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Coetzer-Liversage A, Stein LAR, Shuster CL, Bassett SS, Martin R, Clair Michaud M. Monitoring Motivational Interviewing Strategies: Creating Provider and Client Reports to Encourage Implementation. Subst Use Misuse 2024; 59:1519-1526. [PMID: 38816908 PMCID: PMC11240879 DOI: 10.1080/10826084.2024.2360101] [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] [Indexed: 06/01/2024]
Abstract
BACKGROUND Motivational interviewing (MI) is an evidence-based practice that has been successfully applied to at-risk youth. Well-validated measures that track MI integrity may not be used in practice settings due to the time to complete them, recording requirements and training involved. A simpler, less resource-intensive instrument may encourage programs and providers to attend more to the quality of MI use during implementation. PURPOSE To validate a method involving two measures, Youth and Provider Logs, to assist in monitoring MI use. METHODS Clients and providers reported on provider behaviors consistent and inconsistent with MI during the session. Factor analyses were conducted to examine whether measures showed clear scales assessing MI use and analyses were conducted to assess validity of these measures. RESULTS Both Youth and Provider Logs showed a clear and consistent 3-factor structure assessing MI-consistent behavior, MI-inconsistent behavior, and alcohol-related topics. Significant correlations were found between Youth Logs and youth reports of rapport with providers, and satisfaction with services. Provider MI-inconsistent scores were significantly inversely predictive of observer fidelity scores over time. CONCLUSION This study offers provider and client measures for tracking use of MI in sessions, which are a simpler, less resource-intensive method for monitoring MI, and may encourage fidelity during implementation.
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Affiliation(s)
| | - L A R Stein
- Department of Psychology, University of Rhode Island, Rhode Island, USA
- Behavioral Sciences Department, Brown University, Providence, RI 02912
- Developmental Disabilities, and Hospitals, Cranston, RI, USA
- Rhode Island Training School, Rhode Island Training School, Cranston, RI, USA
| | - Coral L Shuster
- Department of Psychology, University of Rhode Island, Rhode Island, USA
| | - Shayna S Bassett
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Rosemarie Martin
- Behavioral Sciences Department, Brown University, Providence, RI 02912
- Center for Alcohol/Addiction Studies, Brown University, Providence, RI 02903
| | - Mary Clair Michaud
- Rhode Island Training School, Rhode Island Training School, Cranston, RI, USA
- Rhode Island Department of Children, Youth, and Families, Rhode Island Department of Children, Youth, and Families
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Loveless JP, Rosen JH, Yost JS. Implementing a workflow-integrated motivational interviewing training program for psychiatry trainees on an inpatient consultation-liaison rotation: lessons learned. Front Psychiatry 2023; 14:1184053. [PMID: 37275965 PMCID: PMC10232741 DOI: 10.3389/fpsyt.2023.1184053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
Background Effective consultation-liaison psychiatry (CLP) is proactive, collaborative, and requires providers to have proficiency with therapeutic skills beyond nosology and medication management. Motivational interviewing (MI) is an evidenced-based intervention that should be considered essential for CLP trainees to learn. Given that the demands of training and patient care are already experienced as stressful for many psychiatry trainees, the authors endeavored to create a MI training program that was integrated into trainees' normal CLP workflow. Method Twenty-two trainees on an inpatient CLP rotation participated in a six-week MI training program that was incorporated into their regular workflow. The program included didactic sessions with role-playing, as well as on-demand between-session coaching via an expert in MI. Trainee participation and perceptions of MI were measured via a questionnaire that was administered prior to each training session. Results Trainee participation in the didactic sessions was inconsistent. Questionnaire data revealed positive baseline perceptions of motivational interviewing and its usefulness in inpatient medical settings. Additionally, as trainees participated in the program, perceived knowledge of motivational interviewing as well as awareness of motivational issues among their patients increased. Finally, participation in program was not perceived as disruptive to daily workflow for the participants. Discussion This the first documented attempt at implementing a MI training program for CLP trainees that was integrated into their regular workflow. Preliminary data identified some encouraging trends, but also unexpected challenges. These lessons could inform how these types of training programs are implemented moving forward.
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Affiliation(s)
- James P. Loveless
- Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, United States
| | | | - Joanna S. Yost
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
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Ball GDC, O’Neill MG, Noor R, Alberga A, Azar R, Buchholz A, Enright M, Geller J, Ho J, Holt NL, Lebel T, Rosychuk RJ, Tarride JE, Zenlea I. A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol. Pilot Feasibility Stud 2023; 9:14. [PMID: 36691103 PMCID: PMC9868519 DOI: 10.1186/s40814-023-01246-w] [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] [Received: 06/30/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families' access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children's and caregivers' acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data. METHODS In our 2.5-year study, 108 6-17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families' barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive. DISCUSSION Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition. TRIAL REGISTRATION This trial was registered prospectively at ClinicalTrials.gov (# NCT05403658 ; first posted: June 3, 2022).
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Affiliation(s)
- Geoff D. C. Ball
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Marcus G. O’Neill
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Rafat Noor
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Angela Alberga
- grid.410319.e0000 0004 1936 8630Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC Canada
| | - Rima Azar
- grid.260288.60000 0001 2169 3908Psychobiology of Stress & Health Lab, Department of Psychology, Mount Allison University, Sackville, NB Canada
| | - Annick Buchholz
- grid.34428.390000 0004 1936 893XDepartment of Psychology, Carleton University, Ottawa, ON Canada
| | | | - Josie Geller
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Josephine Ho
- grid.22072.350000 0004 1936 7697Department of Paediatrics, University of Calgary, Calgary, AB Canada
| | - Nicholas L. Holt
- grid.17089.370000 0001 2190 316XFaculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB Canada
| | - Tracy Lebel
- Patient and Family Partner, Edmonton, AB Canada
| | - Rhonda J. Rosychuk
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Jean-Eric Tarride
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Ian Zenlea
- grid.17063.330000 0001 2157 2938Department of Pediatrics, University of Toronto, Toronto, ON Canada
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Michalopoulou M, Jebb SA, Aveyard P. Effectiveness of Motivational Interviewing in Managing Overweight and Obesity. Ann Intern Med 2022; 175:W105. [PMID: 36122404 DOI: 10.7326/l22-0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
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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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Feinberg E, Augustyn M, Broder-Fingert S, Bennett A, Weitzman C, Kuhn J, Hickey E, Chu A, Levinson J, Sandler Eilenberg J, Silverstein M, Cabral HJ, Patts G, Diaz-Linhart Y, Rosenberg J, Miller JS, Guevara JP, Fenick AM, Blum NJ, Blum NJ. Effect of Family Navigation on Diagnostic Ascertainment Among Children at Risk for Autism: A Randomized Clinical Trial From DBPNet. JAMA Pediatr 2021; 175:243-250. [PMID: 33427861 PMCID: PMC7802008 DOI: 10.1001/jamapediatrics.2020.5218] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Early identification of autism spectrum disorder (ASD) is associated with improved cognitive and behavioral outcomes. Targeted strategies are needed to support equitable access to diagnostic services to ensure that children from low-income and racial/ethnic minority families receive the benefits of early ASD identification and treatment. OBJECTIVE To test the efficacy of family navigation (FN), an individually tailored, culturally informed care management strategy, to increase the likelihood of achieving diagnostic ascertainment among young children at risk for ASD. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial of 249 families of children aged 15 to 27 months who had positive screening results for possible ASD was conducted in 11 urban primary care sites in 3 cities. Data collection occurred from February 24, 2015, through November 5, 2018. Statistical analysis was performed on an intent-to-treat basis from November 5, 2018, to July 27, 2020. INTERVENTIONS Families were randomized to FN or conventional care management (CCM). Families receiving FN were assigned a navigator who conducted community-based outreach to families to address structural barriers to care and support engagement in recommended services. Families receiving CCM were assigned to a care manager, who did limited telephone outreach. Families received FN or CCM after positive initial screening results and for 100 days after diagnostic ascertainment. MAIN OUTCOMES AND MEASURES The primary outcome, diagnostic ascertainment, was measured as the number of days from randomization to completion of the child's clinical developmental evaluation, when a diagnosis of ASD or other developmental disorder was determined. RESULTS Among 250 families randomized, 249 were included in the primary analysis (174 boys [69.9%]; mean [SD] age, 22.0 [3.5] months; 205 [82.3%] publicly insured; 233 [93.6%] non-White). Children who received FN had a greater likelihood of reaching diagnostic ascertainment over the course of 1 year (FN, 108 of 126 [85.7%]; CCM, 94 of 123 [76.4%]; unadjusted hazard ratio [HR], 1.39 [95% CI, 1.05-1.84]). Site (Boston, New Haven, and Philadelphia) and ethnicity (Hispanic vs non-Hispanic) moderated the effect of FN (treatment × site interaction; P = .03; Boston: HR, 2.07 [95% CI, 1.31-3.26]; New Haven: HR, 1.91 [95% CI, 0.94-3.89]; and Philadelphia: HR, 0.91 [95% CI, 0.60-1.37]) (treatment × ethnicity interaction; P < .001; Hispanic families: HR, 2.81 [95% CI, 2.23-3.54] vs non-Hispanic families: HR, 1.49 [95% CI, 1.45-1.53]). The magnitude of FN's effect was significantly greater among Hispanic families than among non-Hispanic families (diagnostic ascertainment among Hispanic families: FN, 90.9% [30 of 33], and CCM, 53.3% [16 of 30]; vs non-Hispanic families: FN, 89.7% [35 of 39], and CCM, 77.5% [31 of 40]). CONCLUSIONS AND RELEVANCE Family navigation improved the likelihood of diagnostic ascertainment among children from racial/ethnic minority, low-income families who were detected as at risk for ASD in primary care. Results suggest differential effects of FN by site and ethnicity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02359084.
