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Hurtubise K, Phoenix M, Camden C, Gauthier R, Stratford P, Dostie R, Beaudoin AJ, Maltais D, Berbari J, Gaboury I. The Development and Pilot Testing of a Fidelity Checklist for a Family-Centered Telehealth Intervention for Parents of Children with Motor Delay. Int J Telerehabil 2024; 16:e6603. [PMID: 39022432 PMCID: PMC11249651 DOI: 10.5195/ijt.2024.6603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
This multi-methods study describes the development of a pediatric rehabilitation telehealth intervention fidelity checklist, estimates its inter-rater reliability, and documents raters' implementation experience. A literature scan and expert consultation identified eighteen key behaviors and categorized them into three subdomains, measured using a 5-point measurement system. To estimate the checklist's inter-rater reliability, three raters scored 33 video recordings. A Shrout and Fleiss Class 1,1 intraclass correlation (ICC)) and 95% confidence intervals (CI) calculated ICCs = 0.5 (CI: 0, 0.9) for both the Therapist and the Parent-Therapists subdomains, and the Parent subdomain an ICC = 0.3 (CI: 0, 0.8). In the implementation surveys, raters reported high levels of satisfaction (100%), ease of use (84% to 88%), and confidence in their video ratings (87% to 100%). Changes in procedures and scoring were recommended. Capturing raters' implementation experiences is crucial in the early evaluation of the fidelity checklists for telehealth.
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Affiliation(s)
- Karen Hurtubise
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculté de Médicine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Phoenix
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Chantal Camden
- Faculté de Médicine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Raphaëlle Gauthier
- Faculté de Médicine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Paul Stratford
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rosalie Dostie
- Faculté de Médicine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Audrée Jeanne Beaudoin
- Faculté de Médicine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Désirée Maltais
- École de sciences de réadaptation, Faculté de Médecine, Université Laval, Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Québec, Canada
| | - Jade Berbari
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Isabelle Gaboury
- Faculté de Médicine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Naar S, Chapman JE, Aarons GA. Efficient and effective measurement of provider competence in community-based substance use treatment settings: Performance of the Motivational Interviewing Coach Rating Scale (MI-CRS). JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209027. [PMID: 36996970 PMCID: PMC11065477 DOI: 10.1016/j.josat.2023.209027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 03/02/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Efficient and effective fidelity measurement is necessary to improve rigor and reduce burden of motivational interviewing (MI) implementation studies for both fidelity outcomes and quality improvement strategies. This article reports on such a measure developed with rigorous methodology and tested in community-based substance abuse treatment settings. METHODS This scale development study analyzed data from a National Institute on Drug Abuse study testing the Leadership and Organizational Change for Implementation (LOCI) strategy. Utilizing item response theory (IRT) methods and Rasch modeling, we analyzed coded recordings (N = 1089) of intervention sessions of 238 providers from 60 substance use treatment clinics across nine agencies in an implementation trial focusing on MI. RESULTS These methods yielded a reliable and valid 12-item scale representing single construct dimensionality, strong item-session maps, good rating scale functionality, and item fit. Separation reliability and absolute agreement for adjacent categories was high. No items were significantly misfitting, though one was borderline. The LOCI community providers were less likely to be scored in the advanced competence range and items were more difficult compared to the original development sample. CONCLUSIONS The 12-item Motivational Interviewing Coach Rating Scale (MI-CRS) showed excellent performance in a large sample of community-based substance use treatment providers using real recordings. The MI-CRS is the first efficient and effective fidelity measure appropriate for diverse ethnic groups, with interventions that are MI only or interventions that integrate MI with other treatments, and with adolescents and adults. Follow-up coaching by trained supervisors may be needed for community-based providers to achieve the highest level of MI competence.
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Affiliation(s)
- Sylvie Naar
- Florida State University, United States of America.
| | | | - Gregory A Aarons
- University of California, San Diego, United States of America; UC San Diego ACTRI Dissemination and Implementation Science Center, United States of America
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Ellis AE, Martino S, Simiola V, Bellamy C, O'Connell M, Cook JM. Training Male Sexual Abuse Survivors as Peer Leaders to Deliver Motivational Interviewing and Trauma-Informed Affirmative Care. JOURNAL OF CHILD SEXUAL ABUSE 2023; 32:494-512. [PMID: 37080178 DOI: 10.1080/10538712.2023.2203691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This paper provides a description and evaluation of training male sexual abuse survivors to deliver Motivational Interviewing (MI) and Motivational Interviewing with Trauma-Informed Affirmative Care (MI-AC) online to sexual and gender minority (SGM) men with sexual assault histories and depression. After a search and selection process, 26 men with lived experience of sexual abuse received MI training that included the use of role-playing, video demonstrations, and practice followed by weekly supervision while co-leading groups. Peer leaders completed several measures pre and post training, including beliefs about MI and self-reported learning of MI and satisfaction with the training. A sample of MI and MI-AC audio sessions were independently rated for adherence and competence. Peer leaders' beliefs about MI changed over time, while self-rated skill level stayed consistent. Peer leaders demonstrated good adherence to the MI and MI-AC conditions. Results suggest that men with lived experience of sexual trauma effectively learned to deliver MI and/or MI-AC to SGM male survivors in online groups. These interventions have the potential to expand the reach of limited services for this population as well as reduce their depression and assist in SGM men with histories of sexual abuse entering into formal mental health services.
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Affiliation(s)
- Amy E Ellis
- Nova Southeastern University, Fort Lauderdale, FL, USA
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McLeod BD, Porter N, Hogue A, Becker-Haimes EM, Jensen-Doss A. What is the Status of Multi-Informant Treatment Fidelity Research? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:74-94. [PMID: 36480728 DOI: 10.1080/15374416.2022.2151713] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The precise measurement of treatment fidelity (quantity and quality in the delivery of treatment strategies in an intervention) is essential for intervention development, evaluation, and implementation. Various informants are used in fidelity assessment (e.g., observers, practitioners [clinicians, teachers], clients), but these informants often do not agree on ratings. This scoping review aims to ascertain the state of science around multi-informant assessment of treatment fidelity. METHOD A literature search of articles published through December 2021 identified 673 articles. Screening reduced the number of articles to 44, and the final study set included 35 articles. RESULTS There was substantial variability across studies regarding study design, how fidelity was operationalized, and how reliability was defined and assessed. Most studies evaluated the agreement between independent observers and practitioner-report, though several other informant pairs were assessed. Overall, findings suggest that concordance across fidelity informants was low to moderate, with a few key exceptions. CONCLUSIONS It is difficult to draw clear conclusions about the degree to which single versus multiple informant assessment is needed to produce an accurate and complete picture of treatment fidelity. The field needs to take steps to determine how to leverage multi-informant assessment to accurately assess treatment fidelity.
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Affiliation(s)
- Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University
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Fried TR, Yang M, Martino S, Iannone L, Zenoni M, Blakley L, O’Leary JR, Redding CA, Paiva AL. Effect of Computer-Tailored Print Feedback, Motivational Interviewing, and Motivational Enhancement Therapy on Engagement in Advance Care Planning: A Randomized Clinical Trial. JAMA Intern Med 2022; 182:1298-1305. [PMID: 36342678 PMCID: PMC9641591 DOI: 10.1001/jamainternmed.2022.5074] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/17/2022] [Indexed: 11/09/2022]
Abstract
Importance There is a tension between clinician-led approaches to engagement in advance care planning (ACP), which are effective but resource-intensive, and self-administered tools, which are more easily disseminated but rely on ability and willingness to complete. Objective To examine the efficacy of computer-tailored print feedback (CTPF), motivational interviewing (MI), and motivational enhancement therapy (MET) on completion of a set of ACP activities, each as compared with usual care. Design, Setting, and Participants This randomized clinical trial was conducted from October 2017 to December 2020 via telephone contact with primary care patients at a single VA facility; 483 veterans aged 55 years or older were randomly selected from a list of patients with a primary care visit in the prior 12 months, with oversampling of women and people from minoritized racial and ethnic groups. Statistical analysis was performed from January to June 2022. Interventions Mailed CTPF generated in response to a brief telephone assessment of readiness to engage in and attitudes toward ACP; MI, an interview exploring ambivalence to change and developing a change plan; and MET, MI plus print feedback, delivered by telephone at baseline, 2, and 4 months. Main Outcome and Measures Self-reported completion of 4 ACP activities: communicating about views on quality vs quantity of life, assignment of a health care agent, completion of a living will, and submitting documents for inclusion in the electronic health record at 6 months. Results The study included 483 persons, mean (SD) age 68.3 (8.0) years, 18.2% women and 31.1% who were people from minoritized racial and ethnic groups. Adjusting for age, education, race, gender, and baseline stage of change for each ACP, predicted probabilities for completing the ACP activities were: usual care 5.7% (95% CI, 2.8%-11.1%) for usual care, 17.7% (95% CI, 11.8%-25.9%; P = .003) for MET, 15.8% (95% CI, 10.2%-23.6%; P = .01) for MI, P = .01, and 10.0% (95% CI, 5.9%-16.7%; P = .18) for CTPF. Conclusions and Relevance This randomized clinical trial found that a series of 3 MI and MET counseling sessions significantly increased the proportion of middle-aged and older veterans completing a set of ACP activities, while print feedback did not. These findings suggest the importance of clinical interaction for ACP engagement. Trial Registration ClinicalTrials.gov Identifier: NCT03103828.
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Affiliation(s)
- Terri R. Fried
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Manshu Yang
- Department of Psychology, College of Health Sciences, University of Rhode Island, South Kingstown
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Psychology Service, VA Connecticut Healthcare System, West Haven
| | - Lynne Iannone
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven
- Program on Aging, Yale School of Medicine, New Haven, Connecticut
| | - Maria Zenoni
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven
- Program on Aging, Yale School of Medicine, New Haven, Connecticut
| | - Laura Blakley
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Psychology Service, VA Connecticut Healthcare System, West Haven
| | - John R. O’Leary
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven
- Program on Aging, Yale School of Medicine, New Haven, Connecticut
| | - Colleen A. Redding
- Department of Psychology, College of Health Sciences, University of Rhode Island, South Kingstown
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island, South Kingstown
| | - Andrea L. Paiva
- Department of Psychology, College of Health Sciences, University of Rhode Island, South Kingstown
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Rapelli G, Pietrabissa G, Angeli L, Manzoni GM, Tovaglieri I, Perger E, Garbarino S, Fanari P, Lombardi C, Castelnuovo G. Study protocol of a randomized controlled trial of motivational interviewing-based intervention to improve adherence to continuous positive airway pressure in patients with obstructive sleep apnea syndrome: The MotivAir study. Front Psychol 2022; 13:947296. [PMID: 36092104 PMCID: PMC9456614 DOI: 10.3389/fpsyg.2022.947296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This study aims to evaluate the effectiveness of the MotivAir program-a phone-based intervention based on Motivational Interviewing (MI) principles and techniques-in enhancing adherence to Continuous Positive Airway Pressure (CPAP) therapy among patients with Obstructive Sleep Apnea Syndrome (OSAS). Methods A multicenter randomized controlled trial (RCT) design with random allocation at the level of the individual will be conducted to compare the impact of the experimental program (usual care plus MI) with a control group receiving usual care only in improving selected clinical and psychological parameters in the patients. A minimum sample of 80 participants (40 patients per group) will be recruited in each center according to the inclusion criteria. After the initial screening, participants will be randomly assigned to either the experimental group or the control condition. The program will last 180 days and will be delivered by a trained nurse. The impact of the MotivAir program on selected primary (adherence to CPAP in terms of average hours of usage per night and the Apnea-Hypopnea Index, AHI) and secondary (motivation, perceived competence, quality of life, sleepiness) outcomes will be measured at baseline, and after 1-, 3-, and 6-month from CPAP initiation. Discussion Participants are expected to show an increased level of adherence to CPAP and to acquire the skills and self-confidence necessary to deal with the psychological consequences of their chronic condition.
