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Durpoix A, Rolling J, Coutelle R, Lalanne L. Psychotherapies in opioid use disorder: toward a step-care model. J Neural Transm (Vienna) 2024; 131:437-452. [PMID: 37987829 PMCID: PMC11055728 DOI: 10.1007/s00702-023-02720-8] [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] [Received: 07/27/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
Opioid use disorder (OUD) is characterized by a lack of control in opioid use, resulting in psychological distress and deficits in interpersonal and social functioning. OUD is often associated with psychiatric comorbidities that increase the severity of the disorder. The consequences of OUD are dramatic in terms of increased morbi-mortality. Specific medications and psychotherapies are essential tools not only in the treatment of OUD but also in the prevention of suicide and overdoses. In our review, we assess the different types of psychotherapies (counseling, motivational interviewing, contingency management, cognitive-behavioral therapy, and dialectical-behavior therapy) that are delivered to opioid users, either associated or un-associated with OUD medications and/or medications for psychiatric disabilities. We describe the application of these therapies first to adult opioid users and then to adolescents. This work led us to propose a stepped-care model of psychotherapies for OUD which provided information to assist clinicians in decision-making regarding the selection of psychotherapeutic strategies according to patients' OUD severity.
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Affiliation(s)
- Amaury Durpoix
- Addictology Department, Strasbourg University Hospital, 1, place de l'Hôpital, 67091, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
| | - Julie Rolling
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, Strasbourg, France
- Regional Center for Psychotrauma Great East, Strasbourg, France
- Centre National de la Recherche Scientifique Unité Propre de Recherche 3212 (CNRS UPR 3212), Institute for Cellular and Integrative Neurosciences (INCI), Strasbourg, France
| | - Romain Coutelle
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, Strasbourg, France
- INSERM U1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, Strasbourg, France
| | - Laurence Lalanne
- Addictology Department, Strasbourg University Hospital, 1, place de l'Hôpital, 67091, Strasbourg, France.
- INSERM U1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, Strasbourg, France.
- Strasbourg University, Faculty of Medicine, Strasbourg, France.
- Fédération de Médecine translationnelle de Strasbourg, Strasbourg, France.
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Hershberger PJ, Flowers SR, Bayless SL, Conway K, Crawford TN. Interface Between Motivational Interviewing and Burnout. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:181-187. [PMID: 38495574 PMCID: PMC10941786 DOI: 10.2147/amep.s450179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/11/2024] [Indexed: 03/19/2024]
Abstract
Background The contemporary challenges of improving patient engagement in chronic disease management and addressing the growing problem of physician burnout are commonly viewed as separate issues. However, there is extensive evidence that person-centered approaches to patient engagement, such as motivational interviewing (MI), are associated both with better outcomes for patients and improved well-being for clinicians. Methods We conducted an exploratory survey study to ascertain whether resident physicians who perceive that they embrace and utilize the MI approach also report less burnout. A total of 318 residents in several specialties were invited via email to complete a 10-question survey about patient engagement and the experience of burnout. Frequencies and percentages were calculated for all categorical/ordinal variables to describe survey participants and question responses. Correlation coefficients were obtained to assess relationships between all burnout and engagement questions. Results A total of 79 residents completed the survey (response rate of 24.8%). There was broad agreement about the importance of patient engagement and the use of the MI approach, and approximately 60% of residents indicated that burnout was a problem. Two items related to residents' perceived use of MI were correlated with feeling a sense of personal accomplishment, one of the protective factors against burnout. Conclusion Consistent with other studies indicating that person-centered approaches are associated both with better patient outcomes and provider wellbeing, our data suggest that residents' self-reported use of the MI approach in patient care may be related to less burnout. It appears that training in the MI approach in graduate medical education may be simultaneously good for patient outcomes and good for resident well-being.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Stacy R Flowers
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Sharlo L Bayless
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Katharine Conway
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Hershberger PJ, Pei Y, Bricker DA, Crawford TN, Shivakumar A, Castle A, Conway K, Medaramitta R, Rechtin M, Wilson JF. Motivational interviewing skills practice enhanced with artificial intelligence: ReadMI. BMC MEDICAL EDUCATION 2024; 24:237. [PMID: 38443862 PMCID: PMC10916112 DOI: 10.1186/s12909-024-05217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Finding time in the medical curriculum to focus on motivational interviewing (MI) training is a challenge in many medical schools. We developed a software-based training tool, "Real-time Assessment of Dialogue in Motivational Interviewing" (ReadMI), that aims to advance the skill acquisition of medical students as they learn the MI approach. This human-artificial intelligence teaming may help reduce the cognitive load on a training facilitator. METHODS During their Family Medicine clerkship, 125 third-year medical students were scheduled in pairs to participate in a 90-minute MI training session, with each student doing two role-plays as the physician. Intervention group students received both facilitator feedback and ReadMI metrics after their first role-play, while control group students received only facilitator feedback. RESULTS While students in both conditions improved their MI approach from the first to the second role-play, those in the intervention condition used significantly more open-ended questions, fewer closed-ended questions, and had a higher ratio of open to closed questions. CONCLUSION MI skills practice can be gained with a relatively small investment of student time, and artificial intelligence can be utilized both for the measurement of MI skill acquisition and as an instructional aid.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
| | - Yong Pei
- Department of Computer Science, College of Computing and Software Engineering, Kennesaw State University, Kennesaw, GA, USA
| | - Dean A Bricker
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Ashutosh Shivakumar
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Angie Castle
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Katharine Conway
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Raveendra Medaramitta
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Maria Rechtin
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Josephine F Wilson
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Abstract
This review traces the development of motivational interviewing (MI) from its happenstance beginnings and the first description published in this journal in 1983, to its continuing evolution as a method that is now in widespread practice in many professions, nations and languages. The efficacy of MI has been documented in hundreds of controlled clinical trials, and extensive process research sheds light on why and how it works. Developing proficiency in MI is facilitated by feedback and coaching based on observed practice after initial training. The author reflects on parallels between MI core processes and the characteristics found in 70 years of psychotherapy research to distinguish more effective therapists. This suggests that MI offers an evidence-based therapeutic style for delivering other treatments more effectively. The most common use of MI now is indeed in combination with other treatment methods such as cognitive behaviour therapies.