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Affiliation(s)
- Emily Feinberg
- Division of General Academic Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts,Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Marilyn Augustyn
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Sarabeth Broder-Fingert
- Division of General Academic Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Amanda Bennett
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carol Weitzman
- Developmental and Behavioral Pediatrics, Division of General Pediatrics, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut,Now with Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Jocelyn Kuhn
- Division of General Academic Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Emily Hickey
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts ,Now with Waisman Center, University of Wisconsin–Madison, Madison
| | - Andrea Chu
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Julia Levinson
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | - Michael Silverstein
- Division of General Academic Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Howard J. Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Gregory Patts
- Biostatistics, Epidemiology, and Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Yaminette Diaz-Linhart
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Jessica Rosenberg
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Judith S. Miller
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - James P. Guevara
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Biostatistics, Epidemiology, and Informatics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Ada M. Fenick
- Developmental and Behavioral Pediatrics, Division of General Pediatrics, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Nathan J. Blum
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Nathan J Blum
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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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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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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Viner RM, Kinra S, Christie D, Cole TJ, Costa S, Croker H, Fry T, Hsia Y, Hudson L, Kessel AS, Morris S, Nazareth I, Nicholls D, Park MH, Saxena S, Taylor B, White B, Wong IC. Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BackgroundFive linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway.Objectives(1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E).MethodsFive substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre.ResultsStudy A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledge, perceptions and intentions. Study B – risk estimation models for cardiovascular and psychosocial comorbidities of obesity require further development. An online consultation tool for primary care practitioners is acceptable and feasible. Study C – the Healthy Eating and Lifestyle Programme, when delivered in the community by graduate mental health workers, showed no significant effect on body mass index at 6 months (primary outcome) when compared with enhanced usual care. Study D – anti-obesity drugs appear efficacious in meta-analysis, and their use has expanded rapidly in the last decade. However, the majority of prescriptions are rapidly discontinued after 1–3 months of treatment. Few young people described positive experiences of anti-obesity drugs. Prescribing was rarely compliant with the National Institute for Health and Care Excellence guidance. Study E – bariatric surgery appears safe, effective and highly cost-effective in adolescents in the NHS.Future work and limitationsWork is needed to evaluate behaviour and body mass index change in the National Childhood Measurement Programme more accurately and improve primary care professionals’ understanding of the National Childhood Measurement Programme feedback, update and further evaluate the Computer-Assisted Treatment of CHildren (CATCH) tool, investigate delivery of weight management interventions to young people from deprived backgrounds and those with significant psychological distress and obtain longer-term data on anti-obesity drug use and bariatric surgery outcomes in adolescence.Trial registrationCurrent Controlled Trials ISRCTN99840111.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Russell M Viner
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Sanjay Kinra
- Department of Genetics and Adolescent Paediatrics, London School of Hygiene & Tropical Medicine, London, UK
| | - Deborah Christie
- Department of Behavioural Science and Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim J Cole
- Department of Infection, Immunology and Inflamation, Institute of Child Health, University College London, London, UK
| | - Silvia Costa
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Helen Croker
- The Obesity and Policy Research Unit, Institute of Child Health, University College London, London, UK
| | - Tam Fry
- Child Growth Foundation, Edgware, UK
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Lee Hudson
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anthony S Kessel
- Director of Global Public Health, Public Health England, London, UK
| | - Steve Morris
- Centre of Applied Health Research, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Science, University College London, London, UK
| | - Dasha Nicholls
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Min Hae Park
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sonia Saxena
- Faculty of Medicine, Imperial College London, London, UK
| | - Barry Taylor
- Paediatrics and Child Health, The Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Billy White
- Department for Children’s and Young People’s Diabetes, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian C Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, University College London, London, UK
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Broder-Fingert S, Kuhn J, Sheldrick RC, Chu A, Fortuna L, Jordan M, Rubin D, Feinberg E. Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol. Trials 2019; 20:728. [PMID: 31842963 PMCID: PMC6915979 DOI: 10.1186/s13063-019-3853-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background Delivery of behavioral interventions is complex, as the majority of interventions consist of multiple components used either simultaneously, sequentially, or both. The importance of clearly delineating delivery strategies within these complex interventions—and furthermore understanding the impact of each strategy on effectiveness—has recently emerged as an important facet of intervention research. Yet, few methodologies exist to prospectively test the effectiveness of delivery strategies and how they impact implementation. In the current paper, we describe a study protocol for a large randomized controlled trial in which we will use the Multiphase Optimization Strategy (MOST), a novel framework developed to optimize interventions, i.e., to test the effectiveness of intervention delivery strategies using a factorial design. We apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation. Methods/design The MOST framework contains three distinct phases: Preparation, Optimization, and Evaluation. The Preparation phase for this study occurred previously. The current study consists of the Optimization and Evaluation phases. Children aged 3-to-12 years old who are detected as “at-risk” for behavioral health disorders (n = 304) at a large, urban federally qualified community health center will be referred to a Family Partner—a bicultural, bilingual member of the community with training in behavioral health and systems navigation—who will perform FN. Families will then be randomized to one of 16 possible combinations of FN delivery strategies (2 × 2 × 2× 2 factorial design). The primary outcome measure will be achieving a family-centered goal related to behavioral health services within 90 days of randomization. Implementation data on the fidelity, acceptability, feasibility, and cost of each strategy will also be collected. Results from the primary and secondary outcomes will be reviewed by our team of stakeholders to optimize FN delivery for implementation and dissemination based on effectiveness, efficiency, and cost. Discussion In this protocol paper, we describe how the MOST framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation. Trial registration ClinicalTrials.gov, NCT03569449. Registered on 26 June 2018.
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Affiliation(s)
- Sarabeth Broder-Fingert
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA. .,Boston University School of Medicine, Boston, MA, USA.
| | - Jocelyn Kuhn
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA
| | | | - Andrea Chu
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Lisa Fortuna
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Medicine, Boston, MA, USA
| | | | - Dana Rubin
- Boston University School of Medicine, Boston, MA, USA.,DotHouse Health Center, Dorchester, MA, USA
| | - Emily Feinberg
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Medicine, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA.,DotHouse Health Center, Dorchester, MA, USA
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11
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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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12
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Gagneur A, Gosselin V, Bergeron J, Farrands A, Baron G. Development of motivational interviewing skills in immunization (MISI): a questionnaire to assess MI learning, knowledge and skills for vaccination promotion. Hum Vaccin Immunother 2019; 15:2446-2452. [PMID: 30829114 DOI: 10.1080/21645515.2019.1586030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: Vaccine hesitancy is a complex problem. We previously demonstrated that motivational interviewing (MI) could be helpful to enhance parents' motivation to vaccinate their child. The aim of this study is to develop a new, simple and robust evaluation tool that is suitable for evaluating MI learning of vaccination health professionals. Methods: We designed the Motivational Interviewing Skills in Immunization (MISI), a short written questionnaire to evaluate the MI knowledge and skills of participants in an immunization context. It covers three key areas: knowledge of MI, ability to apply MI-related skills, participant self-confidence in using MI. Questionnaire content and face validity were assessed by MI experts and internal consistency, reliability and effect size were analyzed using a multiple pretest-posttest design. Results: Psychometric measures showed good to excellent internal consistency of the questionnaire for all three areas (Cronbach's and KR coefficient: 0.70 to 0.88). Test-retest reliability showed good measurement stability (ICC: 0.53). Good sensitivity to change was also obtained (Cohen's d: 0.80 to 1.66). Conclusion: The MISI questionnaire is the first paper/pencil evaluation method to assess MI training specific to immunization. Psychometric measures showed high reliability. Practice implications: This questionnaire could provide a convenient and inexpensive method to evaluate knowledge and competencies following immunization-specific MI training.
