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Peavy KM, Klipsch A, Soma CS, Pace B, Imel ZE, Tanana MJ, Soth S, Ricardo-Bulis E, Atkins DC. Improving the quality of counseling and clinical supervision in opioid treatment programs: how can technology help? Addict Sci Clin Pract 2024; 19:8. [PMID: 38245783 PMCID: PMC10799386 DOI: 10.1186/s13722-024-00435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The opioid epidemic has resulted in expanded substance use treatment services and strained the clinical workforce serving people with opioid use disorder. Focusing on evidence-based counseling practices like motivational interviewing may be of interest to counselors and their supervisors, but time-intensive adherence tasks like recording and feedback are aspirational in busy community-based opioid treatment programs. The need to improve and systematize clinical training and supervision might be addressed by the growing field of machine learning and natural language-based technology, which can promote counseling skill via self- and supervisor-monitoring of counseling session recordings. METHODS Counselors in an opioid treatment program were provided with an opportunity to use an artificial intelligence based, HIPAA compliant recording and supervision platform (Lyssn.io) to record counseling sessions. We then conducted four focus groups-two with counselors and two with supervisors-to understand the integration of technology with practice and supervision. Questions centered on the acceptability of the clinical supervision software and its potential in an OTP setting; we conducted a thematic coding of the responses. RESULTS The clinical supervision software was experienced by counselors and clinical supervisors as beneficial to counselor training, professional development, and clinical supervision. Focus group participants reported that the clinical supervision software could help counselors learn and improve motivational interviewing skills. Counselors said that using the technology highlights the value of counseling encounters (versus paperwork). Clinical supervisors noted that the clinical supervision software could help meet national clinical supervision guidelines and local requirements. Counselors and clinical supervisors alike talked about some of the potential challenges of requiring session recording. CONCLUSIONS Implementing evidence-based counseling practices can help the population served in OTPs; another benefit of focusing on clinical skills is to emphasize and hold up counselors' roles as worthy. Machine learning technology can have a positive impact on clinical practices among counselors and clinical supervisors in opioid treatment programs, settings whose clinical workforce continues to be challenged by the opioid epidemic. Using technology to focus on clinical skill building may enhance counselors' and clinical supervisors' overall experiences in their places of work.
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Affiliation(s)
- K Michelle Peavy
- PRISM, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | | | | | - Zac E Imel
- Lyssn.Io, Seattle, Washington, USA
- University of Utah, Salt Lake City, UT, USA
| | | | - Sean Soth
- Evergreen Treatment Services, Seattle, Washington, USA
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Tafrate RC, Mitchell D, Cox SM, Hogan T. Measuring a motivational interviewing practice orientation in criminal justice practitioners: initial validation of the response style screening questionnaire. Front Psychol 2023; 14:1308086. [PMID: 38144982 PMCID: PMC10746862 DOI: 10.3389/fpsyg.2023.1308086] [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: 10/05/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction The use of collaborative communication techniques by criminal justice practitioners has been identified as a component of core correctional practices (CCPs). Criminal justice agencies and programs are investing in motivational interviewing (MI) training for their staff with varying intensity, follow-up coaching, and expectations for integration into practice. The present article describes the development and initial validation of the Response Style Screening Questionnaire (RSSQ), a practitioner completed tool assessing an MI-consistent practice orientation. Over three studies, we examined the factor structure, reliability, and correlations between the scale and self-reported and behavioral validity indicators. Method Study 1 examined the factor structure of the RSSQ with a sample of 825 criminal justice practitioners. In Study 2, data from 350 probation officers completing the RSSQ alongside measures of work-orientation and attitudes was used to conduct a confirmatory factor analysis and an initial assessment of its construct validity. In Study 3, correlations between the RSSQ and audio recorded office visits of 33 probation officers coded for MI and relationship building skills examined the scale's criterion validity. Results In Study 1, an exploratory factor analysis with an oblique rotation yielded 18 items on four factors. In Study 2, four and five factor models were tested, with the 4-factor model of Study 1 yielding the best fit. Two of the 4 factor-derived subscales reflect styles inconsistent with MI: (1) Confrontational style, and (2) Sustain Talk style; while the remaining two reflect styles consistent with MI: (3) Eliciting style, and (4) Change Talk style. Confrontational style scores were correlated with a work-orientation reflecting probation as a law enforcement endeavor, while Eliciting and Change Talk scores were correlated with a behavior change and resource broker work-orientations. In Study 3, Confrontational and Sustain Talk style scores were negatively correlated with a variety of MI skills and CCPs displayed on audio recordings, while Change Talk style scores were positively correlated with use of such skills. Discussion Overall, the findings suggest the RSSQ is a potentially useful new practitioner self-report tool for assessing an MI practice orientation.