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Affiliation(s)
- William R Miller
- Department of Psychology, The University of New Mexico, Albuquerque, NM, USA
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5
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Sloboda Z, Johnson KA, Fishbein DH, Brown CH, Coatsworth JD, Fixsen DL, Kandel D, Paschall MJ, Silva FS, Sumnall H, Vanyukov M. Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders Through an Integrated Dissemination and Implementation Framework. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1078-1090. [PMID: 37052866 PMCID: PMC10476513 DOI: 10.1007/s11121-023-01532-2] [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] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
Major research breakthroughs over the past 30 years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to "normalize" what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve "normalization."
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Affiliation(s)
- Zili Sloboda
- Applied Prevention Science International, Ontario, OH, USA.
| | - Kimberly A Johnson
- Department of Mental Health Law and Policy, College of Community and Behavioral Sciences, University of South Florida, Tampa, FL, USA
- International Consortium of Universities of Drug Demand Reduction, Tampa, FL, USA
| | - Diana H Fishbein
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- National Prevention Science, The Pennsylvania State University, State College, Harrisburg, PA, USA
| | | | | | - Dean L Fixsen
- Active Implementation Research Network, Inc, Chapel Hill, NC, USA
| | - Denise Kandel
- Department of Psychiatry and School of Public Health, Columbia University, New York, NY, USA
| | - Mallie J Paschall
- Prevention Research Center (PRC), Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | | | - Harry Sumnall
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Michael Vanyukov
- Departments of Pharmaceutical Sciences, Psychiatry, and Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
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Chan CA, Windish DM. A survey of motivational interviewing training experiences among internal medicine residents. PATIENT EDUCATION AND COUNSELING 2023; 112:107738. [PMID: 37028175 DOI: 10.1016/j.pec.2023.107738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/29/2023] [Accepted: 04/01/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Assess resident physicians' training experiences and self-reported application of motivational interviewing (MI) skills. METHODS A cross-sectional nationally representative survey of internal medicine and medicine/pediatric residents from October 2021 - May 2022. Residents reported their MI skill training settings: lectures, standardized patients, role plays, group exercises, direct observation of patient encounters, and a full day or more course. Respondents reported frequency of using specific MI skills in the prior six months during behavior change conversations with patients. RESULTS The response rate 71.2% (202/281). Respondents received MI training in medical school (67.7%), residency (27.2%), both (22.7%), or none (23.5%). Respondents reported MI training through formal lectures/information discussion (77.5%), MI exercises (77.5%), direct observation of a real patient encounter (38.7%), and one or more full-day workshops (8.5%). Most respondents never or only sometimes elicited change talk statements (73.2%), responded to a patient's sustain talk (64.3%), and developed discrepancies in behavior between individuals' current actions and desired behaviors (75%). CONCLUSIONS Significant training gaps exist within resident MI education, which may reduce the application of MI skills. PRACTICAL IMPLICATIONS Behavior change is crucial to many aspects of patient health outcomes. This lack of knowledge may impact future physicians' ability to comprehensively care for patients.
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Affiliation(s)
- Carolyn A Chan
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
| | - Donna M Windish
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
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Gable KN, Hunziker S. Creation of a motivational interviewing-based pharmacy communications course: From dissemination to assessment. CURRENTS IN PHARMACY TEACHING & LEARNING 2023:S1877-1297(23)00105-3. [PMID: 37246123 DOI: 10.1016/j.cptl.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND PURPOSE Pharmacists are frequently faced with evocative patient care conversations surrounding medication taking behaviors and overall health and wellness. Teaching communication is a core focus within pharmacy education; however, there is often less emphasis placed on learning motivational interviewing (MI). We will share challenges and successes associated with the creation and dissemination of a MI-based communications course with pharmacy student learners. EDUCATIONAL ACTIVITY AND SETTING A fast-paced, five-week, active learning course was created for first-year pharmacy students. Learning activities focused on exploration of ambivalence in clinical practice, roadblocks to active listening, resisting the righting reflex, the spirit of MI, and the core skills of MI. The Motivational Interviewing Competency Assessment was utilized to assess student MI competency at the completion of the course. FINDINGS This MI-based course has been well-received by pharmacy student learners. It serves as a foundation for communication skills development, as students continue the practice and grow these skills throughout the curriculum. Communication skills assessment and feedback are an integral aspect of MI learning; however, this process does increase the workload of course instructors. A limitation to the global creation of a MI-based course is the reduced number of pharmacy educators who are proficient in training MI. SUMMARY As the practice of pharmacy and patient care continues to evolve, effective communication skills that include MI, are essential to the provision of person-centered, empathic patient care.