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Affiliation(s)
- Arnaud Gagneur
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke , Quebec , Canada.,Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Virginie Gosselin
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Julie Bergeron
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada.,Department of Research in Health Sciences, Université de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Anne Farrands
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Geneviève Baron
- Eastern Townships Public Health Department , Sherbrooke , Quebec , Canada.,Department of Community Health Sciences, Faculty of Medecine and Health Sciences, Université de Sherbrooke , Sherbrooke , Quebec , Canada.,Centre de Recherche de l'Institut universitaire de première ligne en santé et services sociaux , Sherbrooke , Québec , Canada
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13
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Christie D, Hudson LD, Kinra S, Wong ICK, Nazareth I, Cole TJ, Sovio U, Gregson J, Kessel AS, Mathiot A, Morris S, Panca M, Costa S, Holt R, Viner RM. A community-based motivational personalised lifestyle intervention to reduce BMI in obese adolescents: results from the Healthy Eating and Lifestyle Programme (HELP) randomised controlled trial. Arch Dis Child 2017; 102:695-701. [PMID: 28687677 PMCID: PMC5537518 DOI: 10.1136/archdischild-2016-311586] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Approximately 7% of children and young people aged 5-15 years in the UK have obesity at a level likely to be associated with comorbidities. The majority of multicomponent lifestyle programmes have limited applicability and generalisability for British adolescents.The Healthy Eating and Lifestyle Programme (HELP) was a specific adolescent-focused intervention, designed for obese 12 to 18-year-olds seeking help to manage their weight. Participants were randomised to the 12-session HELP intervention or standard care. The primary outcome was difference in mean body mass index (BMI) (kg/m2) between groups at week 26 adjusted for baseline BMI, age and sex. SUBJECTS 174 subjects were randomised (87 in each arm), of whom 145 (83%) provided primary outcome data at week 26. RESULTS At week 26 there were no significant effects of the intervention on BMI (mean change in BMI 0.18 kg/m2 for the intervention arm, 0.25 kg/m2 for the control arm; adjusted difference between groups: -0.11 kg/m2 (95% CI -0.62 to 0.40), p=0.7). At weeks 26 and 52 there were no significant differences between groups in any secondary outcomes. CONCLUSION At minimum this study reinforces the need for higher level, structured interventions to tackle the growing public health burden of obesity in the UK and internationally.The HELP intervention was no more effective than a single educational session for reducing BMI in a community sample of obese adolescents.Further work is needed to understand how weight management programmes can be delivered effectively to young people from diverse and deprived backgrounds in which childhood obesity is common. The study has significant implications in terms of informing public health interventions to tackle childhood obesity. TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN99840111.
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Affiliation(s)
- Deborah Christie
- University College London Hospitals and UCL Institute of Epidemiology and Health Care, London, UK
| | | | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Irwin Nazareth
- Primary Care and Population Health, UCL Institute of Epidemiology & Health, London, UK
| | - Tim J Cole
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Anne Mathiot
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK,UCL Institute of Epidemiology & Health, London, UK
| | | | - Monica Panca
- UCL Institute of Epidemiology & Health, London, UK
| | - Silvia Costa
- UCL Institute of Epidemiology & Health, London, UK
| | - Rebecca Holt
- UCL Institute of Epidemiology & Health, London, UK
| | - Russell M Viner
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
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14
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Ball GDC, Spence ND, Browne NE, O'Connor K, Srikameswaran S, Zelichowska J, Ho J, Gokiert R, Mâsse LC, Carson V, Morrison KM, Kuk JL, Holt NL, Kebbe M, Gehring ND, Cesar M, Virtanen H, Geller J. The readiness and motivation interview for families (RMI-Family) managing pediatric obesity: study protocol. BMC Health Serv Res 2017; 17:261. [PMID: 28399913 PMCID: PMC5387327 DOI: 10.1186/s12913-017-2201-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Experts recommend that clinicians assess motivational factors before initiating care for pediatric obesity. Currently, there are no well-established clinical tools available for assessing motivation in youth with obesity or their families. This represents an important gap in knowledge since motivation-related information may shed light on which patients might fail to complete treatment programs. Our study was designed to evaluate the measurement properties and utility of the Readiness and Motivational Interview for Families (RMI-Family), a structured interview that utilizes a motivational interviewing approach to (i) assess motivational factors in youth and their parents, and (ii) examine the degree to which motivation and motivation-related concordance between youth and parents are related to making changes to lifestyle habits for managing obesity in youth. METHODS From 2016 to 2020, this prospective study will include youth with obesity (body mass index [BMI] ≥97th percentile; 13-17 years old; n = 250) and their parents (n = 250). The study will be conducted at two primary-level, multidisciplinary obesity management clinics based at children's hospitals in Alberta, Canada. Participants will be recruited and enrolled after referral to these clinics, but prior to initiating clinical care. Each youth and their parent will complete the RMI-Family (~1.5 h) at baseline, and 6- and 12-months post-baseline. Individual (i.e., youth or parent) and family-level (i.e., across youth and parent) responses to interview questions will be scored, as will aspects of interview administration (e.g., fidelity to motivational interviewing tenets). The RMI-Family will also be examined for test-retest reliability. Youth data collected at each time point will include demography, anthropometry, lifestyle habits, psychosocial functioning, and health services utilization. Cross-sectional and longitudinal associations between individual and family-level interview scores on the RMI-Family and these clinical measures will be examined. DISCUSSION As a measurement tool drawing on family-centered care and motivational interviewing, the RMI-Family was designed to increase understanding of the role of motivational factors in pediatric obesity management, allowing healthcare providers and policymakers to manage pediatric obesity more effectively and efficiently. Findings will help to create an innovative, tailored model of health care delivery that uses resources judiciously and is designed to best meet families' needs.
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Affiliation(s)
- Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Nicholas D Spence
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nadia E Browne
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kathleen O'Connor
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Suja Srikameswaran
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Joanna Zelichowska
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Josephine Ho
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, Edmonton, AB, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Valerie Carson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Katherine M Morrison
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jennifer L Kuk
- Faculty of Health, School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Nicholas L Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Maryam Kebbe
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nicole D Gehring
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Melody Cesar
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Heidi Virtanen
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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15
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Vendetti JA, McRee BG, Del Boca FK. Development of the SBIRT checklist for observation in real-time (SCORe). Addiction 2017; 112 Suppl 2:34-42. [PMID: 28074570 DOI: 10.1111/add.13657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/17/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been implemented widely in medical settings, with little attention focused on how well providers adhere to evidence-based service delivery in everyday practice. The purposes of this paper were to: (1) introduce a flexible, relatively simple methodology, the SBIRT Checklist for Observation in Real-time (SCORe), to assess adherence to evidence-based practice and provide preliminary evidence supporting its criterion validity; and (2) illustrate the feasibility and potential utility of the SCORe by analyzing observations of providers within four large-scale SBIRT programs in the United States. METHODS Eighteen potential adherence judges were trained to recognize SBIRT service elements presented in realistic taped portrayals constructed to serve as criterion coding standards. Across the four SBIRT programs, 76 providers were observed performing 388 services in three types of medical settings; emergency departments (n = 10), hospital out-patient/ambulatory clinics (n = 16) and hospital in-patient settings (n = 5). RESULTS Across two exercises, trainees identified 81% of screening and 75% of brief intervention (BI) elements correctly; for the six FRAMES components (Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy), agreement ranged from 69% to 91%. Across programs, 56% of screening, 54% of brief intervention (BI) (81% of FRAMES) and 53% of referral to treatment elements were observed. Programs differed significantly in adherence [screening, P = 0.024; BI, P < 0.001; FRAMES, P < 0.001; referral to treatment (RT), P < 0.001]; medical setting differences were minimal. CONCLUSIONS The Screening, Brief Intervention and Referral to Treatment Checklist for Observation in Real-time provides a flexible method for assessing adherence to evidence-based Screening, Brief Intervention and Referral to Treatment service protocols. Preliminary evidence supports the criterion validity, feasibility and potential utility of the Screening, Brief Intervention and Referral to Treatment Checklist for Observation in Real-time protocol.