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Affiliation(s)
- Raymond Chip Tafrate
- Department of Criminology and Criminal Justice, Central Connecticut State University, New Britain, CT, United States
| | - Damon Mitchell
- Department of Criminology and Criminal Justice, Central Connecticut State University, New Britain, CT, United States
| | - Stephen M. Cox
- Department of Criminology and Criminal Justice, Central Connecticut State University, New Britain, CT, United States
| | - Tom Hogan
- Institute for the Study of Crime and Justice, Central Connecticut State University, New Britain, CT, United States
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Gabarda A, Butterworth S, Liang Q, Beckjord E. Pilot Study of a Motivational Interviewing Training on Practitioners' Skill Set for Patient Centered Communication. Am J Health Promot 2023; 37:1070-1077. [PMID: 37494296 DOI: 10.1177/08901171231191130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
PURPOSE Increase practitioners' Motivational Interviewing (MI) skill set to develop intrinsic motivation and behavior change competencies. DESIGN Pilot comparing intervention group with waitlist-control group. SETTING Health Plan in northeast of U.S. INTERVENTION Training program including a 3 day 19 hour MI training intensive, 1.5 hour follow-up skill-building trainings, and quality assurance review using an MI assessment tool paired with strengths-based mentoring. Cohort 1 (experimental group) received the intervention for 6-months and cohort 2 for 3 months (control group). MEASURES Practitioners' MI skill set was assessed pre- and post-intervention using Motivational Interviewing Competency Assessment (MICA). Practitioners' MI knowledge and attitudes were assessed pre- and post-training using adapted Motivational Interviewing Knowledge and Attitudes Test (MIKAT). Active learning and confidence questionnaires were administered post-training. ANALYSIS A generalized linear mixed model with repeated measures to analyze difference in MICA growth rates; paired T-test for MIKAT pre/post training analysis. Descriptive statistics for active learning and confidence. RESULTS MICA scores significantly improved for both cohorts (P < .0001). Practitioners had significant increase in knowledge and attitudes for MI (P < .001) and confidence in using MI (P < .01). High levels of active learning were observed (93-100%). CONCLUSION With planning, adequate resources/support, and iterative processes for adjustment, practitioners can improve their MI skill set in a short period of time with modest investment of practitioner resources.
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Affiliation(s)
| | - Susan Butterworth
- Center for Health System Improvement, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Qingfeng Liang
- UPMC Center for High Value Health Care, Pittsburgh, PA, USA
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Hurlocker MC, Moyers TB, Hatch M, Curran G, McCrady B, Venner KL, Witkiewitz K. Effectiveness and feasibility of a motivational interviewing intake (MII) intervention for increasing client engagement in outpatient addiction treatment: an effectiveness-implementation hybrid design protocol. Addict Sci Clin Pract 2023; 18:63. [PMID: 37865777 PMCID: PMC10589931 DOI: 10.1186/s13722-023-00412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Client discontinuation from outpatient addiction treatment programs is common, and the initial intake is the service delivery point with the highest attrition rate. Replacing the comprehensive intake assessment with a person-centered Motivational Interviewing (MI) intervention is a potential solution to address provider and client concerns about the disengaging, time-intensive nature of the typical initial intake. It remains unclear whether the use of an alternative to the standard intake at the initial visit can fit within typical organizational reporting requirements, whether it decreases attrition, and whether implementation of person-centered intake procedures within outpatient addiction treatment programs is feasible, acceptable, and can be sustained. PURPOSE To describe the methods and design of an effectiveness-implementation hybrid type 1 trial of a Motivational Interviewing at Intake (MII) intervention using the Consolidated Framework for Implementation Research (CFIR). METHODS The study will determine the effectiveness of two intake conditions: (1) standard comprehensive intake assessment (intake-as-usual [IAU]), and (2) MII consisting of a person-centered discussion between provider and client about the client's desire and intent to enter treatment. Although both interventions are focused on understanding client presenting complaints and needs for treatment, the delivery differs as the IAU uses a semi-structured assessment guide, while MII applies the theory of MI to have a conversation about treatment engagement. Adults seeking outpatient addiction treatment services will be randomly assigned to the MII condition (n = 75) or the IAU condition (n = 75). Primary outcomes will be client engagement (i.e., treatment entry, attendance, and completion) obtained from the electronic medical record. Secondary outcomes (client motivation and therapeutic alliance) will be putative mechanisms of client engagement assessed immediately before and after the intake. The trial also will explore determinants of effective, sustainable implementation using assessments of organizational readiness and capacity to change, as well as interviews on MII implementation feasibility. CONCLUSION This trial of an MII intervention will investigate the feasibility of a motivational intervention as an initial contact with substance use treatment-seeking clients as well as indicators of intervention effectiveness within the systems where it is employed. Trial registration Clinicaltrials.gov identifier: NCT05489068.
