1
|
Davis BJ, Fenley A, Sanders A, Ipekci B, Thibeau H, Khan T, Shashidhar G, Keshavan M, Kline E. Development of the motivational interviewing for loved ones skills assessment (MILO-SA). Early Interv Psychiatry 2023; 17:792-797. [PMID: 36638835 PMCID: PMC10627348 DOI: 10.1111/eip.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/19/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
AIM Expressed emotion of family members is a key target for intervention for bettering psychosocial outcomes for transitional-age youth experiencing mental health crises. Motivational Interviewing for Loved Ones (MILO) seeks to reduce expressed emotion by teaching parents motivational interviewing skills such as taking a non-judgmental stance, exploring their loved one's thoughts and feelings, expressing optimism and confidence, and avoiding taking an expert role. This report details the creation of the Motivational Interviewing for Loved Ones- Skills Assessment (MILO-SA), its psychometric properties, and convergent validity with other measures of motivational interviewing adeptness. METHODS Our sample (n = 54) consisted of baseline assessments from parents participating in a pilot study of MILO. Parents were assessed for baseline knowledge of motivational interviewing as well as MILO skills with the MILO-SA and a traditional assessment clinician application of motivational interviewing skills. RESULTS We found that the MILO-SA displayed high interrater reliability (k = 0.81), and convergent validity with motivational interviewing knowledge (r = 0.32) as well as traditional assessments of clinician adeptness applying motivational interviewing skills (r = 0.67). CONCLUSIONS Our findings suggest that the MILO-SA has strong psychometric properties and is a useful tool for assessing parent acquisition of motivational interviewing skills. Specifically, the MILO-SA can be used in future studies focused on teaching non-clinicians motivational interviewing skills.
Collapse
Affiliation(s)
- Beshaun J. Davis
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alicia Fenley
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Aliyah Sanders
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Bediha Ipekci
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
| | - Heather Thibeau
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
| | - Tabinda Khan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gautami Shashidhar
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Kline
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Kline ER, Thibeau H, Sanders AS, Davis BJ, Fenley A, McIntyre T, English K, Keshavan MS. The School of Hard Talks: A telehealth parent training group for caregivers of adolescents and young adults. Early Interv Psychiatry 2023; 17:244-251. [PMID: 35715966 PMCID: PMC10588675 DOI: 10.1111/eip.13321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/19/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022]
Abstract
AIM A large body of evidence demonstrates the importance of the family environment in the developmental trajectory of mental illness in young people. Caregiver communication skills training represents a potential model for influencing the outcomes of adolescents and young adults struggling with emerging mental health and behavioural difficulties. The aim of the current study is to describe the development of a telehealth group training intervention for caregivers of adolescents and young adults, and to report the results of a pilot feasibility-effectiveness study that took place in 2020-2021. METHODS The "School of Hard Talks" intervention consisted of 8 h of training in communication skills consistent with motivational interviewing techniques. All pilot study participants were assigned to receive the intervention. Outcomes of interest were family conflict, caregiver stress, caregiver self-efficacy and expressed emotion (EE). Participants were assessed three times: prior to the intervention, after the intervention and 12 weeks later. RESULTS A total of 62 participants enrolled in the study, of whom 49 completed the intervention. Large, significant improvements were observed over time in all four domains of interest. Qualitative feedback from parents was very positive and added context to quantitative observations. CONCLUSIONS The School of Hard Talks was a feasible and effective intervention targeting both caregiver wellbeing as well as important mechanisms of risk for youth psychopathology, namely family conflict and EE. Further research involving a larger sample and a control condition are needed to confirm these findings.
Collapse
Affiliation(s)
- Emily R. Kline
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Heather Thibeau
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - A. Simone Sanders
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Beshaun J. Davis
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Alicia Fenley
- Department of Psychology, Boston University, Boston, Massachusetts, USA
| | - Theresa McIntyre
- Children’s Behavioral Health Knowledge Center, Massachusetts Department of Mental Health, Boston, Massachusetts, USA
| | - Kelly English
- Children’s Behavioral Health Knowledge Center, Massachusetts Department of Mental Health, Boston, Massachusetts, USA
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Kline ER, Thibeau H, Davis BJ, Fenley A, Sanders AS, Ipekci B, Oblath R, Yen S, Keshavan MS. Motivational interviewing for loved ones: Randomized controlled trial of brief training for first episode psychosis caregivers. Schizophr Res 2022; 250:43-49. [PMID: 36279833 PMCID: PMC10593126 DOI: 10.1016/j.schres.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Research shows that family involvement in psychosis treatment leads to better patient outcomes. Interventions that involve and counsel family members may improve patient outcomes by addressing barriers to treatment adherence and lowering family expressed emotion, thereby creating a less stressful and more supportive home environment. Learning to use motivational interviewing communication skills may help caregivers to decrease conflict and expressed emotion and improve treatment adherence. METHODS The current study is a pilot randomized controlled trial testing the impact of "Motivational Interviewing for Loved Ones" (MILO), a brief five-hour psychoeducational intervention for caregivers, in a sample of family members of individuals with early course psychosis (N = 40). Using a randomized crossover design, caregivers were randomized to either immediate MILO or a six-week waitlist control condition; all participants eventually received the intervention. RESULTS Caregiver participants experienced large (d = 1.08-1.43) and significant improvements in caregiver wellbeing, caregiver self-efficacy, family conflict, and expressed emotion. There was no change over time in caregiver-reported patient treatment adherence. Relative to waitlist, MILO had significant effects on family conflict and expressed emotion, a trending effect on perceived stress, and no effect on parenting self-efficacy or treatment adherence. CONCLUSIONS MILO showed benefits for caregivers of FEP patients in this small, controlled trial. Further testing in a larger randomized controlled trial is warranted to better characterize MILO's effects for caregivers and patients across a range of diagnoses.