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Affiliation(s)
- Giada Rapelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Licia Angeli
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Ilaria Tovaglieri
- Department of Pulmonary Rehabilitation, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Elisa Perger
- Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Disorders Center, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences, University of Genoa, Genoa, Italy
| | - Paolo Fanari
- Department of Pulmonary Rehabilitation, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Carolina Lombardi
- Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Disorders Center, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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Louie E, Giannopoulos V, Baillie A, Uribe G, Wood K, Teesson M, Haber PS, Morley KC. Relationship between clinician-level attributes and implementation outcomes from the Pathways to Comorbidity Care training program. BMC MEDICAL EDUCATION 2022; 22:605. [PMID: 35931994 PMCID: PMC9354347 DOI: 10.1186/s12909-022-03671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The process of determining the best strategy for increasing the uptake of evidence-based practice might be improved through an understanding of relevant clinician-level factors. The Pathways to Comorbidity Care (PCC) training program (Louie E, et al., J Dual Diagnosis 17:304-12, 2021) aimed to facilitate integrated management of comorbid drug and alcohol and mental disorders amongst drug and alcohol clinicians. We hypothesised that uptake of integrated management of comorbidity following the implementation of the PCC program would be associated with clinician-level: (i) demographics (gender, education, experience), (ii) attitudes (evidence-based practice, therapist manuals, counselling self-efficacy), and (iii) organisational readiness to change. METHODS Twenty clinicians participated in the 9-month PCC training program. Attitudes towards evidence-based practices and psychotherapist manuals, self-efficacy, and organisational readiness to change, along with demographics, were measured at baseline. At follow-up, change in Comorbidity Practice (CoP) scores related to integrated comorbidity management were obtained using a file audit checklist and categorised into high (at least 60% increase in CoP), medium or low (a decrease of - 20% or less in CoP). Clinician-level characteristics were examined across the implementation categories. RESULTS There were no significant differences found between implementation groups on sociodemographic variables (p's > 0.30), attitudes to evidence-based practices, attitudes to therapist manuals, and self-efficacy (p's > 0.52). The high implementation group demonstrated significantly higher scores on leadership practices aspect of organisational readiness to change relative to the low and medium implementation group ((F(2, 16) = 3.63, p = 0.05; Cohen's d = .31) but not on the other subscales (p's > 0.07). CONCLUSIONS Confidence that leadership will play a positive role in the implementation process may improve effectiveness of comorbidity training programs for drug and alcohol clinicians. On the other hand, contrary to our hypothesis, counselling self-efficacy, evidence-based practice attitudes, attitudes towards therapist manuals, gender, education and experience were not distinguishing factors.
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Affiliation(s)
- Eva Louie
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Vicki Giannopoulos
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Gabriela Uribe
- Menzies Centre for Health Policy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Katie Wood
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
| | - Paul S Haber
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C Morley
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia.
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Britt E, Soleymani S, Wallace‐Bell M, Garland A. Motivational interviewing for employment: An exploration of practitioner skill and client change talk. JOURNAL OF EMPLOYMENT COUNSELING 2022. [DOI: 10.1002/joec.12198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Eileen Britt
- School of Psychology, Speech & Hearing University of Canterbury Christchurch New Zealand
| | - Sara Soleymani
- School of Psychology, Speech & Hearing University of Canterbury Christchurch New Zealand
| | - Mark Wallace‐Bell
- School of Health Sciences University of Canterbury Christchurch New Zealand
| | - Anna Garland
- School of Psychology, Speech & Hearing University of Canterbury Christchurch New Zealand
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Hinde JM, Garner BR, Watson CJ, Ramanan R, Ball EL, Tueller SJ. The implementation & sustainment facilitation (ISF) strategy: Cost and cost-effectiveness results from a 39-site cluster randomized trial integrating substance use services in community-based HIV service organizations. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221089266. [PMID: 37091108 PMCID: PMC9924275 DOI: 10.1177/26334895221089266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: As part of the Substance Abuse Treatment to HIV Care Project, the Implementation & Sustainment Facilitation (ISF) strategy was found to be an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy for integrating a motivational interviewing-based brief intervention (MIBI) for substance use disorders. This study presents the cost and cost-effectiveness results. Methods: Thirty-nine HIV service organizations were randomized to receive the ATTC-only condition or the ATTC + ISF condition. Two staff from each organization received the ATTC-training. In ATTC + ISF organizations, the same two staff and additional support staff participated in facilitation sessions to support MIBI implementation. We estimated costs using primary data on the time spent in each strategy and the time spent delivering 409 MIBIs to clients. We estimated staff-level cost-effectiveness for the number of MIBIs delivered, average MIBI quality scores, and total client days abstinent per staff. We used sensitivity analyses to test how changes to key variables affect the results. Results: Adjusted per-staff costs were $2,915 for the ATTC strategy and $5,371 for ATTC + ISF, resulting in an incremental cost of $2,457. ATTC + ISF significantly increased the number of MIBIs delivered (3.73) and the average MIBI quality score (61.45), yielding incremental cost effectiveness ratios (ICERs) of $659 and $40. Client days abstinent increased by 59 days per staff with a quality-adjusted life-year ICER of $40,578 (95% confidence interval $29,795–$61,031). Conclusions: From the perspective of federal policymakers, ISF as an adjunct to the ATTC strategy may be cost-effective for improving the integration of MIBIs within HIV service organizations, especially if scaled up to reach more clients. Travel accounted for nearly half of costs, and virtual implementation may further increase value. We also highlight two considerations for cost-effectiveness analysis with hybrid trials: study protocols kept recruitment low and modeling choices affect how we interpret the effects on client-level outcomes.
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Sellinger JJ, Martino S, Lazar C, Mattocks K, Rando K, Serowik K, Ablondi K, Fenton B, Gilstad-Hayden K, Brummett B, Holtzheimer PE, Higgins D, Reznik TE, Semiatin AM, Stapley T, Ngo T, Rosen MI. The acceptability and feasibility of screening, brief intervention, and referral to treatment for pain management among new England veterans with chronic pain: A pilot study. Pain Pract 2022; 22:28-38. [PMID: 33934499 PMCID: PMC9084457 DOI: 10.1111/papr.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Musculoskeletal disorders often lead to chronic pain in Veterans. Chronic pain puts sufferers at risk for substance misuse, and early intervention is needed for both conditions. This pilot study tested the feasibility and acceptability of a Screening, Brief Intervention, and Referral to Treatment for Pain Management intervention (SBIRT-PM) to help engage Veterans seeking disability compensation for painful musculoskeletal disorders in multimodal pain treatment and to reduce risky substance use, when indicated. METHODS This pilot study enrolled 40 Veterans from 8 medical centers across New England in up to 4 sessions of telephone-based counseling using a motivational interviewing framework. Counseling provided education about, and facilitated engagement in, multimodal pain treatments. Study eligibility required Veterans be engaged in no more than 2 Veteran Affairs (VA) pain treatment modalities, and study participation involved a 12-week postassessment and semistructured interview about the counseling process. RESULTS Majorities of enrolled Veterans screened positive for comorbid depression and problematic substance use. Regarding the offered counseling, 80% of participants engaged in at least one session, with a mean of 3 sessions completed. Ninety percent of participants completed the postassessment. Numerically, most measures improved slightly from baseline to week 12. In semistructured interviews, participants described satisfaction with learning about new pain care services, obtaining assistance connecting to services, and receiving support from their counselors. DISCUSSION It was feasible to deliver SBIRT-PM to Veterans across New England to promote engagement in multimodal pain treatment and to track study outcomes over 12 weeks. Preliminary results suggest SBIRT-PM was well-received and has promise for the targeted outcomes.
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Affiliation(s)
- John J Sellinger
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christina Lazar
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kenneth Rando
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kristin Serowik
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Karen Ablondi
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brenda Fenton
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Bradley Brummett
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Paul E Holtzheimer
- White River Junction VA Medical Center, White River Junction, Vermont, USA
- Dartmouth School of Medicine, Hanover, New Hampshire, USA
| | - Diana Higgins
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thomas E Reznik
- Providence VA Medical Center, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | | | - Tu Ngo
- Bedford VA Medical Center, Bedford, Massachusetts, USA
| | - Marc I Rosen
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
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Ellis AE, Martino S, Simiola V, Mackintosh MA, Bellamy C, Cook JM. Study design and interventions for a peer-delivered motivational interviewing group treatment for sexual and gender minority male sexual trauma survivors. Contemp Clin Trials 2021; 111:106597. [PMID: 34653650 DOI: 10.1016/j.cct.2021.106597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Sexual abuse of boys and men is a public health problem that has received relatively little attention from clinical scholars and researchers. Given unique pathways for development of and recovery from trauma-related emotional distress, sexual abuse survivors who identify as men may require distinct psychosocial interventions to engage in formal mental health care and assist in symptom reduction. This paper describes the rationale for and methodology of a randomized controlled trial comparing the effectiveness of Motivational Interviewing (MI) versus MI with affirmative care (MI-AC) for sexual and gender minority men who have been sexually traumatized. This study is designed to randomly assign 356 participants to either condition of six online group sessions delivered by two trained peers with lived experience of sexual trauma. Assessments will be conducted at baseline, post-treatment, 60- and 120-day follow-up. The primary hypotheses are that participants assigned to MI-AC, compared to those in MI only, will report reduced symptoms of depression and increased levels of engagement in formal mental health treatment. Additional hypotheses relate to secondary outcome variables, including post-traumatic stress disorder, suicidality, and substance use.
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Affiliation(s)
- Amy E Ellis
- Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Steve Martino
- Yale School of Medicine, New Haven, CT, United States of America; VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Vanessa Simiola
- Kaiser Permanente, Center for Health Care Research, Honolulu, HI, United States of America
| | | | - Chyrell Bellamy
- Yale School of Medicine, New Haven, CT, United States of America
| | - Joan M Cook
- Yale School of Medicine, New Haven, CT, United States of America
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12
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Barwick M, Barac R, Kimber M, Akrong L, Johnson SN, Cunningham CE, Bennett K, Ashbourne G, Godden T. Advancing implementation frameworks with a mixed methods case study in child behavioral health. Transl Behav Med 2021; 10:685-704. [PMID: 30698775 PMCID: PMC7413184 DOI: 10.1093/tbm/ibz005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Despite a growing policy push for the provision of services based on evidence, evidence-based treatments for children and youth with mental health challenges have poor uptake, yielding limited benefit. With a view to improving implementation in child behavioral health, we investigated a complementary implementation approach informed by three implementation frameworks in the context of implementing motivational interviewing in four child and youth behavioral health agencies: the Active Implementation Frameworks (AIF) (process), the Consolidated Framework for Implementation Research (factors), and the Implementation Outcomes Framework (evaluation). The study design was mixed methods with embedded interrupted time series and motivational interviewing (MI) fidelity was the primary outcome. Focus groups and field notes informed perspectives on the implementation approach, and a questionnaire explored the salience of Consolidated Framework for Implementation Research (CFIR) factors. Findings validate the process guidance provided by the AIF and highlight CIFR factors related to implementation success. Novel CFIR factors, not elsewhere reported in the literature, are identified that could potentially extend the framework if validated in future research. Introducing fidelity measurement in practice proved challenging and was not sustained beyond the study. A complementary implementation approach was successful in implementing MI in child behavioral health agencies. In contrast with the typical train and hope approach to implementation, practice change did not occur immediately post-training but emerged over a 7 month period of consultation and practice following a discrete interactive training period. The saliency of CFIR constructs aligned with findings from studies conducted in other contexts, demonstrating external validity and highlighting common factors that can focus planning and measurement.
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Affiliation(s)
- Melanie Barwick
- Research Institute, The Hospital for Sick Children, Toronto, Canada.,Department of Psychiatry, University of Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Canada
| | - Raluca Barac
- Memorial University, St John's, Newfoundland, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Lindsay Akrong
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | | | - Charles E Cunningham
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,McMaster Children's Hospital, Hamilton, Canada
| | - Kathryn Bennett
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | - Tim Godden
- Centre for Addiction and Mental Health, Toronto, Canada
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13
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Rojewski AM, Fucito LM, Baker NL, Palmer AM, Foster MG, Warren GW, Bernstein SL, Toll BA. Preoperative contingency management intervention for smoking abstinence in cancer patients: trial protocol for a multisite randomised controlled trial. BMJ Open 2021; 11:e051226. [PMID: 34187835 PMCID: PMC8245459 DOI: 10.1136/bmjopen-2021-051226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Continued smoking following a cancer diagnosis has substantial health risks including increased overall and cancer-specific mortality, risk of secondary malignancies, cancer treatment toxicity and risk of surgical complications. These risks can be mitigated by quitting smoking. The preoperative period represents a prime opportunity in which to administer robust smoking cessation treatment to both improve health and support and improve surgical outcomes. We will conduct a randomised clinical trial to evaluate the effectiveness of financial incentives delivered contingent on biochemically verified smoking abstinence (contingency management (CM)) in patients with cancer undergoing surgery. METHODS AND ANALYSIS The study will take place across two study sites, and participants (N=282) who smoke, are diagnosed with or suspected to have any type of operable cancer and have a surgical procedure scheduled in the next 10 days to 5 weeks will be randomised to receive standard care plus Monitoring Only or CM prior to surgery. All patients will receive breath carbon monoxide (CO) tests three times per week, nicotine replacement therapy and counselling. The CM group will also earn payments for self-reported smoking abstinence confirmed by CO breath test ≤4 ppm on an escalating schedule of reinforcement (with a reset if they smoked). Point prevalence abstinence (PPA) outcomes (self-report of 7-day abstinence confirmed by CO≤4 ppm and/or anabasine ≤2 ng/mL) will be assessed on the day of surgery and 6 months after surgery. The effect of CM on 7-day PPA at the time of surgery and 6-month follow-up will be modelled using generalised linear mixed effects models. ETHICS AND DISSEMINATION This study has been reviewed and approved by the Medical University of South Carolina Institutional Review Board. We will disseminate our scientific results through traditional research-oriented outlets such as presentations at scientific meetings and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04605458.