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Affiliation(s)
- Margo C Hurlocker
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA.
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, 87106, USA.
| | - Theresa B Moyers
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Melissa Hatch
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Geoffrey Curran
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
- Health Services Research and Development Service, Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Barbara McCrady
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Kamilla L Venner
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, 87106, USA
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Gette JA, Regan T, Schumacher JA. Screening, brief intervention, and referral to treatment (SBIRT) for cannabis: A scoping review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208957. [PMID: 36880902 DOI: 10.1016/j.josat.2023.208957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/04/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Screening, brief intervention, and referral to treatment (SBIRT) has been used to change substance use behavior. Despite cannabis being the most prevalent federally illicit substance, we have limited understanding of use of SBIRT for managing cannabis use. This review aimed to summarize the literature on SBIRT for cannabis use across age groups and contexts over the last two decades. METHODS This scoping review followed the a priori guide outlined by the PRISMA (Preferred Reporting Items for Scoping Reviews and Meta-Analyses) statement. We gathered articles from PsycINFO, PubMed, Sage Journals Online, ScienceDirect, and SpringerLink. RESULTS The final analysis includes forty-four articles. Results indicate inconsistent implementation of universal screens and suggest screens assessing cannabis-specific consequences and utilizing normative data may increase patient engagement. Broadly, SBIRT for cannabis demonstrates high acceptability. However, the impact of SBIRT on behavior change across various modifications to intervention content and modality has been inconsistent. In adults, patients with primary cannabis use are not engaging in recommended treatment at similar rates to other substances. Results also suggest a lack of research addressing referral to treatment in adolescents and emerging adults. DISCUSSION Based on this review, we offer several to improve each component of SBRIT that may increase implementation of screens, effectiveness of brief interventions, and engagement in follow-up treatment.
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Affiliation(s)
- J A Gette
- Center for Alcohol and Substance Use Studies, Rutgers, the State University of New Jersey, Piscataway, NJ, United States of America.
| | - T Regan
- Department of Psychiatry, the University of Mississippi Medical Center, Jackson, MS, United States of America
| | - J A Schumacher
- Department of Psychiatry, the University of Mississippi Medical Center, Jackson, MS, United States of America
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Schnell T, Grömm CM, Klöckner N. Predictive impact of different acute cannabis intoxication effects with regard to abstinence motivation and cessation of use. Sci Rep 2023; 13:709. [PMID: 36639397 PMCID: PMC9839715 DOI: 10.1038/s41598-023-27592-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
Cannabis use is a common risk factor for psychoses. But although prevalence of consumption as well as potency of cannabis increased, the incidence of schizophrenia remained stable. The discontinuation hypothesis suggests that a potential increase of psychoses incidence may be relativized by more frequent cessation of consumption due to higher rates of adverse psychosis-like intoxication effects (PLE), caused by stronger cannabis. A mixed methods online survey was administered to 441 current and past users to analyze the predictive impact of different acute intoxication effects regarding abstinence motivation/cessation of use. Our hypothesis was that PLE would be experienced as the most aversive intoxication effect and therefore have the highest predictive significance. Possible confounds were included (craving, patterns of consumption and sociodemographics). Further analyzes compared past versus current users regarding the quality of intoxication effects, suggesting that past users retrospectively experienced more unpleasant experiences than current users. Free-text data explored subjective reasons for abstinence. We found that paranoid/dysphoric intoxication effects were most predictive for abstinence motivation. Less predictive were psychosis-like intoxication effects such as hallucinations. Group comparisons revealed significant more unpleasurable and less positive intoxication effects in past users compared with current users. Current users with the intention to stop consumption showed significantly more paranoia/dysphoria intoxication compared to users with no intention to stop use. As a conclusion, different intoxication experiences have different effects on abstinence motivation and substance use behavior. They therefore provide a focus that should be increasingly integrated into treatment concepts.