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Affiliation(s)
- Kelly N Gable
- Professor and Director of Well-being and Resilience, SIUE School of Pharmacy, 200 University Park Drive, Edwardsville, IL 62025, United States.
| | - Stephanie Hunziker
- Clinical Assistant Professor and Director of Skills and Simulation, SIUE School of Pharmacy, 200 University Park Drive, Edwardsville, IL 62025, United States.
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Hart MJ, McQuillin SD, Iachini A, Weist MD, Hills KJ, Cooper DK. Expanding School-Based Motivational Interviewing Through Delivery by Paraprofessional Providers: A Preliminary Scoping Review. SCHOOL MENTAL HEALTH 2023; 15:1-19. [PMID: 37359157 PMCID: PMC10039438 DOI: 10.1007/s12310-023-09580-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/28/2023]
Abstract
The supply of school mental health (SMH) providers and services cannot meet the demand of students in-need, and this gap is expected to widen in coming years. One way to increase the reach of helpful services for youth is to grow the SMH workforce through task-shifting to paraprofessionals. Task-shifting could be especially promising in expanding Motivational Interviewing (MI) interventions, as MI can be molded to target a number of academic and behavioral outcomes important to schools. However, no review of training exclusively paraprofessional samples in MI has yet been conducted. The current paper provides a scoping review of 19 studies of training paraprofessional providers to use MI to evaluate trainee characteristics, training content and format, and outcomes. Of these 19 studies, 15 reported that paraprofessionals improved in using MI following training. Nine studies reported that task-shifting MI was positively received by clients and/or providers. Six studies examined task-shifting MI in youth-serving contexts, and four examined the practice in traditional school contexts, suggesting its potential for use in SMH. Other findings and implications, such as client behavior change and provider fidelity, are shared, along with ideas for advancing research, practice, and policy in this subfield.
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Affiliation(s)
- Mackenzie J. Hart
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton St., Suite 450, Columbia, South Carolina 29208 USA
| | - Samuel D. McQuillin
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton St., Suite 450, Columbia, South Carolina 29208 USA
| | - Aidyn Iachini
- College of Social Work- University of South Carolina, 1512 Pendleton St., Hamilton College Suite 332, Columbia, South Carolina 29208 USA
| | - Mark D. Weist
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton St., Suite 450, Columbia, South Carolina 29208 USA
| | - Kimberly J. Hills
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton St., Suite 450, Columbia, South Carolina 29208 USA
- Department of Psychology, University of South Carolina, 1331 Elmwood Ave., Suite 140F, Columbia, South Carolina 29201 USA
| | - Daniel K. Cooper
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton St., Suite 450, Columbia, South Carolina 29208 USA
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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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Increasing Attendance in Addiction Treatment With Limited Resources: A Narrative Review. J Addict Med 2023; 17:13-20. [PMID: 35861341 DOI: 10.1097/adm.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Treatment nonattendance frequently compromises client outcomes in psychosocial addiction treatment services. However, there is limited literature on strategies that increase attendance and retention without a significant resource burden on clinician or organization. This review of 13 studies describes strategies that do not financially reward clients for attendance or require more than 1 day of training/supervision to implement. These strategies are as follows: role induction; pretreatment written or verbal contact; short message service and telephone reminders; and contracting, prompting, and reinforcement. There is some evidence that role induction strategies can increase attendance in early treatment, with stronger evidence for a more intensive approach. Short message service and telephone reminders show a consistent positive impact on early attendance, although the relationship may weaken over time and for individuals with more complex needs (ie, high impulsivity). The strategy: contracting, prompting, and reinforcement shows promising findings, particularly in the first 3 months of treatment. There is considerable variability in study designs, interventions, and sample sizes-future research should more precisely identify relationships between outcomes and the "active ingredients" in each strategy. However, preliminary evidence suggests that some low clinician/organization-burden strategies increase treatment attendance and retention. The mechanisms underpinning these strategies may overlap with therapeutic engagement theories (eg, outcome expectations, common-factors model). Although these interventions have small to moderate effect sizes, their relative simplicity and low cost increase the likelihood of being implemented at a broad scale, amplifying their benefits.