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Affiliation(s)
- Alana M Rojewski
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Charleston, South Carolina, USA
| | - Lisa M Fucito
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nathaniel L Baker
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amanda M Palmer
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Madeline G Foster
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Graham W Warren
- Hollings Cancer Center, Charleston, South Carolina, USA
- Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Steven L Bernstein
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Benjamin A Toll
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Charleston, South Carolina, USA
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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14
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Pantalon MV, Dziura J, Li FY, D'Onofrio G, Weiss J, Bernstein SL. A Brief Negotiation Interview Adherence Scale for Smoking Cessation: A psychometric evaluation. J Subst Abuse Treat 2021; 126:108398. [PMID: 34116807 DOI: 10.1016/j.jsat.2021.108398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/01/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
Practitioner adherence to the Brief Negotiation Interview (BNI) for high-risk alcohol consumption and opioid use disorder can be measured using the BNI Adherence Scale, for alcohol (BAS-A) and opioids (BAS-O), respectively. However, no psychometrically validated brief intervention adherence scale for smoking cessation has been reported in the literature. Our objective was to develop and examine the psychometric properties of a BAS for smoking cessation (BASS). In the context of a clinical trial of the BNI in an emergency department (ED)-which incorporates motivational interviewing (MI), feedback, and behavioral contracting-plus nicotine replacement therapy (NRT), and a Smokers' Quitline referral and brochure (BNI), compared with brochure-only (control), we developed and examined the psychometric properties of the BAS-S, a scale that requires raters to answer whether each critical action of the BNI was implemented. Three independent raters rated three hundred and eighty-eight audio-recorded BNI sessions. The results indicated that the BAS-S had excellent internal consistency, and discriminant validity, inter-rater reliability, and construct validity. The following 3-factor (10-item) solution accounted for 43% of the variance: factor 1, "Feedback,", factor 2, "NRT Motivation," and factor 3, "Plan Negotiation." The study found predictive validity for the Feedback factor, suggesting that patients who were provided feedback on the harms of their smoking were significantly less likely to achieve biologically confirmed 7-day tobacco abstinence at their 3-month follow-up than those who were not provided such feedback (p < 0.03). The BAS-S is a psychometrically valid measure of adherence to the BNI for smoking cessation.
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Affiliation(s)
- Michael V Pantalon
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA.
| | - James Dziura
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA; Yale School of Public Health, 60 College St., New Haven, CT 06510, USA
| | - Fang-Yong Li
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA
| | - Gail D'Onofrio
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA
| | - June Weiss
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA
| | - Steven L Bernstein
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA; Yale School of Public Health, 60 College St., New Haven, CT 06510, USA; Yale Cancer Center, 333 Cedar St., New Haven, CT 06510, USA
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15
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Louie E, Barrett EL, Baillie A, Haber P, Morley KC. A systematic review of evidence-based practice implementation in drug and alcohol settings: applying the consolidated framework for implementation research framework. Implement Sci 2021; 16:22. [PMID: 33663523 PMCID: PMC7931583 DOI: 10.1186/s13012-021-01090-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 02/11/2021] [Indexed: 12/31/2022] Open
Abstract
Background There is a paucity of translational research programmes to improve implementation of evidence-based care in drug and alcohol settings. This systematic review aimed to provide a synthesis and evaluation of the effectiveness of implementation programmes of treatment for patients with drug and alcohol problems using the Consolidated Framework for Implementation Research (CFIR). Methods A comprehensive systematic review was conducted using five online databases (from inception onwards). Eligible studies included clinical trials and observational studies evaluating strategies used to implement evidence-based psychosocial treatments for alcohol and substance use disorders. Extracted data were qualitatively synthesised for common themes according to the CFIR. Primary outcomes included the implementation, service system or clinical practice. Risk of bias of individual studies was appraised using appropriate tools. A protocol was registered with (PROSPERO) (CRD42019123812) and published previously (Louie et al. Systematic 9:2020). Results Of the 2965 references identified, twenty studies were included in this review. Implementation research has employed a wide range of strategies to train clinicians in a few key evidence-based approaches to treatment. Implementation strategies were informed by a range of theories, with only two studies using an implementation framework (Baer et al. J Substance Abuse Treatment 37:191-202, 2009) used Context-Tailored Training and Helseth et al. J Substance Abuse Treatment 95:26-34, 2018) used the CFIR). Thirty of the 36 subdomains of the CFIR were evaluated by included studies, but the majority were concerned with the Characteristics of Individuals domain (75%), with less than half measuring Intervention Characteristics (45%) and Inner Setting constructs (25%), and only one study measuring the Outer Setting and Process domains. The most common primary outcome was the effectiveness of implementation strategies on treatment fidelity. Although several studies found clinician characteristics influenced the implementation outcome (40%) and many obtained clinical outcomes (40%), only five studies measured service system outcomes and only four studies evaluated the implementation. Conclusions While research has begun to accumulate in domains such as Characteristics of Individuals and Intervention Characteristics (e.g. education, beliefs and attitudes and organisational openness to new techniques), this review has identified significant gaps in the remaining CFIR domains including organisational factors, external forces and factors related to the process of the implementation itself. Findings of the review highlight important areas for future research and the utility of applying comprehensive implementation frameworks. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01090-7.
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Affiliation(s)
- Eva Louie
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Emma L Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Baillie
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Paul Haber
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kirsten C Morley
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia. .,Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.
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16
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Martino S, Lazar C, Sellinger J, Gilstad-Hayden K, Fenton B, Barnett PG, Brummett BR, Higgins DM, Holtzheimer P, Mattocks K, Ngo T, Reznik TE, Semiatin AM, Stapley T, Rosen MI. Screening, Brief Intervention, and Referral to Treatment for Pain Management for Veterans Seeking Service-Connection Payments for Musculoskeletal Disorders: SBIRT-PM Study Protocol. PAIN MEDICINE 2020; 21:S110-S117. [PMID: 33313731 PMCID: PMC7734657 DOI: 10.1093/pm/pnaa334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Veterans with significant chronic pain from musculoskeletal disorders are at risk of substance misuse. Veterans whose condition is the result of military service may be eligible for a disability pension. Department of Veterans Affairs compensation examinations, which determine the degree of disability and whether it was connected to military service, represent an opportunity to engage Veterans in pain management and substance use treatments. A multisite randomized clinical trial is testing the effectiveness and cost-effectiveness of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) for Veterans seeking compensation for musculoskeletal disorders. This telephone-based intervention is delivered through a hub-and-spoke configuration. Design This study is a two-arm, parallel-group, 36-week, multisite randomized controlled single-blind trial. It will randomize 1,100 Veterans experiencing pain and seeking service-connection for musculoskeletal disorders to either SBIRT-PM or usual care across eight New England VA medical centers. The study balances pragmatic with explanatory methodological features. Primary outcomes are pain severity and number of substances misused. Nonpharmacological pain management and substance use services utilization are tracked in the trial. Summary Early trial enrollment targets were met across sites. SBIRT-PM could help Veterans, at the time of their compensation claims, use multimodal pain treatments and reduce existing substance misuse. Strategies to address COVID-19 pandemic impacts on the SBIRT-PM protocol have been developed to maintain its pragmatic and exploratory integrity.
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Affiliation(s)
- Steve Martino
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University, New Haven, Connecticut
| | - Christina Lazar
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University, New Haven, Connecticut
| | - John Sellinger
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University, New Haven, Connecticut
| | | | - Brenda Fenton
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University, New Haven, Connecticut
| | - Paul G Barnett
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, California
| | - Brad R Brummett
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts.,University of Massachusetts, Amherst, Massachusetts
| | - Diana M Higgins
- VA Boston Healthcare System, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Paul Holtzheimer
- White River Junction VA Medical Center, White River Junction, Vermont.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tu Ngo
- Bedford VA Medical Center, Bedford, Massachusetts
| | - Thomas E Reznik
- Providence VA Medical Center, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | - Marc I Rosen
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University, New Haven, Connecticut
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17
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Olmstead TA, Martino S, Ondersma SJ, Gilstad-Hayden K, Forray A, Yonkers KA. The short-term impact on economic outcomes of SBIRT interventions implemented in reproductive health care settings. J Subst Abuse Treat 2020; 120:108179. [PMID: 33298305 DOI: 10.1016/j.jsat.2020.108179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/02/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the impact of screening, brief intervention, and referral to treatment (SBIRT) administered in reproductive health care settings on a variety of economic outcomes, including general health care utilization, criminal activity, and motor vehicle crashes. Whether and by how much SBIRT affects economic outcomes are important unanswered questions related to the economic impact of this technique. METHODS We collected data as part of a randomized clinical trial that examined whether SBIRT delivered electronically (e-SBIRT) or by a clinician (SBIRT) is superior to enhanced usual care (EUC) for substance misuse. Participants were a convenience sample of 439 women from two reproductive health care centers who used cigarettes, risky amounts of alcohol, illicit drugs, or misused prescription medication. For each participant, we measured economic outcomes by self-report 6 months pre- and post-intervention. We used difference-in-differences regression models to estimate the impact of e-SBIRT and SBIRT, compared to EUC, on changes in each of the economic outcomes from pre- to post-intervention. RESULTS None of the difference-in-differences estimates weas statistically significant after adjusting for multiple comparisons. CONCLUSION In a population of women receiving routine care in reproductive health care settings, we did not find a significant effect of either e-SBIRT or SBIRT, compared to EUC, on general health care utilization, criminal activity, or motor vehicle outcomes. However, individual trials are typically underpowered to detect effects that are small but important from a public health perspective. These results may be crucial for future systematic reviews and meta-analyses to determine the economic impact of SBIRT programs from a variety of perspectives.
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Affiliation(s)
- Todd A Olmstead
- The University of Texas at Austin, Lyndon B. Johnson School of Public Affairs, 2300 Red River Street, Austin, TX, 78701, USA.
| | - Steve Martino
- Yale School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT 06516, USA; VA Connecticut Healthcare System, Psychology Service, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Steven J Ondersma
- Wayne State University, Department of Psychiatry & Behavioral Neurosciences and Merrill-Palmer Skillman Institute, 71 East Ferry St., Detroit, MI 48202, USA
| | - Kathryn Gilstad-Hayden
- Yale School of Medicine, Department of Psychiatry, 40 Temple Street, New Haven, CT 06510, USA
| | - Ariadna Forray
- Yale School of Medicine, Department of Psychiatry, 40 Temple Street, New Haven, CT 06510, USA
| | - Kimberly A Yonkers
- Yale University School of Epidemiology and Public Health, Division of Chronic Disease, 60 College Street, New Haven, CT 06520, USA; Yale School of Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, 333 Cedar Street, New Haven, CT 06520, USA; Yale School of Medicine, Department of Psychiatry, 40 Temple Street, New Haven, CT 06510, USA
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18
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Hurlocker MC, Madson MB, Schumacher JA. Motivational interviewing quality assurance: A systematic review of assessment tools across research contexts. Clin Psychol Rev 2020; 82:101909. [PMID: 32920371 DOI: 10.1016/j.cpr.2020.101909] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/20/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
The need for sustained skill development and quality assurance when executing behavioral interventions is best demonstrated in the empirical evolution of Motivational Interviewing (MI). As a brief behavioral intervention that identifies the therapeutic process as an active treatment ingredient, it is critical for researchers, trainers, and administrators to use psychometrically sound and theoretically congruent tools to evaluate provider skills and fidelity when executing MI. Yet, no prior work has evaluated the breadth of MI tools employed across research contexts. Therefore, this review identified MI fidelity and skill development tools across measurement, training and efficacy/effectiveness studies and evaluated their psychometric strength and fit with current MI theory. We identified 199 empirical studies that employed an MI fidelity/skill tool and we found 21 tools with varying degrees of empirical support and theoretical congruence. Specifically, we identified five observer-, two trainee- and one client-rated tool with strong empirical support, and nine observer- and two client-rated tools with preliminary empirical support. We detailed the empirical strength, including the extent to which tools were linked to trainee/client outcomes across research contexts and offer recommendations on which MI tools to use in training, efficacy, and effectiveness trials.
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Affiliation(s)
- Margo C Hurlocker
- Center on Alcoholism, Substance Abuse, and Addictions, Department of Psychology, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM 87106, USA.
| | - Michael B Madson
- School of Psychology, University of Southern Mississippi, 118 College Dr, Hattiesburg, MS 39406, USA.
| | - Julie A Schumacher
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State St, Jackson, MS 39216, USA.
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19
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Faghihian R, Faghihian E, Kazemi A, Tarrahi MJ, Zakizade M. Impact of motivational interviewing on early childhood caries: A systematic review and meta-analysis. J Am Dent Assoc 2020; 151:650-659. [PMID: 32854867 DOI: 10.1016/j.adaj.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The authors aimed to assess the scientific evidence on motivational interviewing for the clinical reduction of early childhood caries compared with traditional dental health education. METHODS Search terms were selected on the basis of Medical Subject Headings and non-Medical Subject Headings terms. The main key words were motivational interviewing, early childhood caries, and education. Potentially eligible studies involved the clinical assessment of caries rate in children whose parents or caregivers received motivational interviewing as an intervention. The authors assessed the risk of bias using the Cochrane risk-of-bias tool. In March 2019, the authors performed an electronic database search of literature published in English within the following databases: Scopus, Cochrane, PubMed, and Embase. RESULTS Of 329 articles retrieved initially, 14 were eligible for inclusion in the systematic review and 3 articles contributed to the meta-analysis. For statistical analysis, the mean difference of continuous data was analyzed at a 95% confidence interval using the random-effects model. CONCLUSIONS Overall, the evidence presented in this review was limited. Although the results of the meta-analysis showed that motivational interviewing is as effective as dental health education in controlling early childhood caries, we need more and better designed and reported interventions to assess its impact on early childhood caries accurately.