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Affiliation(s)
- Thomas Schnell
- Medical School Hamburg, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Christina-Marie Grömm
- Medical School Hamburg, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - Nils Klöckner
- Medical School Hamburg, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
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7
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Westra HA. The implications of the Dodo bird verdict for training in psychotherapy: prioritizing process observation. Psychother Res 2022; 33:527-529. [PMID: 36525623 DOI: 10.1080/10503307.2022.2141588] [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: 12/23/2022] Open
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Implementation of motivational interviewing in the general practice setting: a qualitative study. BMC PRIMARY CARE 2022; 23:21. [PMID: 35172737 PMCID: PMC8800318 DOI: 10.1186/s12875-022-01623-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022]
Abstract
Background General Practitioners (GPs) and Practice Nurses (PNs) collaboratively play an important role in preventing and monitoring chronic diseases. They are trained in Motivational Interviewing (MI), which is a communication style to intrinsically motivate patients to a healthier lifestyle. However, being trained in MI skills does not necessarily mean that it is implemented in daily practice so patients actually benefit. The aim of this study is to identify factors that facilitate or impede the implementation of MI in General Practice. Methods A total of 152 participants (93 GP-trainees and 59 PN-trainees) who were trained in MI completed a questionnaire regarding the implementation of MI. Semi-structured interviews (N = 17) were conducted with GPs and PNs (ranging from almost graduated to highly experienced) who were selected through the process of maximum variation sampling. The interview guide was based on the five-stage implementation model of Grol and Wensing. Results Thirteen factors that influence the implementation of MI in General Practice were identified. They can be allocated to three categories: (1) setting factors such as time, (2) GP/PN factors such as self-efficacy, and (3) patient factors such as cultural background. Conclusions Overall, GPs and PNs considered MI to be useful and part of their professional responsibility. Most difficulties become apparent in stage 4 (change: applying MI skills in practice) and 5 (consolidation: integrating MI into daily routine and embedment in organisation) of Grol and Wensing’s model. Therefore, it is important that training does not only focus on MI skills. It is essential to pay explicit attention to the factors that impact implementation, as well as the appropriate tools to tackle the barriers. These insights can help trainers to effectively support GPs and PNs to apply and maintain their MI skills in daily practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01623-z.
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McAfee NW, Schumacher JA, Madson MB, Villarosa-Hurlocker MC, Williams DC. The Status of SBIRT Training in Health Professions Education: A Cross-Discipline Review and Evaluation of SBIRT Curricula and Educational Research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1236-1246. [PMID: 35320126 DOI: 10.1097/acm.0000000000004674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To assess the quality of curricular research on the Screening Brief Intervention and Referral to Treatment (SBIRT) approach and determine the presence of useful training modalities, particularly motivational interviewing (MI) training, across health care training curricula. METHOD The authors conducted a systematic review of published, peer-reviewed studies in PubMed, ERIC, CINAHL, Ovid HealthSTAR, and PsycINFO databases through March 2021 for English-language studies describing SBIRT, a curriculum for health care trainees, and curricular intervention outcomes. After the records were independently assessed, data were extracted and 20% of the studies were double-coded for interrater reliability. RESULTS Of 1,856 studies, 95 were included in the review; 22 had overlapping samples and were consolidated into 10 nested studies, leaving 83 total. Interrater reliability ranged from moderate (κ = .74, P < .001) to strong (κ = .91, P < .001) agreement. SBIRT training was delivered to trainees across many professions, including nursing (n = 34, 41%), medical residency (n = 28, 34%), and social work (n = 24, 29%). Nearly every study described SBIRT training methods (n = 80, 96%), and most reported training in MI (n = 54, 65%). On average, studies reported 4.06 (SD = 1.64) different SBIRT training methods and 3.31 (SD = 1.59) MI training methods. Their mean design score was 1.92 (SD = 0.84) and mean measurement score was 1.89 (SD = 1.05). A minority of studies measured SBIRT/MI skill (n = 23, 28%), and 4 studies (5%) set a priori benchmarks for their curricula. CONCLUSIONS SBIRT training has been delivered to a wide range of health care trainees and often includes MI. Rigor scores for the studies were generally low due to limited research designs and infrequent use of objective skill measurement. Future work should include predefined training benchmarks and validated skills measurement.