Collapse
Affiliation(s)
- Emily R Kline
- Boston University School of Medicine, Department of Psychiatry, 720 Harrison Avenue, Boston, MA 02118, United States of America; Boston Medical Center, Department of Psychiatry, 850 Harrison Avenue, Boston, MA 02118, United States of America; Harvard Medical School, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America; Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America.
| | - Heather Thibeau
- Boston Medical Center, Department of Psychiatry, 850 Harrison Avenue, Boston, MA 02118, United States of America; Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America
| | - Beshaun J Davis
- Harvard Medical School, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America; Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America
| | - Alicia Fenley
- Boston University, Department of Psychology, 900 Commonwealth Avenue, Boston, MA 02215, United States of America
| | - Aliyah Simone Sanders
- Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America
| | - Bediha Ipekci
- Boston University School of Medicine, Department of Psychiatry, 720 Harrison Avenue, Boston, MA 02118, United States of America; Boston Medical Center, Department of Psychiatry, 850 Harrison Avenue, Boston, MA 02118, United States of America
| | - Rachel Oblath
- Boston University School of Medicine, Department of Psychiatry, 720 Harrison Avenue, Boston, MA 02118, United States of America; Boston Medical Center, Department of Psychiatry, 850 Harrison Avenue, Boston, MA 02118, United States of America
| | - Shirley Yen
- Harvard Medical School, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America; Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America
| | - Matcheri S Keshavan
- Harvard Medical School, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America; Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America
| |
Collapse
|
4
|
Kline ER, Thibeau H, Sanders AS, English K, Davis BJ, Fenley AR, Keshavan MS. Motivational Interviewing for Loved Ones in Early Psychosis: Development and Pilot Feasibility Trial of a Brief Psychoeducational Intervention for Caregivers. Front Psychiatry 2021; 12:659568. [PMID: 33868061 PMCID: PMC8047061 DOI: 10.3389/fpsyt.2021.659568] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Treatment delay and non-adherence in first episode psychosis is a pressing public health problem. Ambivalence regarding psychiatric intervention and labeling among young people with psychosis is a contributing factor. For these individuals, caregivers often facilitate the pathway to care and support ongoing engagement and adherence. Caregivers describe distress and burden associated with this role. This manuscript describes the development and pilot feasibility testing of a motivational interviewing-derived communication training for caregivers of individuals with untreated or under-treated early course psychosis. Individuals with lived experience were consulted in the intervention development process. The training consisted of four 60-min sessions teaching the philosophy and basic skills of motivational interviewing as well as two brief practice calls. Feasibility was assessed with regard to study enrollment, retention, and completion. Satisfaction was assessed through the Client Satisfaction Questionnaire and qualitative feedback. Thirty-one caregivers consented to this pilot feasibility trial and participated via telehealth over the course of 5 months. Intervention completion and reported satisfaction were high, with 94% of consented participants completing at least three training sessions and 84% reporting that they would "definitely" recommend the training to a friend in similar circumstances. There were no between-clinician differences in MILO session attendance (F [2] = 0.53, p = 0.596) or satisfaction total scores (F [2] = 1.03, p = 0.371). Brief motivational interviewing skills training appears to be a feasible and valued intervention for caregivers of individuals with poorly managed early course psychosis. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04010747.
Collapse
Affiliation(s)
- Emily R Kline
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Boston Medical Center, Boston, MA, United States.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Heather Thibeau
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Aliyah S Sanders
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| | - Kelly English
- Massachusetts Department of Mental Health, Boston, MA, United States
| | - Beshaun J Davis
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Alicia R Fenley
- Department of Psychology, Boston University, Boston, MA, United States
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| |
Collapse
|