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20
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Yonkers KA, Dailey JI, Gilstad-Hayden K, Ondersma SJ, Forray A, Olmstead TA, Martino S. Abstinence outcomes among women in reproductive health centers administered clinician or electronic brief interventions. J Subst Abuse Treat 2020; 113:107995. [PMID: 32359666 PMCID: PMC8372233 DOI: 10.1016/j.jsat.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, and referral to treatment (SBIRT) for substance use among women seeking reproductive healthcare services. Women who screened positive for substance use were randomly assigned to either clinician-administered SBIRT, an electronically-administered brief intervention (e-SBIRT), or an enhanced usual care condition. At a 6-month follow-up assessment, compared to enhanced usual care, the clinician-administered SBIRT increased 1-month point prevalence of abstinence from the primary substance by 7.7%, and e-SBIRT increased abstinence by 12.8%. Both brief interventions were more useful than enhanced usual care and could increase substance use abstinence rates among women in reproductive healthcare clinics. The electronic brief intervention is particularly attractive given that it appears as efficacious as, but requires fewer resources than, clinician-delivered brief interventions.
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Affiliation(s)
- Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06510, USA.
| | - Jason I Dailey
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Steven J Ondersma
- Wayne State University, Merrill Palmer Skillman Institute, 71 E. Ferry Ave, Detroit, MI 48202, USA.
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Todd A Olmstead
- University of Texas at Austin, PO Box Y, Austin, TX 78713, USA.
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
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21
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Gill I, Oster C, Lawn S. Assessing competence in health professionals' use of motivational interviewing: A systematic review of training and supervision tools. PATIENT EDUCATION AND COUNSELING 2020; 103:473-483. [PMID: 31585819 DOI: 10.1016/j.pec.2019.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/19/2019] [Accepted: 09/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To conduct a systematic review of instruments for assessing the competency of therapists in motivational interviewing (MI) for training purposes. METHODS A search of Medline, Emcare, CINAHL, Scopus, Proquest, and Web of Science databases yielded 20,313 articles, of which 105 were included in the review. Data were summarised in terms of the instruments' development, adherence to MI principles, administration characteristics, psychometric properties, advantages, and disadvantages. RESULTS Twelve instruments were identified. Tools tended to be better at covering simpler MI techniques. Differences in administration burden allow users to choose between briefer but cheaper and more detailed yet costly tools. Psychometric testing was often limited, and even if more extensive, the quality was often inconsistent. Although each tool tended to have relatively unique advantages (e.g. use of client ratings), they shared common disadvantages (e.g. lack of psychometric testing). CONCLUSION A number of tools can be used to assess MI competency, each with their own strengths but notable weaknesses that should be considered by potential users. PRACTICE IMPLICATIONS There is a need to further test existing tools before creating new ones, due to the repetition of the same limitations. Standardised guidelines should also be created to ensure each tool meets the same quality standards.
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Affiliation(s)
- Isabelle Gill
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Candice Oster
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Flinders Human Behaviour and Health Research Unit, Margaret Tobin Centre, Flinders University, Adelaide, South Australia, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Flinders Human Behaviour and Health Research Unit, Margaret Tobin Centre, Flinders University, Adelaide, South Australia, Australia.
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Ottman KE, Kohrt BA, Pedersen GA, Schafer A. Use of role plays to assess therapist competency and its association with client outcomes in psychological interventions: A scoping review and competency research agenda. Behav Res Ther 2019; 130:103531. [PMID: 31902517 DOI: 10.1016/j.brat.2019.103531] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023]
Abstract
A major challenge in scaling-up psychological interventions worldwide is how to evaluate competency among new workforces engaged in psychological services. One approach to measuring competency is through standardized role plays. Role plays have the benefits of standardization and reliance on observed behavior rather than written knowledge. However, role plays are also resource intensive and dependent upon inter-rater reliability. We undertook a two-part scoping review to describe how competency is conceptualized in studies evaluating the relationship of competency with client outcomes. We focused on use of role plays including achieving inter-rater reliability and the association with client outcomes. First, we identified 4 reviews encompassing 61 studies evaluating the association of competency with client outcomes. Second, we identified 39 competency evaluation tools, of which 21 were used in comparisons with client outcomes. Inter-rater reliability (intraclass correlation coefficient) was reported for 15 tools and ranged from 0.53 to 0.96 (mean ICC = 0.77). However, we found that none of the outcome comparison studies measured competency with standardized role plays. Instead, studies typically used therapy quality (i.e., session ratings with actual clients) as a proxy for competency. This reveals a gap in the evidence base for competency and its role in predicting client outcomes. We therefore propose a competency research agenda to develop an evidence-base for objective, standardized role plays to measure competency and its association with client outcomes. OPEN SCIENCE REGISTRATION #: https://osf.io/nqhu7/.
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Affiliation(s)
- Katherine E Ottman
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L St NW, Suite 600, Washington, D.C, 20037, USA
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L St NW, Suite 600, Washington, D.C, 20037, USA.
| | - Gloria A Pedersen
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L St NW, Suite 600, Washington, D.C, 20037, USA
| | - Alison Schafer
- World Health Organization, Department of Mental Health and Substance Use, Avenue Appia 20, Geneva 27, 1211, Switzerland
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Lundahl B, Droubay BA, Burke B, Butters RP, Nelford K, Hardy C, Keovongsa K, Bowles M. Motivational interviewing adherence tools: A scoping review investigating content validity. PATIENT EDUCATION AND COUNSELING 2019; 102:2145-2155. [PMID: 31514978 DOI: 10.1016/j.pec.2019.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We sought to understand the content validity of Motivational Interviewing (MI)as a concept and the relative emphasis of specific MI aspects by assessing MI adherence measures. METHOD We followed PRISMA guidelines for scoping reviews. Twenty-eight adherence measures were identified. From these, 407 specific MI adherence codes were extracted and submitted to content analysis. RESULTS Fifteen MI themes emerged, 13 focused on clinician behaviors and 2 on client responses. Four themes (OARS, MI Spirit, evoking motivation, and MI-inconsistent behaviors) accounted for 72% of all codes. No other theme (e.g., preventing/responding to resistance, engaging ambivalence) accounted for more than 6% of codes. One measure assessed 11 of 15 themes; on average, 5.68 themes were assessed with a mean of 14.54 questions per measure. Process and psychometric characteristics of the measures are described. CONCLUSIONS/PRACTICE IMPLICATIONS MI adherence measures agree about the importance of certain aspects of MI but lag behind current research and best skill practice. Considerable variance exists in assessing MI nuances and specific behaviors, suggesting questions about what constitutes MI in practice settings and what should be taught. Importantly, most measures focused only on the counselor's behavior, missing the impact of MI on the client.
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Fried TR, Leung SL, Blakley LA, Martino S. Development and Pilot Testing of a Motivational Interview for Engagement in Advance Care Planning. J Palliat Med 2019; 21:897-898. [PMID: 29975613 DOI: 10.1089/jpm.2018.0095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Terri R Fried
- 1 Clinicial Epidemiology Research Center , VA Connecticut Healthcare System, West Haven, Connecticut.,2 Department of Medicine, Yale School of Medicine , New Haven, Connecticut
| | | | - Laura A Blakley
- 4 Palliative Care Service , VA Connecticut Healthcare System, West Haven, Connecticut.,5 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Steven Martino
- 5 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut.,6 Psychology Service , VA Connecticut Healthcare System, West Haven, Connecticut
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Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial. J Gen Intern Med 2019; 34:2520-2529. [PMID: 31468342 PMCID: PMC6848470 DOI: 10.1007/s11606-019-05257-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/28/2019] [Accepted: 07/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse. OBJECTIVE To determine the effectiveness of three strategies for implementing motivational interviewing for substance misuse with general medical inpatients. DESIGN Type 3 hybrid effectiveness-implementation randomized controlled trial (Clinical Trials.gov: NCT01825057). PARTICIPANTS Thirty-eight providers (physicians, physician assistants, nurses) from 13 general medical inpatient services, and 1173 of their patients admitted to an academically affiliated acute care hospital. INTERVENTIONS Implementation strategies included (1) a continuing medical education workshop on detection of substance misuse and provision of a motivational interview; (2) workshop plus bedside supervision (apprenticeship condition); and (3) a workshop plus ability to place a medical order for an interview from a consultation-liaison service (consult condition). MAIN MEASURES Primary outcomes were the percentage of study-eligible patients who received an interview for substance misuse and the integrity (adherence, competence) of the interviews. The secondary outcome was the percent of patient statements within the interviews that indicated motivation for reducing substance misuse. KEY RESULTS 20.5% of patients in the consult condition received an interview, compared to 0.8% (Hedge's g = 1.49) and 3.0% (Hedge's g = 1.26) in the respective workshop only and apprenticeship conditions (p < 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions. CONCLUSIONS Providers' ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances. TRIAL REGISTRY NCT01825057.
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Olmstead TA, Yonkers KA, Ondersma SJ, Forray A, Gilstad-Hayden K, Martino S. Cost-effectiveness of electronic- and clinician-delivered screening, brief intervention and referral to treatment for women in reproductive health centers. Addiction 2019; 114:1659-1669. [PMID: 31111591 PMCID: PMC6684836 DOI: 10.1111/add.14668] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/01/2018] [Accepted: 05/13/2019] [Indexed: 12/29/2022]
Abstract
AIMS To determine the cost-effectiveness of electronic- and clinician-delivered SBIRT (Screening, Brief Intervention and Referral to Treatment) for reducing primary substance use among women treated in reproductive health centers. DESIGN Cost-effectiveness analysis based on a randomized controlled trial. SETTING New Haven, CT, USA. PARTICIPANTS A convenience sample of 439 women seeking routine care in reproductive health centers who used cigarettes, risky amounts of alcohol, illicit drugs or misused prescription medication. INTERVENTIONS Participants were randomized to enhanced usual care (EUC, n = 151), electronic-delivered SBIRT (e-SBIRT, n = 143) or clinician-delivered SBIRT (SBIRT, n = 145). MEASUREMENTS The primary outcome was days of primary substance abstinence during the 6-month follow-up period. To account for the possibility that patients might substitute a different drug for their primary substance during the 6-month follow-up period, we also considered the number of days of abstinence from all substances. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves determined the relative cost-effectiveness of the three conditions from both the clinic and patient perspectives. FINDINGS From a health-care provider perspective, e-SBIRT is likely (with probability greater than 0.5) to be cost-effective for any willingness-to-pay value for an additional day of primary-substance abstinence and an additional day of all-substance abstinence. From a patient perspective, EUC is most likely to be the cost-effective intervention when the willingness to pay for an additional day of abstinence (both primary-substance and all-substance) is less than $0.18 and e-SBIRT is most likely to be the cost-effective intervention when the willingness to pay for an additional day of abstinence (both primary-substance and all-substance) is greater than $0.18. CONCLUSIONS e-SBIRT could be a cost-effective approach, from both health-care provider and patient perspectives, for use in reproductive health centers to help women reduce substance misuse.