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Affiliation(s)
- Janice A Vendetti
- UConn Health, School of Medicine, Department of Community Medicine and Health Care, Farmington, CT, USA
| | - Bonnie G McRee
- UConn Health, School of Medicine, Department of Community Medicine and Health Care, Farmington, CT, USA
| | - Frances K Del Boca
- UConn Health, School of Medicine, Department of Community Medicine and Health Care, Farmington, CT, USA
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16
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Ekong G, Kavookjian J. Motivational interviewing and outcomes in adults with type 2 diabetes: A systematic review. PATIENT EDUCATION AND COUNSELING 2016; 99:944-52. [PMID: 26699083 DOI: 10.1016/j.pec.2015.11.022] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/20/2015] [Accepted: 11/21/2015] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The management of type 2 diabetes (T2D) requires complex behavior changes and treatment regimens to achieve optimal outcomes. Interventions including motivational interviewing (MI) have been explored to help patients achieve behavior change and outcomes; this study aimed to explore evidence and gaps in the literature for MI interventions and outcomes in adults with T2D. METHODS A modified Cochrane method structured the search strategy among databases including MEDLINE, CINAHL, PsycINFO, and others. Inclusion criteria included randomized controlled trials that assessed the effects of MI on behavior changeoutcomes and resultant clinical outcomes in adults with T2D. RESULTS Of the initial 159 studies identified, 14 were eligible for retention. Behavior targets in the retained studies included dietary changes, physical activity, smoking cessation, and alcohol reduction. MI had significant impact on some dietary behaviors and on weight loss. MI intervention structures were heterogeneous across studies; fidelity assessment was infrequent. CONCLUSION The effects of MI interventions on outcomes in T2D showed promising results for dietary behaviors. Clinical change outcomes from MI-based interventions were most favorable for weight management in T2D. PRACTICE IMPLICATIONS Behavior-specific MI interventions may positively influence study outcomes. Assessment of MI intervention fidelity will enhance treatment integrity and claims for validity.
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Affiliation(s)
- Gladys Ekong
- Health Outcomes Research and Policy Department, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA.
| | - Jan Kavookjian
- Health Outcomes Research and Policy Department, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
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17
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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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18
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Madson MB, Schumacher JA, Baer JS, Martino S. Motivational Interviewing for Substance Use: Mapping Out the Next Generation of Research. J Subst Abuse Treat 2016; 65:1-5. [PMID: 26971078 DOI: 10.1016/j.jsat.2016.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - John S Baer
- University of Washington, VA Puget Sound Health Care System
| | - Steve Martino
- Yale University School of Medicine, VA Connecticut Healthcare System
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19
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Efraimsson EÖ, Klang B, Ehrenberg A, Larsson K, Fossum B, Olai L. Nurses' and patients' communication in smoking cessation at nurse-led COPD clinics in primary health care. Eur Clin Respir J 2015; 2:27915. [PMID: 26672958 PMCID: PMC4653311 DOI: 10.3402/ecrj.v2.27915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes. OBJECTIVE To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care. METHODS A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations. RESULTS Only to a small extent did nurses' evoke patients' reasons for change, stimulate collaboration, and support patients' autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients' communication was mainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation. CONCLUSION The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking. PRACTICE IMPLICATIONS To make patients more active, the nurses need more education and continuous training in motivational communication.
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Affiliation(s)
- Eva Österlund Efraimsson
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research, Dalarna, Falun, Sweden.,Dalarna County Council, Norslund Primary Health Care Centre, Falun, Sweden.,School of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - Birgitta Klang
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Red Cross University College of Nursing, Stockholm, Sweden
| | - Anna Ehrenberg
- School of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - Kjell Larsson
- National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bjöörn Fossum
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sophiahemmet University, Stockholm, Sweden
| | - Lena Olai
- Centre for Clinical Research, Dalarna, Falun, Sweden.,School of Health and Social Sciences, Dalarna University, Falun, Sweden.,Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden;
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20
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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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Klonek FE, Quera V, Kauffeld S. Coding interactions in Motivational Interviewing with computer-software: What are the advantages for process researchers? COMPUTERS IN HUMAN BEHAVIOR 2015. [DOI: 10.1016/j.chb.2014.10.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Smith JE, Gianini LM, Garner BR, Malek KL, Godley SH. A Behaviorally-Anchored Rating System to Monitor Treatment Integrity for Community Clinicians Using the Adolescent Community Reinforcement Approach. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2014; 23:185-199. [PMID: 24778544 DOI: 10.1080/1067828x.2012.729258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This study evaluated a process for training raters to reliably rate clinicians delivering the Adolescent Community Reinforcement Approach (A-CRA) in a national dissemination project. The unique A-CRA coding system uses specific behavioral anchors throughout its 73 procedure components. Five randomly-selected raters each rated "passing" and "not passing" examples of the 19 A-CRA procedures. Ninety-four percent of the final ICCs were at least 'good' (≥.60) and 66.7% were 'excellent' (≥.75), and 95% of the ratings exceeded the 60% or better agreement threshold between raters and the gold standard. Raters can be trained to provide reliable A-CRA feedback for large-scale dissemination projects.
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Affiliation(s)
- Jane Ellen Smith
- Department of Psychology, University of New Mexico, Albuquerque, NM
| | - Loren M Gianini
- Yale University School of Medicine, Psychiatry, New Haven, CT
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Ravenell J, Thompson H, Cole H, Plumhoff J, Cobb G, Afolabi L, Boutin-Foster C, Wells M, Scott M, Ogedegbe G. A novel community-based study to address disparities in hypertension and colorectal cancer: a study protocol for a randomized control trial. Trials 2013; 14:287. [PMID: 24011142 PMCID: PMC3844539 DOI: 10.1186/1745-6215-14-287] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/23/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Black men have the greatest burden of premature death and disability from hypertension (HTN) in the United States, and the highest incidence and mortality from colorectal cancer (CRC). While several clinical trials have reported beneficial effects of lifestyle changes on blood pressure (BP) reduction, and improved CRC screening with patient navigation (PN), the effectiveness of these approaches in community-based settings remains understudied, particularly among Black men. METHODS/DESIGN MISTER B is a two-parallel-arm randomized controlled trial that will compare the effect of a motivational interviewing tailored lifestyle intervention (MINT) versus a culturally targeted PN intervention on improvement of BP and CRC screening among black men aged ≥50 with uncontrolled HTN who are eligible for CRC screening. Approximately 480 self-identified black men will be randomly assigned to one of the two study conditions. This innovative research design allows each intervention to serve as the control for the other. Specifically, the MINT arm is the control condition for the PN arm, and vice-versa. This novel, simultaneous testing of two community-based interventions in a randomized fashion is an economical and yet rigorous strategy that also enhances the acceptability of the project. Participants will be recruited during scheduled screening events at barbershops in New York City. Trained research assistants will conduct the lifestyle intervention, while trained community health workers will deliver the PN intervention. The primary outcomes will be 1) within-patient change in systolic and diastolic BP from baseline to six months and 2) CRC screening rates at six months. DISCUSSION This innovative study will provide a unique opportunity to test two interventions for two health disparities simultaneously in community-based settings. Our study is one of the first to test culturally targeted patient navigation for CRC screening among black men in barbershops. Thus, our study has the potential to improve the reach of hypertension control and cancer prevention efforts within a high-risk population that is under-represented in primary care settings. TRIAL REGISTRATION ClinicalTrials.gov, NCT01092078.