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Petros R, Lapham J, Wierman Rubin B, De Fries SA. Supporting Clinical Development Through Integrative Continuing Education for Field Instructors. CLINICAL SOCIAL WORK JOURNAL 2022; 51:131-142. [PMID: 36465476 PMCID: PMC9702937 DOI: 10.1007/s10615-022-00857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/12/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
Field education is the signature pedagogy of social work education, but there is no standardized mechanism to ensure field instructors are trained in the same clinical modalities as social work students or are well-trained in the provision of clinical supervision. Feasibility was assessed of providing field instructors (n = 9) with a continuing education (CE) program to train them in a specialized evidence-based practice, motivational interviewing (MI) in a recovery context, and strategies for supervision. Participants of the CE program gained confidence (p < .05) and knowledge in the spirit (p < .01) and skills (p < .001) of MI; while participants described initial reactions of disdain when role-plays were introduced in the training, they ultimately identified role-plays and facilitator modeling as key features in producing their own practice change and mimicked the use of parallel process - using MI as a way to teach MI - in their provision of supervision. Findings suggest that offering a CE program to train field instructors in a specialized evidence-based practice embedded in course work and strategies for supervision is feasible and may result in enhanced supervision in field education.
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Affiliation(s)
- Ryan Petros
- School of Social Work, University of Washington, 4101 15th Ave NE, 98105 Seattle, WA USA
| | - Jessica Lapham
- School of Social Work, University of Washington, 4101 15th Ave NE, 98105 Seattle, WA USA
| | - Beth Wierman Rubin
- School of Social Work, University of Washington, 4101 15th Ave NE, 98105 Seattle, WA USA
| | - Stacey A. De Fries
- School of Social Work, University of Washington, 4101 15th Ave NE, 98105 Seattle, WA USA
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Resnicow K, Delacroix E, Chen G, Austin S, Stoffel E, Hanson EN, Gerido LH, Kaphingst KA, Yashar BM, Marvin M, Griggs JJ, Cragun D. Motivational interviewing for genetic counseling: A unified framework for persuasive and equipoise conversations. J Genet Couns 2022; 31:1020-1031. [PMID: 35906848 PMCID: PMC9796431 DOI: 10.1002/jgc4.1609] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/31/2022] [Accepted: 06/12/2022] [Indexed: 01/01/2023]
Abstract
Genetic counselors (GCs) have traditionally been trained to adopt a position of equipoise or clinical neutrality. They provide information, answer questions, address barriers, and engage in shared decision-making, but generally, they do not prescribe a genetic test. Historically, GCs have generally been trained not to persuade the ambivalent or resistant patient. More recently, however, there has been discussion regarding when a greater degree of persuasion or directionality may be appropriate within genetic counseling (GC) and what role MI may play in this process. The role for "persuasive GC" is based on the premise that some genetic tests provide actionable information that would clearly benefit patients and families by impacting treatment or surveillance. For other tests, the benefits are less clear as they do not directly impact patient care or the benefits may be more subjective in nature, driven by patient values or psychological needs. For the former, we propose that GCs may adopt a more persuasive clinical approach while for the latter, a more traditional equipoise stance may be more appropriate. We suggest that motivational interviewing (MI) could serve as a unifying counseling model that allows GCs to handle both persuasive and equipoise encounters. For clearly beneficial tests, while directional, the MI encounter can still be non-directive, autonomy-supportive, and patient-centered. MI can also be adapted for equipoise situations, for example, placing less emphasis on eliciting and strengthening change talk as that is more a behavior change strategy than a shared decision-making strategy. The core principles and strategies of MI, such as autonomy support, evocation, open questions, reflective listening, and affirmation would apply to both persuasive and equipoise encounters. Key issues that merit discussion include how best to train GCs both during their initial and post-graduate education.
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Affiliation(s)
- Ken Resnicow
- University of Michigan School of Public HealthAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
| | - Emerson Delacroix
- University of Michigan School of Public HealthAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | - Gabriela Chen
- University of Michigan School of Public HealthAnn ArborMichiganUSA
- Genetic Counseling Graduate Training Program, Department of Human GeneticsUniversity of MichiganAnn ArborMichiganUSA
| | - Sarah Austin
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
| | - Elena Stoffel
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | - Erika N. Hanson
- Department of Internal MedicineUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | | | - Kimberly A. Kaphingst
- Department of CommunicationUniversity of UtahSalt Lake CityUtahUSA
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Beverly M. Yashar
- Department of Internal MedicineUniversity of Michigan School of MedicineAnn ArborMichiganUSA
- Genetic Counseling Graduate Training Program, Department of Human GeneticsUniversity of MichiganAnn ArborMichiganUSA
| | - Monica Marvin
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of Michigan School of MedicineAnn ArborMichiganUSA
- Genetic Counseling Graduate Training Program, Department of Human GeneticsUniversity of MichiganAnn ArborMichiganUSA
| | - Jennifer J. Griggs
- University of Michigan School of Public HealthAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | - Deborah Cragun
- University of South Florida, College of Public HealthTampaFloridaUSA
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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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14
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Budhwani H, Naar S. Training Providers in Motivational Interviewing to Promote Behavior Change. Pediatr Clin North Am 2022; 69:779-794. [PMID: 35934499 PMCID: PMC9833492 DOI: 10.1016/j.pcl.2022.04.008] [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: 02/04/2023]
Abstract
Motivational Interviewing (MI) is a highly specified behavior change communication approach to improve patient-provider relationships, provider communication, and patient health outcomes. Because MI is built on a foundation of patient autonomy support, a feature known to positively influence behavior change during adolescence and emerging adulthood, MI is an evidence-based framework that can inform interventions targeting improvements in health outcomes among youth. MI can be difficult to implement with adequate fidelity, because learning MI requires time and commitment from busy providers with competing priorities. This review addresses best practices for implementing MI within adolescent serving medical settings (eg, pediatrics, family practices, rural health clinics, community health organizations, and so forth), including an orientation to MI, examples of efficacious interventions that were developed leveraging MI, and consideration for the design of training programs that include ongoing support to maximize the likelihood of sustainment.