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Affiliation(s)
- Todd A. Olmstead
- The University of Texas at Austin, Lyndon B. Johnson School of Public Affairs, 2300 Red River Street, Austin, TX 78713, USA
| | - Kimberly A. Yonkers
- Yale University School of Medicine, Department of Psychiatry, 40 Temple Street, Suite 6B, New Haven, CT 06510, USA,Yale University School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, 333 Cedar Street, New Haven, CT 06510, USA,Yale University School of Epidemiology and Public Health, Division of Chronic Disease, 60 College Street, New Haven, CT 06520, USA
| | - Steven J. Ondersma
- Wayne State University, Department of Psychiatry & Behavioral Neurosciences & Merrill-Palmer Skillman Institute, 71 E. Ferry Ave., Detroit, MI 48202, USA
| | - Ariadna Forray
- Yale University School of Medicine, Department of Psychiatry, 40 Temple Street, Suite 6B, New Haven, CT 06510, USA
| | - Kathryn Gilstad-Hayden
- Yale University School of Medicine, Department of Psychiatry, 40 Temple Street, Suite 6B, New Haven, CT 06510, USA
| | - Steve Martino
- Yale University School of Medicine, Department of Psychiatry, 40 Temple Street, Suite 6B, New Haven, CT 06510, USA,VA Connecticut Healthcare System, 950 Campbell Avenue (116B), West Haven, CT 06516, USA
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Risica PM, Tovar A, Palomo V, Dionne L, Mena N, Magid K, Ward DS, Gans KM. Improving nutrition and physical activity environments of family child care homes: the rationale, design and study protocol of the 'Healthy Start/Comienzos Sanos' cluster randomized trial. BMC Public Health 2019; 19:419. [PMID: 30999881 PMCID: PMC6472069 DOI: 10.1186/s12889-019-6704-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early childhood is a crucial time to foster healthy eating and physical activity (PA) habits, which are critical for optimal child health, growth and development. Child care facilities are important settings to promote healthy eating and PA and prevent childhood obesity; however, almost all prior intervention studies have focused on child care centers and not family child care homes (FCCH), which care for over 1.6 million U.S. children. METHODS This paper describes Healthy Start/Comienzos Sanos, a cluster-randomized trial evaluating the efficacy of a multicomponent intervention to improve nutrition and PA environments in English and Spanish-speaking FCCH. Eligible child care providers complete baseline surveys and receive a two-day FCCH observation of the home environment and provider practices. Parent-consented 2-5 year-old children are measured (height, weight, waist circumference), wear accelerometers and have their dietary intake observed during child care using validated protocols. FCCH providers are then randomly assigned to receive an 8-month intervention including written materials tailored to the FCCH providers' need and interest, videos, peer support coaching using brief motivational interviewing, and periodic group meetings focused on either nutrition and PA (Intervention) or reading readiness (Comparison). Intervention materials focus on evidence-based nutrition and physical activity best practices. The initial measures (surveys, two-day observation of the FCCH and provider practices, child diet observation, physical measures, and accelerometer) are assessed again 8 and 12 months after the intervention starts. Primary outcomes are children's diet quality (Healthy Eating Index), time in moderate and vigorous PA and sedentary PA during child care. Secondary outcomes include FCCH provider practices and foods served, and PA environments and practices. Possible mediators (provider attitudes, self-efficacy, barriers and facilitators) are also being explored. Process evaluation measures to assess reach, fidelity and dose, and their relationship with dietary and PA outcomes are included. DISCUSSION Healthy Start/Comienzos Sanos fills an important gap in the field of childhood obesity prevention by rigorously evaluating an innovative multicomponent intervention to improve the nutrition and physical activity environments of FCCH. TRIAL REGISTRATION (# NCT02452645 ) ClinicalTrials.gov Trial registered on May 22, 2015.
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Affiliation(s)
- Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881 USA
| | - Vanessa Palomo
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
| | - Noereem Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881 USA
| | - Kate Magid
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
| | - Diane Stanton Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7461 USA
| | - Kim M. Gans
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT 06269 USA
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269 USA
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Loree AM, Yonkers KA, Ondersma SJ, Gilstad-Hayden K, Martino S. Comparing satisfaction, alliance and intervention components in electronically delivered and in-person brief interventions for substance use among childbearing-aged women. J Subst Abuse Treat 2019; 99:1-7. [PMID: 30797381 DOI: 10.1016/j.jsat.2019.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/27/2018] [Accepted: 01/08/2019] [Indexed: 11/17/2022]
Abstract
Electronic delivery of Screening, Brief Intervention, and Referral to Treatment (e-SBIRT) may be a low-cost and high-reach method for screening and brief intervention in health care settings. However, its relative acceptability, ability to build a therapeutic alliance, and delivery of key intervention components compared to in-person SBIRT (SBIRT) is unclear. The association of these factors with intervention outcomes is also not known. We compared SBIRT and e-SBIRT on satisfaction, alliance, and receipt of intervention components, and evaluated the extent to which these intervention dimensions were related to later substance use. Data were collected as part of a randomized clinical trial (N = 439) examining SBIRT, e-SBIRT, and enhanced usual care for childbearing-aged women in two reproductive healthcare clinics (see Martino et al. (2018) for main trial findings). Participants receiving SBIRT or e-SBIRT (N = 270) rated satisfaction and alliance following a single-session, brief intervention, based on motivational interviewing that targeted hazardous substance use (tobacco, alcohol, illicit drugs and prescribed medications). Trained raters coded audio-recorded SBIRT sessions for the presence of six major intervention components, and evaluated the occurrence of these components in the e-SBIRT software. Overall, participants in both groups reported strong satisfaction (on average, "considerably" to "extremely" satisfied) and perceived working alliance (on average, "very often" to "always" allied). SBIRT participants provided higher overall alliance ratings, felt more encouraged to make their own decisions, and rated the intervention's likely helpfulness to other women higher. Fewer e-SBIRT participants received intervention components focusing on personalized feedback, developing importance of and confidence in making changes to substance use, and developing a plan to change, compared to SBIRT participants. However, e-SBIRT participants were equally or more likely to receive components seeking to help them understand their use, discussing reasons for use, and summarizing and supporting what the patients elected to do. Notably, satisfaction, alliance, and number of intervention components received were not associated with total days of substance use. Although we found no evidence that the intervention characteristics evaluated in this study were associated with outcomes, acceptability and alliance may have other important implications. Findings suggest areas for improvement with respect to e-SBIRT satisfaction and alliance formation. ClinicalTrials.govregistration number: NCT01539525.
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Affiliation(s)
- Amy M Loree
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 900, New Haven, CT 06511, USA.
| | - Kimberly A Yonkers
- Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 900, New Haven, CT 06511, USA.
| | - Steven J Ondersma
- Merrill Palmer Skillman Institute, Department of Psychiatry & Behavioral Neurosciences, Wayne State University, 71 E. Ferry St, Detroit, MI 48201, USA.
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 900, New Haven, CT 06511, USA.
| | - Steve Martino
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 900, New Haven, CT 06511, USA.
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Chinman M, Ebener P, Malone PS, Cannon J, D'Amico EJ, Acosta J. Testing implementation support for evidence-based programs in community settings: a replication cluster-randomized trial of Getting To Outcomes®. Implement Sci 2018; 13:131. [PMID: 30348227 PMCID: PMC6196461 DOI: 10.1186/s13012-018-0825-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Community organizations can have difficulty implementing evidence-based prevention programs. More research is needed on implementation support interventions designed to help these organizations implement programs with quality. Methods Preparing to Run Effective Programs (PREP) is a randomized controlled trial testing Getting To Outcomes (GTO), a 2-year implementation support intervention. It compares 15 Boys and Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 similar sites implementing CHOICE supported by GTO (intervention group). PREP replicates a previous GTO study that had the same design, but featured a teen pregnancy prevention program instead. All sites received typical CHOICE training. Fourteen intervention sites received GTO manuals, training, and onsite technical assistance to help practitioners complete implementation best practices specified by GTO (i.e., GTO steps). During the first year, technical assistance providers helped the intervention group adopt, plan, and deliver CHOICE. Then, this group was trained on evaluation and quality improvement steps of GTO using feedback reports summarizing their own data, which yielded revised plans for subsequent implementation of CHOICE. This paper presents results regarding GTO’s impact on CHOICE fidelity (adherence, quality of delivery, dosage) and the proximal outcomes of the youth participants (aged 10–14)—attitudes and intentions regarding cigarettes, alcohol, and marijuana use. Fidelity was assessed at all sites by observer ratings and attendance logs. Proximal outcomes were assessed via survey at baseline, 3, and 6 months. Results After 1 year, fidelity and proximal outcomes were similar between Intervention and control groups. After 2 years (which included GTO quality improvement activities that took place between years 1 and 2), intervention sites had higher ratings of CHOICE adherence and quality of delivery (dosage remained similar). Proximal outcomes did not differ between groups in either year, although there was universally high endorsement of prosocial responses to those outcomes from the start. Conclusions Findings suggest that systematic implementation support provided by GTO can help community organizations achieve better fidelity. Findings replicate the implementation results from a previous GTO study using the same design, but with a different evidence-based program and different fidelity measures. Although proximal outcomes did not change, in large part due to ceiling effects, the implementation findings suggest GTO can support a variety of programs. Trial registration This project is registered at ClinicalTrials.gov with number NCT02135991. The trial was first registered on May 12, 2014.
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Affiliation(s)
- Matthew Chinman
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA.
| | - Patricia Ebener
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | | | - Jill Cannon
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | | | - Joie Acosta
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA
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Garner BR, Lwin AK, Strickler GK, Hunter BD, Shepard DS. Pay-for-performance as a cost-effective implementation strategy: results from a cluster randomized trial. Implement Sci 2018; 13:92. [PMID: 29973280 PMCID: PMC6033288 DOI: 10.1186/s13012-018-0774-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/31/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pay-for-performance (P4P) has been recommended as a promising strategy to improve implementation of high-quality care. This study examined the incremental cost-effectiveness of a P4P strategy found to be highly effective in improving the implementation and effectiveness of the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based treatment (EBT) for adolescent substance use disorders (SUDs). METHODS Building on a $30 million national initiative to implement A-CRA in SUD treatment settings, urn randomization was used to assign 29 organizations and their 105 therapists and 1173 patients to one of two conditions (implementation-as-usual (IAU) control condition or IAU+P4P experimental condition). It was not possible to blind organizations, therapists, or all research staff to condition assignment. All treatment organizations and their therapists received a multifaceted implementation strategy. In addition to those IAU strategies, therapists in the IAU+P4P condition received US $50 for each month that they demonstrated competence in treatment delivery (A-CRA competence) and US $200 for each patient who received a specified number of treatment procedures and sessions found to be associated with significantly improved patient outcomes (target A-CRA). Incremental cost-effectiveness ratios (ICERs), which represent the difference between the two conditions in average cost per treatment organization divided by the corresponding average difference in effectiveness per organization, and quality-adjusted life years (QALYs) were the primary outcomes. RESULTS At trial completion, 15 organizations were randomized to the IAU condition and 14 organizations were randomized to the IAU+P4P condition. Data from all 29 organizations were analyzed. Cluster-level analyses suggested the P4P strategy led to significantly higher average total costs compared to the IAU control condition, yet this average increase of 5% resulted in a 116% increase in the average number of months therapists demonstrated competence in treatment delivery (ICER = $333), a 325% increase in the average number of patients who received the targeted dosage of treatment (ICER = $453), and a 325% increase in the number of days of abstinence per patient in treatment (ICER = $8.134). Further supporting P4P as a cost-effective implementation strategy, the cost per QALY was only $8681 (95% confidence interval $1191-$16,171). CONCLUSION This study provides experimental evidence supporting P4P as a cost-effective implementation strategy. TRIAL REGISTRATION NCT01016704 .
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Affiliation(s)
- Bryan R. Garner
- RTI International, P. O. Box 12194, Research Triangle Park, Raleigh, NC 27709-2194 USA
| | - Aung K. Lwin
- Schneider Institutes for Health Policy, The Heller School, MS035, Brandeis University, Waltham, MA USA
| | - Gail K. Strickler
- Schneider Institutes for Health Policy, The Heller School, MS035, Brandeis University, Waltham, MA USA
| | | | - Donald S. Shepard
- Schneider Institutes for Health Policy, The Heller School, MS035, Brandeis University, Waltham, MA USA
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Martino S, Ondersma SJ, Forray A, Olmstead TA, Gilstad-Hayden K, Howell HB, Kershaw T, Yonkers KA. A randomized controlled trial of screening and brief interventions for substance misuse in reproductive health. Am J Obstet Gynecol 2018; 218:322.e1-322.e12. [PMID: 29247636 PMCID: PMC6896206 DOI: 10.1016/j.ajog.2017.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/14/2017] [Accepted: 12/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment may reduce substance misuse but has received minimal study among women who are treated in reproductive health settings. OBJECTIVE The purpose of this study was to determine whether "screening, brief intervention and referral to treatment" that is delivered either electronically or by clinician are more effective than enhanced usual care in decreasing days of primary substance use. STUDY DESIGN Women from 2 reproductive centers who smoked cigarettes or misused alcohol, illicit drugs, or prescription medication were allocated randomly to "screening, brief intervention and referral to treatment" delivered electronically or by clinician or to enhanced usual care. Assessments were completed at baseline and at 1-, 3-, and 6-months after a baseline has been established. Coprimary outcomes were days/months of primary substance use and postintervention treatment use. A sample size of 660 women was planned; randomization was stratified by primary substance use and pregnancy status. "Screening, brief intervention and referral to treatment" groups were compared with enhanced usual care groups with the use of generalized estimation equations, and effect sizes were calculated with the use of Cohen's d. RESULTS Between September 2011 and January 2015, women were assigned randomly to a group: 143 women (16.8% pregnant) in the electronic-delivered "screening, brief intervention and referral to treatment" group, 145 women (18.6% pregnant) in the clinician-delivered "screening, brief intervention and referral to treatment" group, and 151 women (19.2% pregnant) in the enhanced usual care group; the retention was >84%. Based on the generalized estimating equations model, predicted mean days per month of use at baseline for primary substance were 23.9 days (95% confidence interval, 22.4-25.5) for the electronic-delivered group, 22.8 days (95% confidence interval, 21.4-24.3) for the clinician-delivered group, and 23.5 days (95% confidence interval, 22.2, 24.9) for enhanced usual care, which respectively declined to 20.5 days (95% confidence interval, 19.0-22.2), 19.8 days (95% confidence interval,18.5-21.3), and 21.9 days (95% confidence interval, 20.7-23.1) at 1 month; 16.9 days (95% confidence interval, 15.0-19.0), 16.6 days (95% confidence interval, 14.8-18.6), and 19.5 days (95% confidence interval, 18.1-21.1) at 3 months; and 16.3 days (95% confidence interval, 14.3-18.7), 16.3 days (95% confidence interval, 14.4-18.5), and 17.9 days (95% confidence interval, 16.1-19.9) at 6 months. Estimated declines were greater in the electronic-delivered group (β [standard error]=-0.090[0.034]; P=.008; Cohen's d, 0.19 at 1 month, 0.30 at 3 months, and 0.17 at 6 months) and the clinician-delivered group (β [standard error]=-0.078[0.037]; P=.038; Cohen's d, 0.17 at 1 month, 0.22 at 3 months, and 0.06 at 6 months) compared with enhanced usual care. Treatment use did not differ between groups. CONCLUSION "Screening, brief intervention and referral to treatment" significantly decreased days of primary substance use among women in reproductive healthcare centers; neither resulted in more treatment use than enhanced usual care.