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Affiliation(s)
- Joseph Ravenell
- Center for Healthful Behavior Change, New York University School of Medicine, 227 E. 30th St., 6th Floor, Room 637, New York, NY 10016, USA
| | - Hayley Thompson
- Population Studies and Disparities Research Program, Karmanos Cancer Institute Department of Oncology, Wayne State University School of Medicine, 4100 John R - MM03CB, Detroit, MI 48201, USA
| | - Helen Cole
- Center for Healthful Behavior Change, New York University School of Medicine, 227 E. 30th St., 6th Floor, Room 632C, New York, NY 10016, USA
| | - Jordan Plumhoff
- Center for Healthful Behavior Change, New York University School of Medicine, 227 E. 30th St., 6th Floor, Room 632B, New York, NY 10016, USA
| | - Gia Cobb
- Center for Healthful Behavior Change, New York University School of Medicine, 227 E. 30th St., 6th Floor, Room 632A, New York, NY 10016, USA
| | - Lola Afolabi
- Formerly with the Center for Healthful Behavior Change, 900 Lenox Rd, Apt 2B, Brooklyn, NY 11203, USA
| | | | - Martin Wells
- 301 Malott Hall, Cornell University, Ithaca, NY 14853, USA
| | - Marian Scott
- St. Luke’s and Roosevelt Hospitals, 555 W. 57th Street, Suite 5-43, New York, NY 10019, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, New York University School of Medicine, 227 E. 30th St., 6th Floor, Room 633, New York, NY 10016, USA
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Tollison SJ, Mastroleo NR, Mallett KA, Witkiewitz K, Lee CM, Ray AE, Larimer ME. The relationship between baseline drinking status, peer motivational interviewing microskills, and drinking outcomes in a brief alcohol intervention for matriculating college students: a replication. Behav Ther 2013; 44:137-51. [PMID: 23312433 PMCID: PMC3676275 DOI: 10.1016/j.beth.2012.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 09/14/2012] [Accepted: 09/14/2012] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to replicate and extend previous findings (Tollison et al., 2008) on the association between peer facilitator adherence to motivational interviewing (MI) microskills and college student drinking behavior. This study used a larger sample size, multiple follow-up time-points, and latent variable analyses allowing for more complex models to be tested in a sample with different characteristics than Tollison et al. Matriculating students who participated in high school sports (N=327) took part in a Brief Alcohol Screening and Intervention for College Students led by peer facilitators trained in motivational interviewing (MI). Participants were assessed pre- and immediately postintervention on contemplation to change, as well as pre-, 5months, and 10months postintervention on drinking quantity. Independent coders used the Motivational Interviewing Treatment Integrity scale (Moyers, Martin, Manuel, & Miller, 2003) to evaluate therapist MI adherence. Contrary to our previous study, results indicated that a higher number of open questions was positively related to increases in drinking, especially for heavier drinkers. Congruent with the previous study, more simple reflections was positively related to increases in drinking. Finally, this study revealed that heavier baseline drinking was associated with more simple reflections. There were no significant results found for changes in contemplation. Results corroborate previous findings that the excessive use of simple reflections may be indicative of countertherapeutic outcomes while raising questions about the relationship between the frequency of open questions and therapeutic outcomes.
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Measuring client perceptions of motivational interviewing: factor analysis of the Client Evaluation of Motivational Interviewing scale. J Subst Abuse Treat 2013; 44:330-5. [DOI: 10.1016/j.jsat.2012.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 07/11/2012] [Accepted: 08/08/2012] [Indexed: 11/21/2022]
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Baer JS, Carpenter KM, Beadnell B, Stoner SA, Ingalsbe MH, Hartzler B, Rosengren DB, Drager Z. Computer Assessment of Simulated Patient Interviews (CASPI): psychometric properties of a web-based system for the assessment of motivational interviewing skills. J Stud Alcohol Drugs 2012; 73:154-64. [PMID: 22152673 DOI: 10.15288/jsad.2012.73.154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Benefits of empirically supported interventions hinge on clinician skill, particularly for motivational interviewing (MI). Existing MI skill assessments are limited with respect to validity (e.g., self-report) and practicality (e.g., coding session tapes). To address these limitations, we developed and evaluated two versions of a web-based assessment of MI skills, the Computer Assessment of Simulated Patient Interviews (CASPI). METHOD Ninety-six counselors from the community and 24 members of the Motivational Interviewing Network of Trainers (MINT) completed the CASPI (N = 120), in which they verbally responded via microphones to video clips comprising three 9-item vignettes. Three coders used an emergent coding scheme, which was compared with alternative MI skills measures. RESULTS CASPI demonstrated excellent internal consistency when averaging across two or three vignettes (α's = .86-.89). Intraclass correlations were above .40 for most items. Confirmatory factor analyses supported a correlated three-factor model: MI-consistent, resistance-engendering, and global change talk orientation rating. Means and factor loadings were invariant across forms (i.e., the two alternative versions of CASPI), and factor loadings were invariant across subgroup (i.e., community counselor or MINT member). Test-retest reliability was good for MI-consistent and resistance-engendering scores (r = .74 and .80, respectively) but low for change talk orientation (r = .29) unless coder was taken into account (r = .69). CASPI showed excellent construct and criterion-related validity. CONCLUSIONS CASPI represents a promising method of assessing MI skills. Future studies are needed to establish its performance in real-world contexts.
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Affiliation(s)
- John S Baer
- Department of Psychology, University of Washington, Seattle, Washington, USA.
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Haddock G, Beardmore R, Earnshaw P, Fitzsimmons M, Nothard S, Butler R, Eisner E, Barrowclough C. Assessing fidelity to integrated motivational interviewing and CBT therapy for psychosis and substance use: the MI-CBT fidelity scale (MI-CTS). J Ment Health 2012; 21:38-48. [PMID: 22257130 DOI: 10.3109/09638237.2011.621470] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Guidelines for the psychological treatment of psychosis and substance use suggest integrated treatments to address both problems are necessary. One such treatment combines cognitive-behaviour therapy (CBT) and motivational interviewing (MI). While there are a number of scales to assess treatment fidelity to CBT and MI separately, none, to date, assess fidelity to integrated MI and CBT (MI-CBT) for psychosis and substance use. AIMS This study aimed to develop a reliable and valid scale to assess fidelity to MI-CBT for people with psychosis and problematic substance use. METHOD Items for a new scale (the MI-CTS fidelity scale) were selected from multiple relevant sources. Inter-rater reliability and validity (against the CTS-Psy and Motivational Interviewing Treatment Integrity (MITI)) scales were investigated. RESULTS The scale had good inter-rater reliability when used to rate adherence versus non-adherence. In relation to validity, the scale related well to CBT and MI scales (the CTS-Psy and MITI). CONCLUSIONS The MI-CTS is useful for assessing adherence to integrated MI-CBT for psychosis and substance misuse and could aid training and implementation of the approach.
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Affiliation(s)
- Gillian Haddock
- School of Psychological Sciences, Zochonis Building, Brunswick Street, University of Manchester, Manchester M13 9PL, UK.
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Hsieh MY, Ponsford J, Wong D, Schönberger M, Taffe J, McKay A. Motivational interviewing and cognitive behaviour therapy for anxiety following traumatic brain injury: a pilot randomised controlled trial. Neuropsychol Rehabil 2012; 22:585-608. [PMID: 22632385 DOI: 10.1080/09602011.2012.678860] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although cognitive-behavioural therapy (CBT) is the treatment of choice for anxiety, its delivery needs to be adapted for individuals with traumatic brain injury (TBI). It also requires clients' active engagement for maximum benefit. This study was a pilot randomised controlled trial involving an anxiety treatment programme adapted for people with TBI, based on CBT and motivational interviewing (MI). Twenty-seven participants with moderate/severe TBI (aged 21-73 years, 78% males) recruited from a brain injury rehabilitation hospital were randomly allocated to receive MI + CBT (n = 9), non-directive counselling (NDC) + CBT (n = 10) and treatment-as-usual (TAU) (n = 8). CBT and MI were manualised and delivered in 12 weekly individual sessions. Primary outcome was self-reported anxiety symptoms assessed at baseline, at the end of NDC/MI and immediately following CBT. Assessment was conducted by assessors blinded to group assignment. Intention-to-treat analyses showed that the two active treatment groups demonstrated significantly greater anxiety reduction than TAU. Participants receiving MI showed greater response to CBT, in terms of reduction in anxiety, stress and non-productive coping, compared to participants who received NDC. The results provided preliminary support for the adapted CBT programme, and the potential utility of MI as treatment prelude. Longer follow-up data are required to evaluate the maintenance of treatment effects.