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Affiliation(s)
- Nicholas W McAfee
- N.W. McAfee is assistant professor, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi; ORCID: 0000-0002-7992-9124
| | - Julie A Schumacher
- J.A. Schumacher is professor, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael B Madson
- M.B. Madson is professor, School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi; ORCID: 0000-0002-2025-8856
| | - Margo C Villarosa-Hurlocker
- M.C. Villarosa-Hurlocker is assistant professor, Department of Psychology, University of New Mexico, Albuquerque, New Mexico; ORCID: 0000-0002-9744-8551
| | - Daniel C Williams
- D.C. Williams is associate professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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Beckman M, Alfonsson S, Rosendahl I, Berman AH, Lindqvist H. A Behavior-based Coding Tool for Assessing Supervisors' Adherence and Competence: Findings From a Motivational Interviewing Implementation Study. Clin Psychol Psychother 2022; 29:1942-1949. [PMID: 35727807 DOI: 10.1002/cpp.2763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/11/2022]
Abstract
Supervision seems to be an essential part of therapist training, and thus also of implementing evidence-based practices. However, there is a shortage of valid and reliable instruments for objective assessment of supervision competence that include both global measures and frequency counts of behavior - two essential aspects of supervisory competence. This study tests the internal consistency and inter-rater reliability of an assessment tool that includes both these measures. Additionally, strategies and techniques used by ten supervisors in 35 Motivational interviewing supervision sessions are described. Codings were conducted after two separate coding training sessions. The internal consistency across the global measures was acceptable (α = 0.70; 0.71). After the second training, the inter-rater reliabilities for all frequency counts were in the moderate to good range, except for two that were in the poor range; inter-rater reliability for one of the four global measures was in the moderate range, and three were in the poor range. A prerequisite for identifying specific supervisor skills central to the development of therapist skills, teaching these skills to supervisors, and performing quality assurance of supervision, is to create instruments that can measure these behaviors. This study is a step in that direction.
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Affiliation(s)
- Maria Beckman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Sven Alfonsson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Ingvar Rosendahl
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Anne H Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden.,Department of Psychology, Clinical Psychology, Uppsala University, Sweden
| | - Helena Lindqvist
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
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Tse N, Tse S, Wong P, Adams P. Collective Motivational Interviewing for Substance Use Problems: Concept and Implications. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00736-3] [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: 11/28/2022] Open
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Sharp A, Brown B, Shreve T, Moore K, Carlson M, Braughton D. Direct-Care Staff Perceptions of Patient Engagement and Treatment Planning in Detox. J Behav Health Serv Res 2021; 48:566-582. [PMID: 34590236 DOI: 10.1007/s11414-021-09757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
As the prevalence of substance use disorders and drug-related deaths continue to rise, addiction treatment facilities are charged with providing effective and efficient services to curb the national substance use crisis. Direct-care staff in treatment service facilities play a crucial role in whether or not evidence-based practices are incorporated. Without their understanding and utilization of patient engagement best practices, an organization risks maintaining the status quo rather than actively pursuing improved outcomes through empirically supported approaches. Through in-depth interviews (N=13) with nurses, counselors, and behavioral health technicians in an inpatient detoxification facility, this study evaluates the perspectives and experiences of direct-care staff through a lens of patient engagement in treatment planning. The findings from these interviews elucidate how participants' personal characteristics and values, perspectives of patient engagement, understanding of treatment planning, and organizational culture and operations facilitate or inhibit the integration of patient engagement for treatment planning in detox.
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Affiliation(s)
- Amanda Sharp
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Down Blvd., Tampa, FL, 33612, USA.
| | - Bonnie Brown
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Down Blvd., Tampa, FL, 33612, USA
| | - Tayler Shreve
- Department of Justice, Law, and Criminology, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA
| | - Kathleen Moore
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Down Blvd., Tampa, FL, 33612, USA
| | - Melissa Carlson
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Down Blvd., Tampa, FL, 33612, USA
| | - David Braughton
- Agency for Community Treatment Services, Inc., 4612 N 56th St., Tampa, FL, 33610, USA
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Sharp A, Armstrong A, Moore K, Carlson M, Braughton D. Patient Perspectives on Detox: Practical and Personal Considerations through a Lens of Patient-Centered Care. Subst Use Misuse 2021; 56:1593-1606. [PMID: 34228598 DOI: 10.1080/10826084.2021.1936050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Inpatient detoxification is often required before a client can move on to additional substance abuse treatment services. Although often short-term, time spent in inpatient detoxification tends to have long-lasting effects on the recovery process. This qualitative study focuses on one treatment facility in Tampa, Florida that offers a range of recovery services, including inpatient detox and outpatient treatment. Focus groups (N = 70 participants) captured client perceptions of direct clinical care operations, access to resources, and relationships with direct care staff within the inpatient detox program. Perceptions were then assessed using a thematic analysis approach with attention to the literature on person-centered care best practices, behavior change, and patient engagement theories to better understand how facility practices affect treatment engagement and retention. Findings elucidated several practical facilitators and barriers to recovery such as facility resources, services offered, transition to aftercare, and sustainability of treatment. Findings also illuminated several personal facilitators and barriers including patient-staff interactions, personal motivation, and family and community support. The resulting recommendations for practice and research are discussed.