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Affiliation(s)
- Steve Martino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT.
| | - Steven J Ondersma
- Department of Psychiatry & Behavioral Neurosciences & Merrill-Palmer Skillman Institute, Detroit, MI
| | - Ariadna Forray
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Todd A Olmstead
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX
| | | | - Heather B Howell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Trace Kershaw
- Division of Chronic Disease, Yale University School of Epidemiology and Public Health, New Haven, CT
| | - Kimberly A Yonkers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale University School of Medicine, New Haven, CT; Division of Chronic Disease, Yale University School of Epidemiology and Public Health, New Haven, CT
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Barnes RD, Ivezaj V, Martino S, Pittman BP, Paris M, Grilo CM. Examining motivational interviewing plus nutrition psychoeducation for weight loss in primary care. J Psychosom Res 2018; 104:101-107. [PMID: 29275778 PMCID: PMC5774024 DOI: 10.1016/j.jpsychores.2017.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/29/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our previous randomized controlled trial found that nutrition psychoeducation (NP), an attention-control condition, produced statistically significantly more weight loss than usual care (UC), whereas motivational interviewing (MI) did not. NP, MI, and UC resulted in medium-large, medium, and negligible effects on weight loss, respectively. To examine whether weight loss could be further improved by combining MI and NP, the current study evaluated the scalable combination (MINP) with accessible web-based materials. METHODS 31 adults with overweight/obesity, with and without binge-eating disorder (BED), were enrolled in the 3-month MINP treatment in primary care. Participants were assessed at baseline, post, and 3-month follow-up. Mixed-model analyses examined MINP effects over time and the prognostic significance of BED. RESULTS Mixed-model analyses revealed that percentage weight loss was statistically significant at post and 3-month follow-up; d'=0.59 and 0.53, respectively. BED status did not predict or moderate weight loss. Twenty-one percent (6 of 28) and 26% (7 of 27) of participants attained 5% weight loss by post-treatment and 3-month follow-up, respectively. Participants with BED had statistically significantly greater improvements in disordered eating and depression (in addition to binge-eating reductions) compared to those without BED. CONCLUSION MINP resulted in weight and psychological improvements at post-treatment and through 3-months after treatment completion. There did not appear to be additional benefits to combining basic nutrition information with MI when compared to the previous randomized controlled trial testing nutrition psychoeducation alone. CLINICAL TRIAL REGISTRATION NCT02578199.
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Affiliation(s)
- Rachel D. Barnes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Brian P. Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Psychology, Yale University, New Haven, CT, USA
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Garner BR, Gotham HJ, Tueller SJ, Ball EL, Kaiser D, Stilen P, Speck K, Vandersloot D, Rieckmann TR, Chaple M, Martin EG, Martino S. Testing the effectiveness of a motivational interviewing-based brief intervention for substance use as an adjunct to usual care in community-based AIDS service organizations: study protocol for a multisite randomized controlled trial. Addict Sci Clin Pract 2017; 12:31. [PMID: 29149914 PMCID: PMC5693500 DOI: 10.1186/s13722-017-0095-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 09/11/2017] [Indexed: 12/13/2022] Open
Abstract
Background In 2010, the first comprehensive National HIV/AIDS Strategy for the United States was released and included three goals: (1) reducing the number of people who become infected with HIV, (2) increasing access to care and improving health outcomes for people living with HIV, and (3) reducing HIV-related health disparities and health inequities. In 2013, as part of its effort to help address the National HIV/AIDS Strategy, the National Institute on Drug Abuse (NIDA) funded a type 2 effectiveness-implementation hybrid trial titled the Substance Abuse Treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS Service Organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. Methods As part of a multisite randomized controlled trial, individuals with comorbid HIV/AIDS and problematic substance use are randomized to receive either the ASOs’ usual care (control condition) or usual care plus a MIBI for substance use (experimental condition) delivered by trained ASO case-management staff. Primary outcome measures are reductions in days of primary substance use, number of substance-related problems, times engaging in risky behaviors, days of non-adherence to HIV medications, and increases in substance use treatment. As part of this paper, we describe the trial protocol in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines. Discussion If successfully able to implement MIBI as an effective adjunct to usual care, the current trial may have a significant impact on increasing the capacity of ASOs to address problematic substance use among individuals living with HIV/AIDS. Reducing the prevalence of problematic substance use among individuals living with HIV/AIDS within the United States may lead to significant improvements on key performance measures (i.e., the HIV Care Continuum and the 90-90-90 target). Trial registration ClinicalTrials.gov: NCT02495402 Electronic supplementary material The online version of this article (10.1186/s13722-017-0095-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bryan R Garner
- RTI International, P. O. Box 12194, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA.
| | - Heather J Gotham
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108, USA
| | - Stephen J Tueller
- RTI International, P. O. Box 12194, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | - Elizabeth L Ball
- RTI International, P. O. Box 12194, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | - David Kaiser
- RTI International, P. O. Box 12194, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | - Patricia Stilen
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108, USA
| | - Kathryn Speck
- University of Nebraska Public Policy Center, 215 Centennial Mall South, Suite 401, Lincoln, NE, 68588, USA
| | - Denna Vandersloot
- Vandersloot Training and Consulting, 11845 NW Stone Mt. Lane, #108, Portland, OR, 97229, USA
| | - Traci R Rieckmann
- Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd. CB669, Portland, OR, 97239, USA
| | - Michael Chaple
- National Development and Research Institutes, Inc, 71 West 23rd Street, New York, NY, 10010, USA
| | - Erika G Martin
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, 1400 Washington Avenue, Milne 300E, Albany, NY, 12222, USA.,Rockefeller Institute of Government, State University of New York, 1400 Washington Avenue, Milne 300E, Albany, NY, 12222, USA
| | - Steve Martino
- Department of Psychiatry, VA Connecticut Healthcare System, Yale University, 950 Campbell Avenue (116B), West Haven, CT, 06516, USA
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Garner BR, Zehner M, Roosa MR, Martino S, Gotham HJ, Ball EL, Stilen P, Speck K, Vandersloot D, Rieckmann TR, Chaple M, Martin EG, Kaiser D, Ford JH. Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy: study protocol for a cluster randomized trial. Addict Sci Clin Pract 2017; 12:32. [PMID: 29149909 PMCID: PMC5693537 DOI: 10.1186/s13722-017-0096-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the extent to which evidence-based practices (EBPs)-treatments that have been empirically shown to be efficacious or effective-are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness-implementation hybrid trial titled the substance abuse treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS service organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. METHODS Using a cluster randomized design, case management and leadership staff from 39 ASOs across the United States were randomized to receive either the ATTC strategy (control condition) or the ATTC + ISF strategy (experimental condition). The ATTC strategy is staff-focused and includes 10 discrete strategies (e.g., provide centralized technical assistance, conduct educational meetings, provide ongoing consultation). The ISF strategy is organization-focused and includes seven discrete strategies (e.g., use an implementation advisor, organize implementation team meetings, conduct cyclical small tests of change). Building upon the exploration-preparation-implementation-sustainment (EPIS) framework, the effectiveness of the ISF strategy is examined via three staff-level measures: (1) time-to-proficiency (i.e., preparation phase outcome), (2) implementation effectiveness (i.e., implementation phase outcome), and (3) level of sustainment (i.e., sustainment phase outcome). DISCUSSION Although not without limitations, the ISF experiment has several strengths: a highly rigorous design (randomized, hypothesis-driven), high-need setting (ASOs), large sample size (39 ASOs), large geographic representation (23 states and the District of Columbia), and testing along multiple phases of the EPIS continuum (preparation, implementation, and sustainment). Thus, study findings will significantly improve generalizable knowledge regarding the best preparation, implementation, and sustainment strategies for advancing EBPs along the EPIS continuum. Moreover, increasing ASO's capacity to address substance use may improve the HIV Care Continuum. Trial registration ClinicalTrials.gov: NCT03120598.
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Affiliation(s)
- Bryan R. Garner
- RTI International, 3040 E. Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Mark Zehner
- School of Medicine and Public Health, University of Wisconsin–Madison, 1930 Monroe St., Madison, WI 53711-2027 USA
| | | | - Steve Martino
- Department of Psychiatry, VA Connecticut Healthcare System, Yale University, 950 Campbell Avenue (116B), West Haven, CT 06516 USA
| | - Heather J. Gotham
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO 64108 USA
| | - Elizabeth L. Ball
- RTI International, 3040 E. Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Patricia Stilen
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO 64108 USA
| | - Kathryn Speck
- University of Nebraska Public Policy Center, 215 Centennial Mall South, Suite 401, Lincoln, NE 68588 USA
| | - Denna Vandersloot
- Vandersloot Training & Consulting, 11845 NW Stone Mt. Lane, #108, Portland, OR 97229 USA
| | - Traci R. Rieckmann
- School of Medicine Psychiatry, and Greenfield Health Medicine, Oregon Health & Science University, 9450 SW Barnes Road St. 100, Portland, OR 97225 USA
| | - Michael Chaple
- National Development and Research Institutes, Inc, 71 West 23rd Street, New York, NY 10010 USA
| | - Erika G. Martin
- Rockefeller Institute of Government, State University of New York, New York, USA
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, 1400 Washington Avenue, Milne 300E, Albany, NY 12222 USA
| | - David Kaiser
- RTI International, 3040 E. Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - James H. Ford
- School of Medicine and Public Health, University of Wisconsin–Madison, 1930 Monroe St., Madison, WI 53711-2027 USA
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Cooper Z, Doll H, Bailey-Straebler S, Bohn K, de Vries D, Murphy R, O'Connor ME, Fairburn CG. Assessing Therapist Competence: Development of a Performance-Based Measure and Its Comparison With a Web-Based Measure. JMIR Ment Health 2017; 4:e51. [PMID: 29089289 PMCID: PMC5686418 DOI: 10.2196/mental.7704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 09/01/2017] [Accepted: 09/20/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Recent research interest in how best to train therapists to deliver psychological treatments has highlighted the need for rigorous, but scalable, means of measuring therapist competence. There are at least two components involved in assessing therapist competence: the assessment of their knowledge of the treatment concerned, including how and when to use its strategies and procedures, and an evaluation of their ability to apply such knowledge skillfully in practice. While the assessment of therapists' knowledge has the potential to be completed efficiently on the Web, the assessment of skill has generally involved a labor-intensive process carried out by clinicians, and as such, may not be suitable for assessing training outcome in certain circumstances. OBJECTIVES The aims of this study were to develop and evaluate a role-play-based measure of skill suitable for assessing training outcome and to compare its performance with a highly scalable Web-based measure of applied knowledge. METHODS Using enhanced cognitive behavioral therapy (CBT-E) for eating disorders as an exemplar, clinical scenarios for role-play assessment were developed and piloted together with a rating scheme for assessing trainee therapists' performance. These scenarios were evaluated by examining the performance of 93 therapists from different professional backgrounds and at different levels of training in implementing CBT-E. These therapists also completed a previously developed Web-based measure of applied knowledge, and the ability of the Web-based measure to efficiently predict competence on the role-play measure was investigated. RESULTS The role-play measure assessed performance at implementing a range of CBT-E procedures. The majority of the therapists rated their performance as moderately or closely resembling their usual clinical performance. Trained raters were able to achieve good-to-excellent reliability for averaged competence, with intraclass correlation coefficients ranging from .653 to 909. The measure was also sensitive to change, with scores being significantly higher after training than before as might be expected (mean difference 0.758, P<.001) even when taking account of repeated data (mean difference 0.667, P<.001). The major shortcoming of the role-play measure was that it required considerable time and resources. This shortcoming is inherent in the method. Given this, of most interest for assessing training outcome, scores on the Web-based measure efficiently predicted therapist competence, as judged by the role-play measure (with the Web-based measure having a positive predictive value of 77% and specificity of 78%). CONCLUSIONS The results of this study suggest that while it was feasible and acceptable to assess performance using the newly developed role-play measure, the highly scalable Web-based measure could be used in certain circumstances as a substitute for the more labor-intensive, and hence, more costly role-play method.