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Affiliation(s)
- Ming-Yun Hsieh
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
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Broekhuizen K, Jelsma JGM, van Poppel MNM, Koppes LLJ, Brug J, van Mechelen W. Is the process of delivery of an individually tailored lifestyle intervention associated with improvements in LDL cholesterol and multiple lifestyle behaviours in people with familial hypercholesterolemia? BMC Public Health 2012; 12:348. [PMID: 22583789 PMCID: PMC3487747 DOI: 10.1186/1471-2458-12-348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 05/04/2012] [Indexed: 11/26/2022] Open
Abstract
Background More insight in the association between reach, dose and fidelity of intervention components and effects is needed. In the current study, we aimed to evaluate reach, dose and fidelity of an individually tailored lifestyle intervention in people with Familial Hypercholesterolemia (FH) and the association between intervention dose and changes in LDL-Cholesterol (LDL-C), and multiple lifestyle behaviours at 12-months follow-up. Methods Participants (n = 181) randomly allocated to the intervention group received the PRO-FIT intervention consisting of computer-tailored lifestyle advice (PRO-FIT*advice) and counselling (face-to-face and telephone booster calls) using Motivational Interviewing (MI). According to a process evaluation plan, intervention reach, dose delivered and received, and MI fidelity were assessed using the recruitment database, website/counselling logs and the Motivational Interviewing Treatment Integrity (MITI 3.1.1.) code. Regression analyses were conducted to explore differences between participant and non-participant characteristics, and the association between intervention dose and change in LDL-C, and multiple lifestyle behaviours. Results A 34% (n = 181) representative proportion of the intended intervention group was reached during the recruitment phase; participants did not differ from non-participants (n = 623) on age, gender and LDL-C levels. Of the participants, 95% received a PRO-FIT*advice log on account, of which 49% actually logged on and completed at least one advice module. Nearly all participants received a face-to-face counselling session and on average, 4.2 telephone booster calls were delivered. None of the face-to-face sessions were implemented according to MI guidelines. Overall, weak non-significant positive associations were found between intervention dose and LDL-C and lifestyle behaviours. Conclusions Implementation of the PRO-FIT intervention in practice appears feasible, particularly PRO-FIT*advice, since it can be relative easily implemented with a high dose delivered. However, only less than half of the intervention group received the complete intervention-package as intended. Strategies to let participants optimally engage in using web-based computer-tailored interventions like PRO-FIT*advice are needed. Further, more emphasis should be put on more extensive MI training and monitoring/supervision. Trial registration NTR1899 at ww.trialregister.nl.
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Affiliation(s)
- Karen Broekhuizen
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
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Therapist competence and treatment adherence for a brief intervention addressing alcohol and violence among adolescents. J Subst Abuse Treat 2011; 42:429-37. [PMID: 22119182 DOI: 10.1016/j.jsat.2011.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 08/24/2011] [Accepted: 09/15/2011] [Indexed: 11/23/2022]
Abstract
This study examines therapist competency and treatment adherence for a brief intervention addressing alcohol misuse and violent behaviors among adolescents aged 14-18 years. Three observational measures of fidelity were used by independent raters to evaluate 60 therapist-delivered sessions (M = 32.5 minutes). Individual items from the Content Adherence scale, the Global Rating of Competence (Global Rating of Motivational Interviewing Therapist [GROMIT]), and the Self Exploration and Change Talk (SECT) demonstrated fair to excellent interrater reliability (intraclass correlations ranged from .40 to 1.0). Principal components analysis was used to identify the underlying factor structure of the Content Adherence and the GROMIT. Parallel analysis suggested the extraction of three components for the Content Adherence reflecting the three distinct goals for each segment of the intervention. Two components were identified for the GROMIT representing the general spirit of motivational interviewing and empowerment. Findings provide support for the fidelity instruments adapted for this study and offer direction for future training and clinical supervision.
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Saarnio P. Therapist's preference on motivational interviewing and its relationship to interpersonal functioning and personality traits. COUNSELLING PSYCHOLOGY QUARTERLY 2011. [DOI: 10.1080/09515070.2011.618258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Söderlund LL, Madson MB, Rubak S, Nilsen P. A systematic review of motivational interviewing training for general health care practitioners. PATIENT EDUCATION AND COUNSELING 2011; 84:16-26. [PMID: 20667432 DOI: 10.1016/j.pec.2010.06.025] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 05/18/2010] [Accepted: 06/20/2010] [Indexed: 05/14/2023]
Abstract
OBJECTIVE This article systematically reviews empirical studies that have evaluated different aspects of motivational interviewing (MI) training for general health care professionals. METHODS Studies were obtained from several databases. To be included, the MI training had to be provided specifically for general health care practitioners for use in their regular face-to-face counselling. The training outcomes had to be linked to the MI training. RESULTS Ten studies were found. The median length of the training was 9h. The most commonly addressed training elements were basic MI skills, the MI spirit, recognizing and reinforcing change talk, and rolling with resistance. Most studies involved follow-up training sessions. The study quality varied considerably. Five studies assessed training outcomes at a single point in time, which yields low internal validity. Four studies used random assignment of practitioners to the MI training and comparison conditions. The training generated positive outcomes overall and had a significant effect on many aspects of the participants' daily practice, but the results must be interpreted with caution due to the inconsistent study quality. CONCLUSIONS The generally favourable training outcomes suggest that MI can be used to improve client communication and counselling concerning lifestyle-related issues in general health care. However, the results must be interpreted with caution due to inconsistent methodological quality of the studies. PRACTICE IMPLICATIONS This review suggests that MI training outcomes are generally favourable, but more high-quality research is needed to help identify the best practices for training in MI.
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Osborn CJ. Bilingual Therapeutics: Integrating the Complementary Perspectives and Practices of Motivational Interviewing and Dialectical Behavior Therapy. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2011. [DOI: 10.1007/s10879-010-9162-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Strayer SM, Martindale JR, Pelletier SL, Rais S, Powell J, Schorling JB. Development and evaluation of an instrument for assessing brief behavioral change interventions. PATIENT EDUCATION AND COUNSELING 2011; 83:99-105. [PMID: 20547030 DOI: 10.1016/j.pec.2010.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 03/03/2010] [Accepted: 04/07/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To develop an observational coding instrument for evaluating the fidelity and quality of brief behavioral change interventions based on the behavioral theories of the 5 A's, Stages of Change and Motivational Interviewing. METHODS Content and face validity were assessed prior to an intervention where psychometric properties were evaluated with a prospective cohort of 116 medical students. Properties assessed included the inter-rater reliability of the instrument, internal consistency of the full scale and sub-scales and descriptive statistics of the instrument. Construct validity was assessed based on student's scores. RESULTS Inter-rater reliability for the instrument was 0.82 (intraclass correlation). Internal consistency for the full scale was 0.70 (KR20). Internal consistencies for the sub-scales were as follows: MI intervention component (KR20=.7); stage-appropriate MI-based intervention (KR20=.55); MI spirit (KR20=.5); appropriate assessment (KR20=.45) and appropriate assisting (KR20=.56). CONCLUSIONS The instrument demonstrated good inter-rater reliability and moderate overall internal consistency when used to assess performing brief behavioral change interventions by medical students. PRACTICE IMPLICATIONS This practical instrument can be used with minimal training and demonstrates promising psychometric properties when evaluated with medical students counseling standardized patients. Further testing is required to evaluate its usefulness in clinical settings.
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Affiliation(s)
- Scott M Strayer
- University of Virginia, Department of Family Medicine, Charlottesville, VA 22908, USA.
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Mastroleo NR, Turrisi R, Carney JV, Ray AE, Larimer ME. Examination of posttraining supervision of peer counselors in a motivational enhancement intervention to reduce drinking in a sample of heavy-drinking college students. J Subst Abuse Treat 2010; 39:289-97. [PMID: 20673621 DOI: 10.1016/j.jsat.2010.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 06/09/2010] [Accepted: 06/14/2010] [Indexed: 11/28/2022]
Abstract
Importance of peer counselor posttraining supervision on motivational interviewing (MI) microskills and postintervention drinking outcomes were evaluated in a sample of heavy-drinking undergraduate students completing Brief Alcohol Screening and Intervention for College Students (BASICS; L.A. Dimeff, J.S. Baer, D.R. Kivlahan, & G.A. Marlatt, 1999). Two peer counselor groups were trained using identical protocols. Posttraining, one group was randomized to receive supervision, whereas the other received no supervision. Groups were subsequently compared on MI microskills. College students (n = 122) were randomly assigned to either assessment-only control, supervision, or no supervision groups and completed a BASICS intervention. Postintervention drinking outcomes were examined. Results suggested supervision aided peer counselors in reducing use of closed-ended questions. Both treatment groups reduced total drinks per week and heavy-drinking behaviors compared to control. No differences on peak blood alcohol concentration (BAC) or alcohol-related consequences were observed. Differences in supervision did not influence drinking outcomes; however, posttraining supervision for peer counselors deficient in MI microskills may be needed to improve BASICS fidelity.
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Affiliation(s)
- Nadine R Mastroleo
- Department of Counselor Education, The Pennsylvania State University, Counseling Psychology, and Rehabilitation Services, University Park, PA 16802, USA.