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Affiliation(s)
- Henna Budhwani
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), School of Public Health (SOPH), Birmingham, AL, USA; Florida State University College of Medicine (FSU), Center for Translational Behavioral Science (CTBScience), Tallahassee, FL, USA.
| | - Sylvie Naar
- Florida State University College of Medicine (FSU), Center for Translational Behavioral Science (CTBScience), Tallahassee, FL, USA
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15
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Janssen W, van Raak J, van der Lucht Y, van Ballegooijen W, Mérelle S. Can Outcomes of a Chat-Based Suicide Prevention Helpline Be Improved by Training Counselors in Motivational Interviewing? A Non-randomized Controlled Trial. Front Digit Health 2022; 4:871841. [PMID: 35801118 PMCID: PMC9253377 DOI: 10.3389/fdgth.2022.871841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To examine whether the outcomes of a chat-based suicide-prevention helpline could be improved by training counselors in motivational interviewing (MI). Methods In a pre- and post-test design, visitors of a chat-based suicide prevention helpline received either the Five-Phase Model (treatment as usual [TAU]) or MI. They completed a pre- and post-chat questionnaire on several suicide-related risk factors. Linear mixed modeling was used to estimate the effect of the condition. Furthermore, the treatment proficiency of newly trained counselors was assessed using MI-Scope. Results A total of 756 visitors and 55 counselors were included in this study. The visitors showed an improvement in suicidal ideation and psychological risk factors after a chat conversation. However, there were no significant differences between the MI and TAU conditions (β = 0.03, 95% CI [−0.23–0.30], p = 0.80). The treatment integrity indices showed that the counselors mostly used MI-consistent techniques but were unable to strategically employ these techniques to evoke enough change talk. Conclusions MI and TAU led to comparable outcomes in a chat-based suicide prevention helpline. The effectiveness of MI might improve by intensifying or improving the training of counselors, keeping the process of engaging more concise or offering visitors multiple sessions of MI.
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Affiliation(s)
- Wilco Janssen
- 113 Suicide Prevention, Amsterdam, Netherlands
- *Correspondence: Wilco Janssen
| | | | | | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
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16
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Fuhrmann S, Kitzmann J, Isailov-Schöchlin M, Vach K, Fabry G, Schulz C, Jähne A, Ratka-Krüger P, Woelber JP. Can motivational interviewing for dental settings be taught online? Results of an uncontrolled interventional trial. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:254-262. [PMID: 34009671 DOI: 10.1111/eje.12698] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 03/16/2021] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Motivational interviewing (MI) is an evidence-based method of promoting oral healthcare behaviour. Conventional training of MI is a time-consuming and costly aspect in the dental curriculum. Therefore, the aim of this study was to evaluate the effectiveness and acceptance of a MI-blended learning programme for dental students. MATERIALS AND METHODS Dental students had to perform an interdisciplinary created "ecourse Motivational Interviewing in medical settings" (eMI-med). After completion, patient-student interviews were recorded and evaluated using the Motivational Interviewing Treatment Integrity Code (MITI-d). Furthermore, the students' self-efficacy regarding smoking cessation and oral hygiene motivation was examined and the acceptance of the tool was enquired. RESULTS Forty interviews with 25 different students were analysed with the MITI-d. Students showed high levels of MI-adherent behaviour (15.45 ± 6.98), open-ended questions (9.95 ± 6.90) and reflections (10.43 ± 8.85), which were comparable to previous classroom trainings. In addition, 90% of the students preferred e-learning over classroom teaching. Furthermore, the students' therapeutical self-efficacies were significantly increased by the programme. CONCLUSION Within the limitations of this study, the created e-learning programme was able to equip dental students with basic knowledge and MI skills. Furthermore, learning MI through e-learning may heighten the self-efficacy of dental students regarding smoking cessation and oral hygiene promotion. Students showed a high acceptance of e-learning, preferring it over traditional learning.
