Motivational Interviewing Technology Helps Youth Experiencing Homelessness

Can arti­fi­cial intel­li­gence help staff sup­port young peo­ple with very real chal­lenges — and pro­vide a tool to sig­nif­i­cant­ly improve staff train­ing in an effec­tive tech­nique? Since 2018, the staff at Covenant House New York, New York City’s largest ser­vice provider for youth expe­ri­enc­ing home­less­ness, have used a coun­sel­ing and con­ver­sa­tion­al method called moti­va­tion­al inter­view­ing to help res­i­dents more read­i­ly embrace change. With sup­port from the Annie E. Casey Foun­da­tion, Covenant House New York part­nered with men­tal health tech­nol­o­gy start­up Lyssn to make train­ing staff in moti­va­tion­al inter­view­ing eas­i­er and more cost effec­tive to help the 1,600 youth who pass through the shel­ter each year.

Moti­va­tion­al inter­view­ing, a set of tech­niques for hav­ing empa­thet­ic con­ver­sa­tions, has been shown to be par­tic­u­lar­ly effec­tive in help­ing youth deal­ing with depres­sion, anx­i­ety or oth­er men­tal health issues. By pin­point­ing their moti­va­tions to make change, youth are bet­ter posi­tioned to take the nec­es­sary steps to real­ize their goals, big or small. At Covenant House New York, staff across all pro­fes­sion­al roles — includ­ing health­care pro­fes­sion­als, res­i­den­tial advi­sors, case man­agers, edu­ca­tors and employ­ment spe­cial­ists — are trained in the coun­sel­ing method. ​“The tru­ly inno­v­a­tive aspect of what Covenant House New York is doing is that every­one under­stands how to use moti­va­tion­al inter­view­ing,” says Cyn­thia Weaver, a senior asso­ciate in Casey’s Evi­dence-Based Prac­tice Group. ​“There’s con­sis­ten­cy across all staff, not just health­care providers, in their approach to encour­ag­ing change.” 

Using arti­fi­cial intel­li­gence to facil­i­tate training

Exec­u­tive Direc­tor and COO Leslie Abbey imple­ment­ed moti­va­tion­al inter­view­ing at Covenant House New York because of its effec­tive­ness and its poten­tial to help young peo­ple achieve impor­tant objec­tives to facil­i­tate the tran­si­tion from the shel­ter — like ensur­ing they have a place to live and hav­ing at least one per­son out­side the orga­ni­za­tion to whom they can turn for support. 

But while the appli­ca­tion of moti­va­tion­al inter­view­ing tech­niques has been shown to con­fer ben­e­fits on youth, it was chal­leng­ing for Covenant House New York to train new employ­ees in the approach and ensure they were prac­tic­ing it cor­rect­ly. One of the biggest hur­dles: Tra­di­tion­al train­ing in moti­va­tion­al inter­view­ing requires hours of expert coach­ing, an espe­cial­ly com­pli­cat­ed process to coor­di­nate for staff work­ing evening and overnight shifts.

To over­come this obsta­cle and to pro­vide con­tin­u­al, robust train­ing, Casey pro­vid­ed a grant so that Lyssn could tai­lor its moti­va­tion­al inter­view­ing arti­fi­cial intel­li­gence — orig­i­nal­ly designed to work with adults — to Covenant House New York’s more diverse youth pop­u­la­tion. By lis­ten­ing to thou­sands of taped ses­sions between Covenant House New York staff and young adults, Lyssn’s tech­nol­o­gy now reflects the chal­lenges faced by many Covenant House res­i­dents — such as expe­ri­ence with human traf­fick­ing, drug use and alien­ation from fam­i­ly and peers — that weren’t cap­tured in Lyssn’s orig­i­nal train­ing algorithm. 

Lyssn’s soft­ware, which com­plies with fed­er­al health pri­va­cy law, records, tran­scribes and codes moti­va­tion­al inter­view­ing ses­sions between Covenant House New York staff and youth. After­ward, Lyssn’s algo­rithms eval­u­ate the interviewer’s per­for­mance and pro­vide instant feed­back on how well they imple­ment­ed moti­va­tion­al inter­view­ing tech­niques. Lyssn also cre­at­ed Client­Bot, a chat­bot app that staff can use to prac­tice their moti­va­tion­al inter­view­ing tech­niques wher­ev­er and when­ev­er they’d like. Client­Bot offers four dif­fer­ent youth per­son­al­i­ties, each pro­grammed to real­is­ti­cal­ly sim­u­late a con­ver­sa­tion the prac­ti­tion­er might have with a client, and gives instant feed­back to enhance moti­va­tion­al inter­view­ing skills. 

“In addi­tion to achiev­ing bet­ter out­comes for youth, evi­dence-based mod­els are help­ful in retain­ing staff because they pro­vide excep­tion­al train­ing,” says Abbey. ​“If you’re doing it cor­rect­ly, there’s an ongo­ing sense of skills devel­op­ment and sat­is­fac­tion that most of our staff get very excit­ed about.” 

Improv­ing out­comes for youth with evi­dence-based models 

While Abbey and her team mon­i­tor goals for Covenant House New York’s wide range of pro­grams, they are just start­ing to mea­sure the effec­tive­ness of moti­va­tion­al inter­view­ing for their res­i­dents. For those mea­sure­ments to be accu­rate, it’s impor­tant that staff are close­ly adher­ing to the mod­el of moti­va­tion­al inter­view­ing that was proven effec­tive by researchers and clinicians. 

The app enables the staff to gauge their adher­ence to the mod­el, also known as fideli­ty mon­i­tor­ing. By mea­sur­ing their per­for­mance and get­ting feed­back on how well they are imple­ment­ing the coun­sel­ing tech­niques, Covenant House New York staff can learn how to improve. 

In the future, Weaver hopes to expand this appli­ca­tion of moti­va­tion­al inter­view­ing beyond Covenant House to oth­er providers and sys­tems serv­ing young peo­ple. Sim­i­lar­ly, Abbey hopes the approach will expand across the coun­try to oth­er orga­ni­za­tions look­ing to ben­e­fit from moti­va­tion­al interviewing. 

“We’re using cut­ting-edge inno­va­tions and work­ing with experts in this field, bring­ing in cur­rent research about what works with youth,” says Abbey. ​“We want good things for our youth.”

Learn more about the Foundation’s invest­ments in tech­nol­o­gy for evi­dence-based inter­ven­tions.