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Deconstructing proficiency in motivational interviewing: mechanics of skilful practitioner delivery during brief simulated encounters. Behav Cogn Psychother 2010; 38:611-28. [PMID: 20615272 DOI: 10.1017/s1352465810000329] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Proficient delivery of motivational interviewing (MI) is often determined by global rating of relational elements or cumulative tallies of technical elements. Yet limited empirical evidence exists to clarify how relational and technical elements are associated, or if rates of skill indices and their constituent technical elements vary within a clinical encounter. AIMS This study sought to document temporal variance in rates of MI skill indices and their constituent technical elements during brief clinical encounters with a standardized patient wherein delivery was "MI-proficient", and to distinguish those temporal patterns from those observed in encounters with "MI-inconsistent" delivery. METHOD Data were accessed from a large MI training trial wherein relational and technical elements of MI delivery were scored for 503 recordings of a simulated 20-minute clinical encounter. Notably, independent raters tallied technical elements in 5-minute segments, allowing evaluation of potential variance among the encounter's quartile intervals. Global ratings of MI spirit identified subsets of recordings with MI-proficient (n = 49) and MI-inconsistent (n = 43) delivery for stratified analyses. RESULTS Analyses contrast temporal trajectories of technical aspects of MI-proficient and MI-inconsistent delivery, with the former characterized by: 1) elicitation and reflective listening as primary opening strategies; 2) increased depth of reflective listening as a predominant strategy in subsequent, focused therapeutic discussion; and 3) increased use of elicitation and information provision in change planning as the encounter approached conclusion. CONCLUSIONS Findings are generally consistent with seminal descriptions of MI (Miller and Rollnick, 1991, 2002), and document temporal aspects of skilful MI delivery in brief encounters.
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Forsberg L, Forsberg LG, Lindqvist H, Helgason AR. Clinician acquisition and retention of Motivational Interviewing skills: a two-and-a-half-year exploratory study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2010; 5:8. [PMID: 20465805 PMCID: PMC2890671 DOI: 10.1186/1747-597x-5-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 05/13/2010] [Indexed: 11/25/2022]
Abstract
Background Motivational interviewing (MI) is a collaborative, client-centred counselling style aimed at eliciting and strengthening clients' intrinsic motivation to change. There is strong research evidence supporting the efficacy of MI, notably in its application among alcohol and drug abuse populations. MI interventions in smoking cessation may yield modest but significant increases in quitting. The present study sought to assess the acquisition and retention of MI skills in counsellors at the Swedish National Tobacco Quitline. Methods Three audio-recorded sessions from each of three counsellors were assessed using the Motivational Interviewing Treatment Integrity (MITI) Code Version 3.0 over 11 assessment periods at fixed intervals in a two-and-a-half year period during which counsellors received ongoing supervision. Results The mean skill for all counsellors improved throughout the study period in most MITI variables. However, great variations in MI skill between counsellors were observed, as well as fluctuations in performance in counsellors over time. Conclusion The present exploratory study covers a longer time period than most evaluations of MI training, and has several advantages with regard to study design. It may provide a basis for (larger sample) replication to test MI skill (as measured by the MITI) in relation to behaviour change in clients, to evaluate MI training, and to assess the acquisition and retention of MI skill over time. Difficulties in acquiring and retaining MI skill may raise the issue of a selection policy for MI training. Moreover, fluctuations in MI skill over time emphasise the greater importance of continuous feedback and supervision over initial MI training, and the need for the use of validated treatment integrity assessment instruments in ordinary clinical implementations of MI.
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Affiliation(s)
- Lisa Forsberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
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Mastroleo NR, Mallett KA, Turrisi R, Ray AE. Psychometric properties of the Peer Proficiency Assessment (PEPA): a tool for evaluation of undergraduate peer counselors' motivational interviewing fidelity. Addict Behav 2009; 34:717-22. [PMID: 19435653 PMCID: PMC2697274 DOI: 10.1016/j.addbeh.2009.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 03/18/2009] [Accepted: 04/16/2009] [Indexed: 11/18/2022]
Abstract
Despite the expanding use of undergraduate student peer counseling interventions aimed at reducing college student drinking, few programs evaluate peer counselors' competency to conduct these interventions. The present research describes the development and psychometric assessments of the Peer Proficiency Assessment (PEPA), a new tool for examining Motivational Interviewing adherence in undergraduate student peer delivered interventions. Twenty peer delivered sessions were evaluated by master and undergraduate student coders using a cross-validation design to examine peer based alcohol intervention sessions. Assessments revealed high inter-rater reliability between student and master coders and good correlations between previously established fidelity tools. Findings lend support for the use of the PEPA to examine peer counselor competency. The PEPA, training for use, inter-rater reliability information, construct and predictive validity, and tool usefulness are described.
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Affiliation(s)
- Nadine R Mastroleo
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912, United States.
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Drymalski WM, Campbell TC. A review of Motivational Interviewing to enhance adherence to antipsychotic medication in patients with schizophrenia: Evidence and recommendations. J Ment Health 2009. [DOI: 10.1080/09638230802052161] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Evaluating motivational enhancement therapy adherence and competence among Spanish-speaking therapists. Drug Alcohol Depend 2009; 103:44-51. [PMID: 19394164 PMCID: PMC2692434 DOI: 10.1016/j.drugalcdep.2009.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 03/09/2009] [Accepted: 03/12/2009] [Indexed: 11/21/2022]
Abstract
Despite the fact that the number of Hispanic individuals in need of treatment for substance use problems is increasing internationally, no studies have investigated the extent to which therapists can provide empirically supported treatments to Spanish-speaking clients with adequate fidelity. Twenty-three bilingual Hispanic therapists from five community outpatient treatment programs in the United States were randomly assigned to deliver either three sessions of motivational enhancement therapy (MET) or an equivalent number of drug counseling-as-usual (CAU) sessions in Spanish to 405 Spanish-speaking clients randomly assigned to these conditions. Independent ratings of 325 sessions indicated the adherence/competence rating system had good to excellent interrater reliability and indicated strong support for an a priori defined fundamental MET skill factor. Support for an advanced MET skill factor was relatively weaker. The rating scale indicated significant differences in therapists' MET adherence and competence across conditions. These findings indicate that the rating system has promise for assessing the performance of therapists who deliver MET in Spanish and suggest that bilingual Spanish-speaking therapists from the community can be trained to implement MET with adequate fidelity and skill using an intensive multisite training and supervision model.
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Donohue B, Allen DN, Romero V, Hill HH, Vasaeli K, Lapota H, Tracy K, Gorney S, Abdel-al R, Caldas D, Herdzik K, Bradshaw K, Valdez R, Van Hasselt VB. Description of a standardized treatment center that utilizes evidence-based clinic operations to facilitate implementation of an evidence-based treatment. Behav Modif 2009; 33:411-36. [PMID: 19535671 DOI: 10.1177/0145445509337369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Developers of evidence-based therapies are enhancing methods of teaching therapists to implement "best practices" with integrity. However, there is a relative dearth of information available as to clinic operations and related contextual factors necessary to sustain successful implementation of these treatments. This article describes various evidence-based administrative strategies and methods utilized by clinic staff to effectively implement a comprehensive evidence-based treatment for substance abuse (i.e., Family Behavior Therapy). The basic structure of the clinic, standardized behavioral methods associated with its day-to-day operations, and maintenance of treatment integrity are delineated. Infrastructural systems are underscored, including clinical record keeping, quality assurance, and staff management.
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Affiliation(s)
- Brad Donohue
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV, USA.
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Gaume J, Gmel G, Faouzi M, Daeppen JB. Counselor skill influences outcomes of brief motivational interventions. J Subst Abuse Treat 2009; 37:151-9. [PMID: 19339147 DOI: 10.1016/j.jsat.2008.12.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 12/04/2008] [Accepted: 12/18/2008] [Indexed: 10/20/2022]
Abstract
The aim of this study was to estimate the influence of counselor skills during brief motivational interventions (BMIs) on patient alcohol use 12 months later. Ninety-five BMIs delivered by five counselors of similar background and training were recorded and coded using the Motivational Interviewing Skills Code (MISC). Baseline alcohol measures and sociodemographics of patients did not differ across counselors, whereas MISC scores and outcome at 12 months did. Multilevel models showed that counselors with better motivational interviewing (MI) skills achieved better outcomes overall and maintained efficacy across all levels of an important predictor (patient ability to change), whereas counselors with poorer MI skills were effective mostly at high levels of ability to change. Findings indicated that avoidance of MI-inconsistent skills was more important than frequency of using MI-consistent skills and that training and selection of counselors should be based more on the overall MI-consistent gestalt than on particular MI techniques.
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Affiliation(s)
- Jacques Gaume
- Alcohol Treatment Centre, Lausanne University Hospital, Lausanne, Switzerland.