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Affiliation(s)
- Sascha Fuhrmann
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Kitzmann
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Private Practice, Hamburg, Germany
| | - Milena Isailov-Schöchlin
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kirstin Vach
- Department of Medical Biometry and Medical Informatics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Götz Fabry
- Department of Medical Psychology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelia Schulz
- Cancer Prevention Team, Tumor Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Jähne
- Oberberg specialist hospital Rhein-Jura Bad Säckingen, Bad Säckingen, Germany
| | - Petra Ratka-Krüger
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johan Peter Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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17
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Kaitz J, Lebeck KD, Catalfamo C. Compassion Is Our Mantra. Am J Psychother 2022; 75:145-146. [PMID: 35469424 DOI: 10.1176/appi.psychotherapy.20210026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jenesse Kaitz
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts (Kaitz); Independent Recovery Research and Program Evaluation, Albuquerque, New Mexico (Lebeck); Outpatient Psychiatry Services, University of Massachusetts Memorial Medical Center, Worcester (Catalfamo)
| | - Kurt D Lebeck
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts (Kaitz); Independent Recovery Research and Program Evaluation, Albuquerque, New Mexico (Lebeck); Outpatient Psychiatry Services, University of Massachusetts Memorial Medical Center, Worcester (Catalfamo)
| | - Christopher Catalfamo
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts (Kaitz); Independent Recovery Research and Program Evaluation, Albuquerque, New Mexico (Lebeck); Outpatient Psychiatry Services, University of Massachusetts Memorial Medical Center, Worcester (Catalfamo)
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18
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Gotham HJ, Cummings JR, Dolce JN, Druss B, Gill KJ, Kopelovich SL, Molfenter T, Olson JR, Benson F, Chwastiak L. Applying implementation science in mental health services: Technical assistance cases from the Mental Health Technology Transfer Center (MHTTC) network. Gen Hosp Psychiatry 2022; 75:1-9. [PMID: 35078020 DOI: 10.1016/j.genhosppsych.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Critical gaps exist between implementation of effective interventions and the actual services delivered to people living with mental disorders. Many technical assistance (TA) efforts rely on one-time trainings of clinical staff and printed guidelines that alone are not effective in changing clinical practice. The Mental Health Technology Transfer Center (MHTTC) Network uses implementation science to accelerate the use of evidence-based practices (EBPs), improve performance, and bring about systems-level change. METHOD Four case examples illustrate how MHTTCs employ the Exploration-Preparation-Implementation-Sustainment (EPIS) implementation framework and intensive implementation strategies to educate clinicians, manage change, and improve processes. These examples include implementing motivational interviewing, cognitive-behavioral therapy for people with psychosis, strategies to decrease the no show rate for virtual appointments, and school mental health systems development. RESULTS From Preparation through Sustainment, MHTTCs successfully employed implementation strategies including learning communities, audit and feedback, and coaching to bring about change. Each project attended to inner and outer contexts to eliminate barriers. The examples also show the benefit of integrating process improvement alongside implementation. CONCLUSIONS The MHTTCs are a model for using implementation science to design technical assistance that leads to more successful practical execution of EBPs; thus reducing the gap between research and practice.
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Affiliation(s)
- Heather J Gotham
- Mental Health Technology Transfer Center Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Janet R Cummings
- Southeast Mental Health Technology Transfer Center, Department of Health and Policy Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joni N Dolce
- Northeast and Caribbean Mental Health Technology Transfer Center, Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, New Brunswick, NJ, USA
| | - Benjamin Druss
- Southeast Mental Health Technology Transfer Center, Department of Health and Policy Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kenneth J Gill
- Northeast and Caribbean Mental Health Technology Transfer Center, Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, New Brunswick, NJ, USA
| | - Sarah L Kopelovich
- Northwest Mental Health Technology Transfer Center, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Washington, DC, USA
| | - Todd Molfenter
- Great Lakes Mental Health Technology Transfer Center, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Jonathan R Olson
- Northwest Mental Health Technology Transfer Center, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Washington, DC, USA
| | - Felicia Benson
- Mental Health Technology Transfer Center Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Lydia Chwastiak
- Northwest Mental Health Technology Transfer Center, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Washington, DC, USA
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19
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Contingency management for treatment attendance: A meta-analysis. J Subst Abuse Treat 2022; 133:108556. [PMID: 34210566 PMCID: PMC8702584 DOI: 10.1016/j.jsat.2021.108556] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/12/2021] [Accepted: 06/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Treatment providers have applied contingency management (CM) treatment, an intervention that often rewards individuals for drug abstinence (i.e., ABS CM), to treatment engagement as well. However, we know little about the magnitude of treatment effects when providers target attendance behaviors (i.e., ATT CM). METHODS This study conducted a systematic search to identify studies that included ATT CM, either in isolation or in combination with ABS CM. The study used meta-analysis to estimate the effect size of ATT CM and ABS CM + ATT CM on treatment attendance and drug abstinence. We identified a total of 10 studies including 12 CM treatments (6 ATT CM and 6 ABS CM + ATT CM) with 1841 participants. RESULTS Results indicated a moderate effect (d = 0.47, 95% confidence interval (CI) [0.25, 0.69]) of ATT CM on attendance relative to non-reward active comparison conditions. Frequency of rewards was significantly associated with larger effect sizes. Results also indicated a small effect (d = 0.22, 95% CI [0.12, 0.33]) of ATT CM on abstinence outcomes relative to nonreward comparisons, p < 0.001. The study found no significant differences in attendance or abstinence between ATT CM and ABS CM + ATT CM (p's > 0.05). CONCLUSION Overall, the results supported ATT CM for increasing treatment engagement, with smaller effects on abstinence. Effects on abstinence were smaller than those observed in prior meta-analyses focused on ABS CM. No significant differences existed in attendance or abstinence outcomes between ATT CM and ABS + ATT CM. However, future studies are needed to experimentally compare ABS CM + ATT CM to ABS CM, and ATT CM to determine additive effects. Clinics implementing CM should consider the differential effects between ATT CM and ABS CM when selecting target behavior(s).