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Affiliation(s)
- Zafra Cooper
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Helen Doll
- Icon Patient Reported Outcomes, Oxford, United Kingdom
| | | | - Kristin Bohn
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Dian de Vries
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Rebecca Murphy
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Pantalon MV, Dziura J, Li FY, Owens PH, O'Connor PG, D'Onofrio G. An interventionist adherence scale for a specialized brief negotiation interview focused on treatment engagement for opioid use disorders. Subst Abus 2017; 38:191-199. [PMID: 28398192 DOI: 10.1080/08897077.2017.1294548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND No psychometrically validated instrument for evaluating the extent to which interventionists correctly implement brief interventions designed to motivate treatment engagement for opioid use disorders has been reported in the literature. The objective of this study was to develop and examine the psychometric properties of the Brief Negotiation Interview (BNI) Adherence Scale for Opioid Use Disorders (BAS-O). METHODS In the context of a randomized controlled trial evaluating the efficacy of 3 models of emergency department care for opioid use disorders, the authors developed and subsequently examined the psychometric properties of the BAS-O, a 38-item scale that required raters to answer whether or not ("Yes" or "No") each of the critical actions of the BNI was correctly implemented by the research interventionist. BAS-O items pertained to the BNI's 4 steps: (1) Raise the Subject, (2) Provide Feedback, (3) Enhance Motivation, and (4) Negotiate and Advise. A total of 215 audio-recorded BNI and 88 control encounters were rated by 3 trained raters who were independent of the study team and blind to study hypotheses, treatment, and assignment. RESULTS The results indicated the BAS-O has fair to excellent psychometric properties, in terms of good internal consistency, excellent interrater reliability, discriminant validity, and construct validity, and fair predictive validity. A 13-item, 2-factor solution accounted for nearly 80% of the variance, where factor 1 addressed "Autonomy and Planning" (7 items) and factor 2 addressed "Motivation and Problems" (6 items). However, predictive validity was found for only one of the BAS-O factor items (i.e., Telling patients that treatment will address a range of issues related to their opioid use disorder). CONCLUSIONS This study suggests that the BAS-O is a psychometrically valid measure of adherence to the specialized BNI for motivating treatment engagement in patients with opioid use disorders, thus providing a brief (13-item), objective method of evaluating BNI skill performance.
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Affiliation(s)
- Michael V Pantalon
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - James Dziura
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Fang-Yong Li
- b Yale University School of Public Health , New Haven , Connecticut , USA
| | - Patricia H Owens
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Patrick G O'Connor
- c Department of Internal Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Gail D'Onofrio
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
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Marín-Navarrete R, Horigian VE, Medina-Mora ME, Verdeja RE, Alonso E, Feaster DJ, Fernández-Mondragón J, Berlanga C, Sánchez-Huesca R, Lima-Rodríguez C, De la Fuente-Martín A. Motivational enhancement treatment in outpatient addiction centers: A multisite randomized trial. Int J Clin Health Psychol 2017; 17:9-19. [PMID: 30487876 PMCID: PMC6236319 DOI: 10.1016/j.ijchp.2016.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/13/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/OBJECTIVES Motivational Enhancement Treatment in Spanish (METS) is a brief intervention aimed at resolving patient ambivalence towards behavior change that has demonstrated efficacy in substance use disorder treatment to reduce use and increase treatment engagement in different populations. In order to have evidence for its implementation in Mexico, a multi-site, randomized, two-arm, controlled clinical trial was conducted at three outpatient addiction treatment centers in the country to compare the effect of METS with Counseling as Usual (CAU). METHOD One hundred and twenty patients were randomized to receive three sessions of METS (n = 54) or CAU (n = 66) during the first four weeks of treatment and were assessed during the following 12 weeks. Primary outcome measures were self-reported days of substance use and of treatment services utilization, which were tested using Generalized Estimating Equations. RESULTS Results associated both conditions with significant changes in substance use over, whereas there were no differences between conditions in substance use or in service utilization. CONCLUSIONS Findings do not support the hypothesis that METS is more effective than CAU, but suggest that brief interventions at treatment initiation may improve patient outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Carlos Berlanga
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), México
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Hall K, Staiger PK, Simpson A, Best D, Lubman DI. After 30 years of dissemination, have we achieved sustained practice change in motivational interviewing? Addiction 2016. [PMID: 26216706 DOI: 10.1111/add.13014] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Motivational interviewing (MI) is the most successfully disseminated evidence-based practice in the substance use disorder (SUD) treatment field. This systematic review considers two questions relevant to policymakers and service providers: (1) does training in MI achieve sustained practice change in clinicians delivering SUD treatment; and (2) do clinicians achieve a level of competence after training in MI that impacts upon client outcomes? METHODS A systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, examining training outcomes for MI in the SUD treatment sector, and for clinicians working in a SUD treatment role. We determined a training method to have resulted in sustained practice change when over 75% of participants met beginning proficiency in MI spirit at a follow-up time-point. RESULTS Of the 20 studies identified, 15 measured training at a follow-up time-point using standard fidelity measures. The proportion of clinicians who reached beginning proficiency was either reported or calculated for 11 of these studies. Only two studies met our criterion of 75% of clinicians achieving beginning proficiency in MI spirit after training. Of the 20 studies identified, two measured client substance use outcomes with mixed results. CONCLUSIONS A broad range of training studies failed to achieve sustained practice change in MI according to our criteria. It is unlikely that 75% of clinicians can achieve beginning proficiency in MI spirit after training unless competency is benchmarked and monitored and training is ongoing. The impact of training on client outcomes requires future examination.
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Affiliation(s)
- Kate Hall
- School of Psychology, Deakin University, Melbourne, Australia.,Turning Point, Eastern Health, Victoria, Australia.,Youth Support and Advocacy Service (YSAS), Victoria, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Melbourne, Australia
| | - Angela Simpson
- School of Psychology, Deakin University, Melbourne, Australia.,Turning Point, Eastern Health, Victoria, Australia.,Youth Support and Advocacy Service (YSAS), Victoria, Australia
| | - David Best
- Turning Point, Eastern Health, Victoria, Australia.,Eastern Health Clinical School, Monash University, Victoria, Australia.,Sheffield Hallam University, Sheffield, UK
| | - Dan I Lubman
- Turning Point, Eastern Health, Victoria, Australia.,Eastern Health Clinical School, Monash University, Victoria, Australia
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Madson MB, Villarosa MC, Schumacher JA, Mohn RS. Evaluating the Validity of the Client Evaluation of Motivational Interviewing Scale in a Brief Motivational Intervention for College Student Drinkers. J Subst Abuse Treat 2016; 65:51-7. [DOI: 10.1016/j.jsat.2016.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
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Moyers TB, Rowell LN, Manuel JK, Ernst D, Houck JM. The Motivational Interviewing Treatment Integrity Code (MITI 4): Rationale, Preliminary Reliability and Validity. J Subst Abuse Treat 2016; 65:36-42. [PMID: 26874558 PMCID: PMC5539964 DOI: 10.1016/j.jsat.2016.01.001] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/27/2015] [Accepted: 01/05/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED The Motivational Interviewing Treatment Integrity code has been revised to address new evidence-based elements of motivational interviewing (MI). This new version (MITI 4) includes new global ratings to assess clinician's attention to client language, increased rigor in assessing autonomy support and client choice, and items to evaluate the use of persuasion when giving information and advice. METHOD Four undergraduate, non-professional raters were trained in the MITI and used it to review 50 audiotapes of clinicians conducting MI in actual treatments sessions. Both kappa and intraclass correlation indices were calculated for all coders, for the best rater pair and for a 20% randomly selected sample from the best rater pair. RESULTS Reliability across raters, with the exception of Emphasize Autonomy and % Complex Reflections, were in the good to excellent range. Reliability estimates decrease when smaller samples are used and when fewer raters contribute. CONCLUSION The advantages and drawbacks of this revision are discussed including implications for research and clinical applications. The MITI 4.0 represents a reliable method for assessing the integrity of MI including both the technical and relational components of the method.
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Affiliation(s)
- Theresa B Moyers
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Lauren N Rowell
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
| | | | - Denise Ernst
- Denise Ernst Training and Consulting, Portland, OR, USA
| | - Jon M Houck
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
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Martino S, Paris M, Añez L, Nich C, Canning-Ball M, Hunkele K, Olmstead TA, Carroll KM. The Effectiveness and Cost of Clinical Supervision for Motivational Interviewing: A Randomized Controlled Trial. J Subst Abuse Treat 2016; 68:11-23. [PMID: 27431042 DOI: 10.1016/j.jsat.2016.04.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/22/2016] [Accepted: 04/27/2016] [Indexed: 11/18/2022]
Abstract
The effectiveness of a competency-based supervision approach called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) was compared to supervision-as-usual (SAU) for increasing clinicians' motivational interviewing (MI) adherence and competence and client retention and primary substance abstinence in a multisite hybrid type 2 effectiveness-implementation randomized controlled trial. Participants were 66 clinicians and 450 clients within one of eleven outpatient substance abuse programs. An independent evaluation of audio recorded supervision sessions indicated that MIA: STEP and SAU were highly and comparably discriminable across sites. While clinicians in both supervision conditions improved their MI performance, clinician supervised with MIA: STEP, compared to those in SAU, showed significantly greater increases in the competency in which they used fundamental and advanced MI strategies when using MI across seven intakes through a 16-week follow-up. There were no retention or substance use differences among the clients seen by clinicians in MIA: STEP or SAU. MIA: STEP was substantially more expensive to deliver than SAU. Innovative alternatives to resource-intensive competency-based supervision approaches such as MIA: STEP are needed to promote the implementation of evidence-based practices.
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Affiliation(s)
- Steve Martino
- VA Connecticut Healthcare System, Psychology Service, 950 Campbell Avenue, West Haven, CT, 06516, USA; Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Manuel Paris
- Yale University School of Medicine, The Hispanic Clinic, 25 Park Street, New Haven, CT, 06511, USA.
| | - Luis Añez
- Yale University School of Medicine, The Hispanic Clinic, 25 Park Street, New Haven, CT, 06511, USA.
| | - Charla Nich
- Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Monica Canning-Ball
- Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Karen Hunkele
- Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Todd A Olmstead
- The University of Texas at Austin, Lyndon B. Johnson School of Public Affairs, 2300 Red River Street, Austin, TX, 78713, USA; Seton/UT Clinical Research Institute, 1400 North IH 35, Austin, TX, 78701, USA.
| | - Kathleen M Carroll
- Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA.
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Martino S, Zimbrean P, Forray A, Kaufman J, Desan P, Olmstead TA, Gueorguieva R, Howell H, McCaherty A, Yonkers KA. See One, Do One, Order One: a study protocol for cluster randomized controlled trial testing three strategies for implementing motivational interviewing on medical inpatient units. Implement Sci 2015; 10:138. [PMID: 26420671 PMCID: PMC4589113 DOI: 10.1186/s13012-015-0327-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background General medical hospitals provide care for a disproportionate share of patients who abuse or are dependent upon substances. This group is among the most costly to treat and has the poorest medical and addiction recovery outcomes. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance use problems in that patients are accessible, have time for an intervention, and are often admitted for complications related to substance use that renders hospitalization a “teachable moment.” Methods/Design This randomized controlled trial will examine the effectiveness of three different strategies for integrating motivational interviewing (MI) into the practice of providers working within a general medical inpatient hospitalist service: (1) a continuing medical education workshop that provides background and “shows” providers how to conduct MI (See One); (2) an apprenticeship model involving workshop training plus live supervision of bedside practice (Do One); and (3) ordering MI from the psychiatry consultation-liaison (CL) service after learning about it in a workshop (Order One). Thirty providers (physicians, physician assistants, nurses) will be randomized to conditions and then assessed for their provision of MI to 40 study-eligible inpatients. The primary aims of the study are to assess (1) the utilization of MI in each condition; (2) the integrity of MI when providers use it on the medical units; and (3) the relative costs and cost-effectiveness of the three different implementation strategies. Discussion If implementation of Do One and Order One is successful, the field will have two alternative strategies for supporting medical providers’ proficient use of brief behavioral interventions, such as MI, for medical inpatients who use substances problematically. Trial registration Clinical Trials.gov (NCT01825057)
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Affiliation(s)
- Steve Martino
- Psychology Service, VA Connecticut Healthcare System, 950 Campbell Avenue (116B), West Haven, CT, 06516, USA. .,Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Paula Zimbrean
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Ariadna Forray
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Joy Kaufman
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Paul Desan
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Todd A Olmstead
- Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, 2300 Red River St., Stop E2700, Sid Richardson Hall, Unit 3, Austin, TX, 78712, USA. .,Seton/UT Clinical Research Institute, 1400 North IH 35, Austin, TX, 78701, USA.