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Garner BR, Barnes B, Godley SH. MONITORING FIDELITY IN THE ADOLESCENT COMMUNITY REINFORCEMENT APPROACH (A-CRA): THE TRAINING PROCESS FOR A-CRA RATERS. ACTA ACUST UNITED AC 2009; 2:43-54. [PMID: 21533009 DOI: 10.1037/h0100373] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ensuring evidence-based treatments are delivered with a high degree of fidelity is an important aspect of transporting these practices to community-based treatment providers. Just as training is critical for clinicians who plan to deliver the Adolescent Community Reinforcement Approach (A-CRA), a process of training and vetting individuals who assess sessions for fidelity also is critical. This article describes the training process for session raters who assess fidelity of A-CRA during the clinician training and certification process. A-CRA is currently being implemented in 32 independent community-based agencies as part of a large initiative funded by the Center for Substance Abuse Treatment.
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Affiliation(s)
- Bryan R Garner
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, (309) 451-7809
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Sheidow AJ, Donohue BC, Hill HH, Henggeler SW, Ford JD. Development of an Audio-Tape Review System for Supporting Adherence to an Evidence-Based Treatment. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2008; 39:553-560. [PMID: 20333270 PMCID: PMC2843926 DOI: 10.1037/0735-7028.39.5.553] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In bridging the science to service gap, effective, yet practical, strategies are needed for supporting practitioner implementation of evidence-based treatments. The development and preliminary evaluation of an adherence monitoring system to support clinician fidelity to an evidence-based treatment for substance-abusing adolescents was tested for community-based practitioners. Session tapes were monitored for adherence to a family-based approach to CM (CM/FB) for 27 practitioners during baseline, post-workshop, and follow-up periods. Approximately half of the practitioners were randomized to receive intensive quality assurance following a CM/FB workshop as part of a larger study. Findings supported the clinical feasibility of the developed system as well as the face and content validity, reliability, and concurrent validity. Future directions are discussed in light of these results, including instructions for the use of the developed system to efficiently train clinicians to adequate fidelity.
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Wahab S, Menon U, Szalacha L. Motivational interviewing and colorectal cancer screening: a peek from the inside out. PATIENT EDUCATION AND COUNSELING 2008; 72:210-7. [PMID: 18467066 PMCID: PMC2562583 DOI: 10.1016/j.pec.2008.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 03/06/2008] [Accepted: 03/23/2008] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This article focuses on design, training, and delivery of motivational interview (MI) in a longitudinal randomized controlled trial intended to assess the efficacy of two separate interventions designed to increase colorectal screening when compared to a usual care, control group. One intervention was a single-session, telephone-based MI, created to increase colorectal cancer screening within primary care populations. The other was tailored health counseling. We present the rationale, design, and process discussions of the one-time motivational interviewing telephone intervention. We discuss in this paper the training and supervision of study interventionists, in order to enhance practice and research knowledge concerned with fidelity issues in motivational interview interventions. METHODS To improve motivational interviewing proficiency and effectiveness, we developed a prescribed training program adapting MI to a telephone counseling session. RESULTS The three interventionists trained in MI demonstrate some MI proficiency assessed by the motivational interviewing treatment integrity scale. In the post-intervention interview, 20.5% of the MI participants reported having had a CRC screening test, and another 19.75% (n=16) had scheduled a screening test. Almost half of the participants (43%) indicated that the phone conversation helped them to overcome the reasons why they had not had a screening test. CONCLUSIONS Ongoing supervision and training (post-MI workshop) are crucial to supporting MI fidelity. The trajectory of learning MI demonstrated by the interventionists is consistent with the eight stages of learning MI. The MI road map created for the interventionists has shown to be more of a distraction than a facilitator in the delivery of the telephone intervention. MI can, however, be considered a useful tool for health education and warrants further study. PRACTICE IMPLICATIONS MI training should include consistent training and process evaluation. MI can, however, be considered a useful tool for health education and warrants further study. MI can also be adapted to diverse health promotion scenarios.
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Affiliation(s)
- Stéphanie Wahab
- Portland State University, Graduate School of Social Work, Portland, OR 97207, USA.
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Madson MB, Loignon AC, Lane C. Training in motivational interviewing: a systematic review. J Subst Abuse Treat 2008; 36:101-9. [PMID: 18657936 DOI: 10.1016/j.jsat.2008.05.005] [Citation(s) in RCA: 218] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 04/10/2008] [Accepted: 05/05/2008] [Indexed: 11/16/2022]
Abstract
Motivational interviewing (MI), an evidence-based counseling approach, has received much recognition from a wide variety of health care professionals. Because of the rising interest in MI, there is increasing demand for training in this counseling approach. The MI training community has answered this call and as a result placed much emphasis on studying the MI training process. The purpose of this article is to provide a systematic review of the published research on MI training. Our goal is to provide a consolidated account of MI trainings outlining the populations receiving training, methods used, and training outcomes. We also identify which aspects of the (W. R. Miller & T. B. Moyers, 2006) eight stages of learning MI each study addressed. Recommendations for advancing the MI training research are highlighted.
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Affiliation(s)
- Michael B Madson
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406-5025, USA.
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Community program therapist adherence and competence in motivational enhancement therapy. Drug Alcohol Depend 2008; 96:37-48. [PMID: 18328638 PMCID: PMC2692429 DOI: 10.1016/j.drugalcdep.2008.01.020] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 01/23/2008] [Accepted: 01/23/2008] [Indexed: 11/27/2022]
Abstract
The extent to which clinicians in addiction treatment programs can implement empirically validated therapies with adequate fidelity that can be discriminated from standard counseling has rarely been evaluated. We evaluated the treatment adherence and competence of 35 therapists from five outpatient community programs who delivered either a three-session adaptation of motivational enhancement therapy (MET) or an equivalent number of drug counseling-as-usual sessions to 461 clients within a National Institute on Drug Abuse Clinical Trial Network multi-site effectiveness protocol. MET therapists were carefully prepared to implement MET using a combination of expert-led intensive workshop training followed by program-based clinical supervision. Independent rating of sessions demonstrated that the adherence and competence items were very reliable (mean interclass correlation coefficients for adherence=.89 and competence=.81) and converged to form two a priori defined skill factors conceptually related to motivational interviewing. Moreover, the factors discriminated between MET therapists and those who delivered drug counseling-as-usual sessions in predicted ways, and were significantly related to in-session change in client motivation and some client treatment outcomes (percent negative drug urine screens). These findings demonstrate the reliability and validity of evaluating motivational interviewing fidelity and suggest that the combination of expert-led workshops followed by program-based clinical supervision may be an effective method for disseminating motivational interviewing in community treatment programs.
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Miller WR, Sorensen JL, Selzer JA, Brigham GS. Disseminating evidence-based practices in substance abuse treatment: a review with suggestions. J Subst Abuse Treat 2006; 31:25-39. [PMID: 16814008 DOI: 10.1016/j.jsat.2006.03.005] [Citation(s) in RCA: 299] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 03/20/2006] [Accepted: 03/20/2006] [Indexed: 11/28/2022]
Abstract
Although substance abuse professionals are generally open to new and better therapeutic methods, most evidence-based treatments do not easily find their way into practice. Natural diffusion processes for innovations in substance abuse treatments are relatively informal and have yielded a widely acknowledged gap between science and community practice. This review focuses on methods for effectively disseminating new treatment methods into practice. Therapist manuals and one-time workshops are in themselves relatively ineffective in helping practitioners gain proficiency in new clinical approaches. Individual performance feedback and coaching improve the acquisition of clinical skills. Specific incentives for implementation may also be needed to encourage treatment providers, programs, and systems to adopt new approaches.
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Affiliation(s)
- William R Miller
- Department of Psychology, MSC03 2220, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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50
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Madson MB, Campbell TC. Measures of fidelity in motivational enhancement: a systematic review. J Subst Abuse Treat 2006; 31:67-73. [PMID: 16814012 DOI: 10.1016/j.jsat.2006.03.010] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 03/01/2006] [Accepted: 03/22/2006] [Indexed: 11/21/2022]
Abstract
The movement to use empirically supported treatments has increased the need for researchers and clinical supervisors to evaluate therapists' adherence to and competence in particular empirically supported interventions. Motivational interviewing (MI) is an empirically supported intervention for substance abuse and other behavioral problems. However, for this intervention to work, it must be provided with fidelity and skill. This article provides a systematic review of MI adherence and competence measures that have been developed and described independently elsewhere. Recommendations for refinement of the measures and future research are also discussed.
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Affiliation(s)
- Michael B Madson
- Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS 39406-5025, USA.
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