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20
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Training Physicians in Motivational Communication to Address Influenza Vaccine Hesitation: A Proof-of-Concept Study. Vaccines (Basel) 2022; 10:vaccines10020143. [PMID: 35214603 PMCID: PMC8875187 DOI: 10.3390/vaccines10020143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Strategies to support health care professionals on how to address vaccine hesitancy are needed. Methods: We developed a 4-h Motivational Communication (MC) training program tailored to help physicians address hesitancy related to influenza vaccination among patients living with rheumatoid arthritis. Five MC competencies were evaluated at baseline and post-training with a standardized patient using the Motivational Interviewing Treatment Integrity [MITI] scale. Adherence to MC during clinical consultations and changes in vaccine intentions was measured as secondary outcomes. Results: Seven rheumatology physicians participated in the training. MITI scores increased in all participants, and 71% (n = 5) achieved thresholds of clinical competency (i.e., ≥3.5/5 at MITI global score and ≥3/5 on at least 3 individual competency score) post-training. Autonomy/support and empathy competencies reached competency thresholds (+2.4 ± 1.3 to +4.1 ± 0.7 and +2.1 ± 0.7 to +4.1 ± 0.7, respectively). Evocation and collaboration competencies improved but without reaching competency thresholds (+1.4 ± 0.8 to +3.1 ± 1.1; +1.4 ± 0.8 to +2.9 ± 1.1, respectively). Direction did not improve. Among 21 patient consultations post-training, 15 (71%) were MC-consistent. Of the 15 patients, 67% (10/15) intended to receive the influenza vaccine and 33% (5/15) received it. Conclusion: A brief MC training program targeting vaccine hesitancy increased MC competency among rheumatology physicians and promoted behavioral change among patients.
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Curtis AC, Satre DD, Sarovar V, Wamsley M, Ly K, Satterfield J. A mobile app to promote alcohol and drug SBIRT skill translation among multi-disciplinary health care trainees: Results of a randomized controlled trial. Subst Abus 2022; 43:13-22. [PMID: 31710269 PMCID: PMC7211553 DOI: 10.1080/08897077.2019.1686723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adherence to clinical practice guidelines for alcohol and drug screening, brief intervention, and referral to treatment (SBIRT) is often inadequate. Mobile apps developed as clinical translation tools could improve the delivery of high fidelity SBIRT. Methods: This study tested the effectiveness of an SBIRT mobile app conceptually aligned with the Theory of Planned Behavior (TPB) to support SBIRT delivery by health care trainees (nursing, social work, internal medicine, psychiatry, and psychology) working in clinical settings (N = 101). Bivariate analyses examined the rate of SBIRT delivery between trainees assigned to the experimental (app) and control (no app) study conditions; as well as the relationship between TPB-based constructs, intention to deliver SBIRT, and screening rates. Results: No significant differences were identified between the study conditions in SBIRT delivery. Significant correlations were found between intent to screen and TPB variables including attitudes/behavioral beliefs concerning substance use treatment (r = .49, p = .01); confidence in clinical skills (r = .36, p = .01); subjective norms (r = .54, p = .01) and perceived behavioral control over appointment time constraints (r = .42, p = .01). Also significant were correlations between percent of patients screened and confidence (r = .24, p = .05); subjective norms (r = .22, p = .05) and perceived behavioral control (r = .28, p = .01). Conclusions: The negative results of the study condition comparisons indicate the need for further investigation of strategies to optimize mobile app utilization, engagement, and effectiveness as a clinical translation tool. Findings of significant correlations between substance use screening rates and both norms and confidence support the potential value of the TPB model in explaining behavior of health care learners in SBIRT delivery.