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Affiliation(s)
- Amanda Sharp
- University of South Florida, Tampa, Florida, USA
| | | | | | | | - David Braughton
- Agency for Community Treatment Services, Tampa, Florida, USA
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Schumacher JA, Coffey SF, Williams DC, Madson MB, McAfee NW. Practice and Dissemination of Motivational Interviewing: A Psychology Internship Curriculum. TRAINING AND EDUCATION IN PROFESSIONAL PSYCHOLOGY 2020; 14:34-41. [PMID: 33312323 DOI: 10.1037/tep0000280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sufficient training in substance use issues has been identified as a common gap in professional psychology graduate training. Satisfactory training in evidence-based practices has also been identified as a common gap for providers who care for individuals with substance use problems. The "practice and dissemination" curriculum we developed seeks to address both of these gaps during the predoctoral internship training year by first training psychology interns to competently deliver motivational interviewing (MI) to individuals with substance use problems and then train community providers and volunteers to do so. From 2012-2013, a total of 55 community providers and volunteers from a homeless shelter, a substance use treatment facility, and a community mental health facility received training in MI through this curriculum by attending continuing education events delivered by 17 psychology interns. Evaluation of the dissemination portion of the curriculum as part of an exempt educational research project revealed that community providers were able to achieve significant increases in MI knowledge, readiness to implement MI, and MI skill as assessed with a video analogue measure by the end of the workshop. They also reported satisfaction with the workshop. These evaluation findings provide preliminary support for the curriculum as a novel and efficacious way to disseminate MI to community providers. Research is necessary to determine long-term outcomes of such training and to identify strategies to overcome potential barriers such as the substantial faculty effort necessary to implement the intensive curriculum.
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Affiliation(s)
- Julie A Schumacher
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - Scott F Coffey
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - Daniel C Williams
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | - Nicholas W McAfee
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
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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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Di Bartolomeo AA, Shukla S, Westra HA, Shekarak Ghashghaei N, Olson DA. Rolling with resistance: A client language analysis of deliberate practice in continuing education for psychotherapists. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
| | - Serena Shukla
- Department of Psychology York University Toronto ON Canada
| | | | | | - David A. Olson
- Department of Psychology York University Toronto ON Canada
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Gavarkovs AG. Behavioral Counseling Training for Primary Care Providers: Immersive Virtual Simulation as a Training Tool. Front Public Health 2019; 7:116. [PMID: 31143761 PMCID: PMC6521729 DOI: 10.3389/fpubh.2019.00116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
Behavioral counseling represents an efficacious approach for improving health behaviors on a population level, and the primary care setting is an appropriate context in which to implement this approach. However, evidence suggests that the utilization of behavioral counseling techniques in primary care, including those informed by motivational interviewing, is sub-optimal. Insufficient training has been cited as a barrier to utilizing counseling in the primary care setting. Recent work has evaluated the effectiveness of virtual simulations that can provide access to "virtual" patients while retaining the scalability inherent to a digital medium. However, these educational interventions have been limited to simulations delivered through a two-dimensional screen. More immersive simulations delivered through a head-mounted display can create a realistic practice environment that encompasses a learner's entire field of view, which may confer additional benefits with respect to training outcomes. The purpose of this short article is to briefly review the relevant literature across disciplines to conceptualize the potential effectiveness of this technology as a training tool for behavioral counseling. Immersive virtual simulations are designed to induce a psychological phenomenon referred to as presence, whereby a learner perceives themselves as existing within the virtual environment. As such, immersive virtual simulations can provide opportunities for practice, coaching, and feedback in an environment that closely approximates the clinical setting in which counseling will be delivered. Through its effects on presence, this technology may be particularly useful for developing empathy, which is an important component of counseling. Recommendations for future research are also provided.
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Affiliation(s)
- Adam G Gavarkovs
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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