:11] And just that kind of stuff in our PowerPoints, it has to be very interactive, it has to be very colorful. One of the things that I included recently in one of my introduction slides was about, when you are using Zoom, ensure that you don’t stand up if you’re not fully dressed. And that just came with a bad experience because everybody has gotten used to getting dressed on the upper half for meetings. And if you’re in a long meeting, it’s very easy for you to forget that when you’re going to get up and get some water or that kind of stuff. I’ve added in my training slide, please do not take your computer to the bathroom, we’ll wait for you. Because I’ve had that as well.

Jeff: [23:56] [Laughter] It’s happened.

Joy: [23:58] Yeah. So for me, training online, I have just been developing it as I go along, and I learn from each training what work, how do you do interactive things using the technology. I had to learn about breakout rooms, and polls, and there are really stuff out there. So I think every MI trainer just need to recognize that we have to get along with the times and recreate. So that’s been my experience. It’s been really very good, but there’s nothing that beats face-to-face. I’m dying to get back out to more face-to-face.

Jeff: [24:32] Yeah. I think many of us are, many of us are missing all of the human contact that really undergirds all of our work. Ali, I’m curious any wisdom that you’ve learned over the last year, either around remote service provision or remote learning.

Ali: [24:49] Yeah. I appreciate hearing your experiences Joy, and particularly in training direct service providers. Trying to meet their needs, finding out what’s most challenging to them, how they’re going to be meeting up with those they serve. Trying to help them find creative ways to do that. Creative and safe ways that are not traumatizing to the person that they’re serving. And so we find that using interest and curiosity about why someone might show up on camera, why someone might not want to be on camera. Rather than making assumptions about that.

Ali: [25:22] Also, when working remotely and using Zoom or other platforms, just remembering to ask permission. How do people want me to join if they want me to join their breakout room. And collaborate with them on some skill practice, do they want me on camera, not on camera, mute or un-mute. Just finding out what people’s needs are and making sure that we’re meeting them. But I think first and foremost, not making assumptions about why people are showing up, how they’re showing up, if they’re not showing up in ways that others are. And making sure that there’s space for people to feel included and feel that the technology is accessible to them and useful to them. And letting them practice in ways that they’re going to then be delivering services directly.

Jeff: [26:08] As we wind down in our closing moments, I am curious what advice you all have for people out there who are providing services to very vulnerable populations in very difficult circumstances. The current COVID pandemic is about a year on at this point. And I think it’s wearing on people, it’s long been wearing on people. But I think the annual, the kind of anniversaries of initial lockdowns is sitting heavy with many of us. And yet the issues that we’ve been talking about existed long before this COVID pandemic, and unfortunately will exist long after this COVID pandemic. As you think about providers who are trying to hold it together for themselves and their families, as well as the people they serve. Any closing advice? Ali, we’ll start with you.

Ali: [27:04] Well, I think finding ways to make yourself available, letting people who need services most. Finding a way to let people know where you are or how to find you and have multiple ways that a person can find you. And people know their services and know their organizations and regions the best. And everyone will have creative solutions for that. But I think that that’s really vital right now when so many that we still feel so isolated. And need to know that help is available and how to get it.

Jeff: [27:34] Thank you for that. Joy, what closing advice do you have for folks?

Joy: [27:38] Yeah, I agree with Ali. Being available and recognizing that there is no returning to the old way. There’s opportunities at this time, and we have to find those opportunities. Because like you say, the pandemic is here, and it will be here for a while. And so learning new ways to deliver services is important. Making sure that we are learning to use the technology that we are seeing what is out there, investing in it, doing stuff like podcasts, and Zoom conversations. And we have support groups on Zoom. You know that … can have a closed group.

Joy: [28:26] Just making sure that whatever used to happen continues and gets better because we can’t not serve and provide services for persons at this time because their vulnerabilities have increased. And so whatever it takes, make the changes, make the adjustment and create the new normal as people have been saying. And make them better. I think the last thing I would say is just remember that whichever group we’re serving, whichever issue that there is, there is a subset that is more vulnerable than the vulnerable. And I think as practitioners, and even when we look at our training room, just try to give an eye to see who is the more vulnerable of this population. How do I reach that person who is most and more in need. And I think that will help us to get through the next couple of days and years and keep doing what we’re doing.

Jeff: [29:35] Joy Crawford, thank you so much for joining us today.

Joy: [29:38] Thank you for having me. It was great sharing the platform with you, Jeff and Ali.

Jeff: [29:42] You’ve been fantastic, and thank you for everything that you do in the world. If our listeners want to learn more about Joy and her work at Eve for Life, they can visit eveforlife.org. And Ali Hall, as always, thank you for joining us.

Ali: [29:56] Thank you Jeff and Joy.

Jeff: [29:58] And to our listeners. Join us next time on Changing the Conversation.

Erika Simon, Producer: [30:02] Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact. Thank you for joining us. This episode was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.

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