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale University School of Medicine, 60 College Street, New Haven, CT, 06510, USA.
| | - Heather Howell
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Ashley McCaherty
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Kimberly A Yonkers
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
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Meier A, McGovern MP, Lambert-Harris C, McLeman B, Franklin A, Saunders EC, Xie H. Adherence and competence in two manual-guided therapies for co-occurring substance use and posttraumatic stress disorders: clinician factors and patient outcomes. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:527-34. [PMID: 26286351 PMCID: PMC4698972 DOI: 10.3109/00952990.2015.1062894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The challenges of implementing and sustaining evidence-based therapies into routine practice have been well-documented. OBJECTIVES This study examines the relationship among clinician factors, quality of therapy delivery, and patient outcomes. METHODS Within a randomized controlled trial, 121 patients with current co-occurring substance use and posttraumatic stress disorders were allocated to receive either manualized Integrated Cognitive Behavioral Therapy (ICBT) or Individual Addiction Counseling (IAC). Twenty-two clinicians from seven addiction treatment programs were trained and supervised to deliver both therapies. Clinician characteristics were assessed at baseline; clinician adherence and competence were assessed over the course of delivering both therapies; and patient outcomes were measured at baseline and 6-month follow-up. RESULTS Although ICBT was delivered at acceptable levels, clinicians were significantly more adherent to IAC (p < 0.05). At session 1, clinical female gender (p < 0.05) and lower education level (p < 0.05) were predictive of increased clinician adherence and competence across both therapies. Adherence and competence at session 1 in either therapy were significantly predictive of positive patient outcomes. ICBT adherence (p < 0.05) and competence (p < 0.01) were predictive of PTSD symptom reduction, whereas IAC adherence (p < 0.01) and competence (p < 0.01) were associated with decreased drug problem severity. CONCLUSIONS The differential impact of adherence and competence for both therapy types is consistent with their purported primary target: ICBT for PTSD and IAC for substance use. These findings also suggest the benefits of considering clinician factors when implementing manual-guided therapies. Future research should focus on diverse clinician samples, randomization of clinicians to therapy type, and prospective designs to evaluate models of supervision and quality monitoring.
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Affiliation(s)
- Andrea Meier
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Mark P. McGovern
- Departments of Psychiatry and of Community & Family Medicine, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Chantal Lambert-Harris
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Bethany McLeman
- Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Anna Franklin
- Dartmouth College, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Elizabeth C. Saunders
- Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Haiyi Xie
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
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Bofill L, Weiss SM, Lucas M, Bordato A, Dorigo A, Fernandez-Cabanillas G, Aristegui I, Lopez M, Waldrop-Valverde D, Jones D. Motivational Interviewing among HIV Health Care Providers: Challenges and Opportunities to Enhance Engagement and Retention in Care in Buenos Aires, Argentina. J Int Assoc Provid AIDS Care 2015; 14:491-6. [PMID: 26056148 DOI: 10.1177/2325957415586257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In Argentina, providers' response to motivational interviewing (MI) to improve engagement and retention in care among challenging patients with HIV was evaluated. Twelve HIV care physicians participated, and their video recordings pre- and post-MI training were also obtained. One week post-training, 11 of the 12 participants were committed to using MI strategies during consult session. Of the 12 participants, 9 demonstrated appropriate utilization of MI techniques and change in HIV education provided during consultation (Z = -2.375, P = .018). Motivational interviewing appears to be a viable strategy to enhance engagement and retention in challenging HIV-positive patients.
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Affiliation(s)
- Lina Bofill
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Mar Lucas
- Fundación Huésped, Buenos Aires, Argentina
| | | | | | | | | | - Maria Lopez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Drenna Waldrop-Valverde
- Nell Hodgson Woodruff School of Nursing/Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Deborah Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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45
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Training Healthcare Providers in Motivational Communication for Promoting Physical Activity and Exercise in Cardiometabolic Health Settings: Do We Know What We Are Doing? CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0457-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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46
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Barnes RD, Ivezaj V. A systematic review of motivational interviewing for weight loss among adults in primary care. Obes Rev 2015; 16:304-18. [PMID: 25752449 PMCID: PMC4491487 DOI: 10.1111/obr.12264] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/25/2014] [Accepted: 12/20/2014] [Indexed: 12/15/2022]
Abstract
Motivational interviewing (MI) is a client-centred method of intervention focused on enhancing intrinsic motivation and behaviour change. A previous review of the literature and meta-analyses support the effectiveness of MI for weight loss. None of these studies, however, focused on the bourgeoning literature examining MI for weight loss among adults within primary care settings, which confers unique barriers to providing weight loss treatment. Further, the current review includes 19 studies not included in previous reviews or meta-analyses. We conducted a comprehensive review of PubMed, MI review papers, and citations from relevant papers. A total of 24 adult randomized controlled trials were identified. MI interventions typically were provided individually by a range of clinicians and compared with usual care. Few studies provided adequate information regarding MI treatment fidelity. Nine studies (37.5%) reported significant weight loss at post-treatment assessment for the MI condition compared with control groups. Thirteen studies (54.2%) reported MI patients achieving at least 5% loss of initial body weight. There is potential for MI to help primary care patients lose weight. Conclusions, however, must be drawn cautiously as more than half of the reviewed studies showed no significant weight loss compared with usual care and few reported MI treatment fidelity.
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Affiliation(s)
- R D Barnes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Pietrabissa G, Ceccarini M, Borrello M, Manzoni GM, Titon A, Nibbio F, Montano M, Bertone G, Gondoni L, Castelnuovo G. Enhancing behavioral change with motivational interviewing: a case study in a Cardiac Rehabilitation Unit. Front Psychol 2015; 6:298. [PMID: 25852614 PMCID: PMC4364083 DOI: 10.3389/fpsyg.2015.00298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/02/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Psychological interventions in cardiac rehabilitation programs appear relevant in as much they significantly contribute to achieve the goals of rehabilitation, to reduce the risk of relapses and to improve patients' adherence to therapy. To this aim, motivational interviewing (MI) has shown promising results in improving motivation to change and individuals' confidence in their ability to do so. OBJECTIVE The purpose of this article is to integrate theory with practice by describing a three-session case scenario. It illustrates how MI's skills and strategies can be used to enhance heart-healthy habits. MI may be synergistic with other treatment approaches and it is used here in conjunction with brief strategic therapy. CONCLUSION By the use of MI principles and techniques, the patient reported an increase in his motivation and ability to change, developing a post discharge plan that incorporates self-care behaviors. CLINICAL IMPLICATIONS MI may be effective in motivating and facilitating health behavior change among obese patients suffering from heart failure.
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Affiliation(s)
- Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| | - Martina Ceccarini
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Faculty of Psychology, University of Bergamo, BergamoItaly
| | - Maria Borrello
- Faculty of Psychology, University of Bergamo, BergamoItaly
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| | - Annamaria Titon
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Ferruccio Nibbio
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Mariella Montano
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Gianandrea Bertone
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Luca Gondoni
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
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Dobber J, van Meijel B, Barkhof E, Scholte op Reimer W, Latour C, Peters R, Linszen D. Selecting an optimal instrument to identify active ingredients of the motivational interviewing-process. J Psychosom Res 2015; 78:268-76. [PMID: 25466386 DOI: 10.1016/j.jpsychores.2014.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 10/08/2014] [Accepted: 10/20/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Motivational Interviewing (MI) can effectively stimulate motivation for health behavior change, but the active ingredients of MI are not well known. To help clinicians further stimulate motivation, they need to know the active ingredients of MI. A psychometrically sound instrument is required to identify those ingredients. The purpose of this study is to describe and evaluate the capability of existing instruments to reliably measure one or more potential active ingredients in the MI process between clients and MI-therapists. METHODS We systematically searched MedLine, Embase, Cinahl, PsycInfo, Cochrane Central, specialised websites and reference lists of selected articles. RESULTS We found 406 papers, 60 papers were retrieved for further evaluation, based on prespecified criteria. Seventeen instruments that were specifically designed to measure MI or aspects of MI were identified. Fifteen papers met all inclusion criteria, and reported on seven instruments that assess potential active ingredients of the interactive MI process. The capability of these instruments to measure potential active ingredients in detail and as a part of the interactive MI process varies considerably. Three of these instruments measure one or more potential active ingredients in a reliable and valid way. CONCLUSION To identify the potential active ingredients in the interactive MI process, a combination of the SCOPE (which measures potential technical active ingredients) and the GROMIT or the global ratings of the MISC2 (to measure potential relational ingredients) seems favourable.
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Affiliation(s)
- Jos Dobber
- Amsterdam School of Health Professions, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Berno van Meijel
- Inholland University of Applied Sciences, Department of Health, Sports & Welfare, Cluster Nursing, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Parnassia Academy, The Hague, the Netherlands; VU University Medical Center, Department of Psychiatry, EGO Institute for Health and Care Research, Amsterdam, the Netherlands
| | - Emile Barkhof
- Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Wilma Scholte op Reimer
- Amsterdam School of Health Professions, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Corine Latour
- Amsterdam School of Health Professions, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Ron Peters
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Don Linszen
- Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
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Barnes RD, White MA, Martino S, Grilo CM. A randomized controlled trial comparing scalable weight loss treatments in primary care. Obesity (Silver Spring) 2014; 22:2508-16. [PMID: 25298016 PMCID: PMC4236282 DOI: 10.1002/oby.20889] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 08/14/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Primary-care (PC) settings may be an opportune place to deliver obesity interventions. Scalable interventions utilizing motivational interviewing (MI), supported by Internet resources, may overcome obstacles to effective obesity treatment dissemination. This study was a randomized controlled trial testing two Web-supported interventions, motivational interviewing (MIC) and nutrition psychoeducation (NPC), an attention-control intervention, in comparison with usual care (UC). METHODS Eighty-nine overweight/obese patients, with and without binge eating disorder (BED), were randomly assigned to MIC, NPC, or UC for 3 months in PC. Patients were assessed independently at post-treatment and at 3-month follow-up. RESULTS Weight, triglyceride levels, and depression scores decreased significantly in NPC when compared to UC but not MIC; UC and MIC did not differ significantly. Weight loss results maintained at 3-month follow-up: approximately 25% MIC and NPC patients achieved at least 5% weight loss which did not differ by BED status. Fidelity ratings were high and treatment adherence was associated with weight loss. CONCLUSIONS This is the first randomized controlled trial in PC testing MI for weight loss to include an attention-control intervention (NPC). NPC, but not MIC, showed a consistent pattern of superior benefits relative to UC. BED status was not associated, but treatment adherence was associated, with weight loss outcomes.
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Affiliation(s)
| | - Marney A. White
- Department of Psychiatry, Yale School of Medicine
- Chronic Disease Epidemiology, Yale School of Public Health
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine
- VA Connecticut Healthcare System
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine
- Department of Psychology, Yale University
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Norberg MM, Hides L, Olivier J, Khawar L, McKetin R, Copeland J. Brief interventions to reduce Ecstasy use: a multi-site randomized controlled trial. Behav Ther 2014; 45:745-59. [PMID: 25311285 DOI: 10.1016/j.beth.2014.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/27/2014] [Accepted: 05/30/2014] [Indexed: 11/26/2022]
Abstract
Studies examining the ability of motivational enhancement therapy (MET) to augment education provision among ecstasy users have produced mixed results and none have examined whether treatment fidelity was related to ecstasy use outcomes. The primary objectives of this multi-site, parallel, two-group randomized controlled trial were to determine if a single-session of MET could instill greater commitment to change and reduce ecstasy use and related problems more so than an education-only intervention and whether MET sessions delivered with higher treatment fidelity are associated with better outcomes. The secondary objective was to assess participants' satisfaction with their assigned interventions. Participants (N=174; Mage=23.62) at two Australian universities were allocated randomly to receive a 15-minute educational session on ecstasy use (n=85) or a 50-minute session of MET that included an educational component (n=89). Primary outcomes were assessed at baseline, and then at 4-, 16-, and 24-weeks postbaseline, while the secondary outcome measure was assessed 4-weeks postbaseline by researchers blind to treatment allocation. Overall, the treatment fidelity was acceptable to good in the MET condition. There were no statistical differences at follow-up between the groups on the primary outcomes of ecstasy use, ecstasy-related problems, and commitment to change. Both intervention groups reported a 50% reduction in their ecstasy use and a 20% reduction in the severity of their ecstasy-related problems at the 24-week follow up. Commitment to change slightly improved for both groups (9%-17%). Despite the lack of between-group statistical differences on primary outcomes, participants who received a single session of MET were slightly more satisfied with their intervention than those who received education only. MI fidelity was not associated with ecstasy use outcomes. Given these findings, future research should focus on examining mechanisms of change. Such work may suggest new methods for enhancing outcomes. Australia and New Zealand Clinical Trial Registry: ACTRN12611000136909.
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Affiliation(s)
- Melissa M Norberg
- Centre for Emotional Health, Department of Psychology, Macquarie University; National Cannabis Prevention and Information Centre, UNSW Medicine, Sydney; National Drug and Alcohol Research Centre, UNSW Medicine, Sydney.
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Institute of Health & Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology
| | - Jake Olivier
- School of Mathematics and Statistics, UNSW, Sydney
| | - Laila Khawar
- National Drug and Alcohol Research Centre, UNSW Medicine, Sydney
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, UNSW Medicine, Sydney; Centre for Research on Ageing, Health and Well-being, the Australian National University, Canberra
| | - Jan Copeland
- National Cannabis Prevention and Information Centre, UNSW Medicine, Sydney
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