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Affiliation(s)
- Alexa C. Curtis
- School of Nursing and Health Professions, University of San Francisco, California 94117
| | - Derek D. Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, California 94143,Division of Research, Kaiser Permanente Northern California, Oakland, California 94612
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, California 94612
| | - Maria Wamsley
- Division of General Internal Medicine, University of California, San Francisco, California 94115
| | - Khanh Ly
- Division of General Internal Medicine, University of California, San Francisco, California 94115
| | - Jason Satterfield
- Division of General Internal Medicine, University of California, San Francisco, California 94115
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Løchting I, Hagen R, Monsen CK, Grotle M, Storheim K, Aanesen F, Øiestad BE, Eik H, Bagøien G. Fidelity of a Motivational Interviewing Intervention for Improving Return to Work for People with Musculoskeletal Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910324. [PMID: 34639624 PMCID: PMC8507704 DOI: 10.3390/ijerph181910324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
The objective of this study was to conduct a fidelity evaluation of a motivational interviewing (MI) intervention delivered by social insurance caseworkers, in a three-arm randomized controlled trial (RCT) for improving return to work for people on sick leave with musculoskeletal disorders. The caseworkers received six days of MI training, including an intervention manual prior to the trial onset, as well as supervision throughout the trial. The caseworkers recorded 21 MI sessions at regular intervals during the trial. An independent MI analysis center scored the recordings using the MI treatment integrity code (MITI 4). In addition, three experienced MI trainers assessed the adherence to the MI intervention manual on a 1–4 Likert scale and MI competence. Total MITI 4 mean scores were at beginning proficiency levels for two components (global technical, mean 3.0; SD 0.6 and the reflections/questions ratio, mean 1.1; SD 0.2) and under beginning proficiency for two components (global relational, mean 3.2; SD 0.7 and complex question, mean 34.0; SD 21.2). The MI trainers’ assessment showed similar results. The mean adherence score for the MI sessions was 2.96 (SD 0.9). Despite delivering a thorough course and supervision package, most of the caseworkers did not reach proficiency levels of good MI competence during the study. The fidelity evaluation showed that a large amount of training, supervision and practice is needed for caseworkers to become competent MI providers. When planning to implement MI, it is important that thorough consideration is given regarding the resources and the time needed to train caseworkers to provide MI in a social insurance setting.
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Affiliation(s)
- Ida Løchting
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956, 0424 Oslo, Norway; (M.G.); (K.S.)
- Correspondence: ; Tel.: +47-9183-2700
| | - Roger Hagen
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway;
- Department of Psychology, Norwegian University of Science and Technology, P.O. Box 8900, 7491 Trondheim, Norway
- Research Institute, Modum Bad, P.O. Box 33, 3370 Vikersund, Norway
| | - Christine K. Monsen
- Division of Mental Health & Addiction, Vestfold Hospital Trust, P.O. Box 2168, 3103 Tønsberg, Norway;
| | - Margreth Grotle
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956, 0424 Oslo, Norway; (M.G.); (K.S.)
- Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. Box 4, 0130 Oslo, Norway; (F.A.); (B.E.Ø.); (H.E.)
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956, 0424 Oslo, Norway; (M.G.); (K.S.)
- Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. Box 4, 0130 Oslo, Norway; (F.A.); (B.E.Ø.); (H.E.)
| | - Fiona Aanesen
- Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. Box 4, 0130 Oslo, Norway; (F.A.); (B.E.Ø.); (H.E.)
| | - Britt Elin Øiestad
- Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. Box 4, 0130 Oslo, Norway; (F.A.); (B.E.Ø.); (H.E.)
| | - Hedda Eik
- Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. Box 4, 0130 Oslo, Norway; (F.A.); (B.E.Ø.); (H.E.)
| | - Gunnhild Bagøien
- Nidelv Community Mental Health Centre, Department of Mental Health, Trondheim University Hospital, P.O. Box 3250, 7006 Trondheim, Norway;
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Hershberger PJ, Pei Y, Bricker DA, Crawford TN, Shivakumar A, Vasoya M, Medaramitta R, Rechtin M, Bositty A, Wilson JF. Advancing Motivational Interviewing Training with Artificial Intelligence: ReadMI. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:613-618. [PMID: 34113205 PMCID: PMC8186935 DOI: 10.2147/amep.s312373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Motivational interviewing (MI) is an evidence-based, brief interventional approach that has been demonstrated to be highly effective in triggering change in high-risk lifestyle behaviors. MI tends to be underutilized in clinical settings, in part because of limited and ineffective training. To implement MI more widely, there is a critical need to improve the MI training process in a manner that can provide prompt and efficient feedback. Our team has developed and tested a training tool, Real-time Assessment of Dialogue in Motivational Interviewing (ReadMI), that uses natural language processing (NLP) to provide immediate MI metrics and thereby address the need for more effective MI training. METHODS Metrics produced by the ReadMI tool from transcripts of 48 interviews conducted by medical residents with a simulated patient were examined to identify relationships between physician-speaking time and other MI metrics, including the number of open- and closed-ended questions. In addition, interrater reliability statistics were conducted to determine the accuracy of the ReadMI's analysis of physician responses. RESULTS The more time the physician spent talking, the less likely the physician was engaging in MI-consistent interview behaviors (r = -0.403, p = 0.007), including open-ended questions, reflective statements, or use of a change ruler. CONCLUSION ReadMI produces specific metrics that a trainer can share with a student, resident, or clinician for immediate feedback. Given the time constraints on targeted skill development in health professions training, ReadMI decreases the need to rely on subjective feedback and/or more time-consuming video review to illustrate important teaching points.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Yong Pei
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Dean A Bricker
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Ashutosh Shivakumar
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Miteshkumar Vasoya
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Raveendra Medaramitta
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Maria Rechtin
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Aishwarya Bositty
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Josephine F Wilson
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Samuel A, Cervero RM, Durning SJ, Maggio LA. Effect of Continuing Professional Development on Health Professionals' Performance and Patient Outcomes: A Scoping Review of Knowledge Syntheses. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:913-923. [PMID: 33332905 DOI: 10.1097/acm.0000000000003899] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Continuing professional development (CPD) programs, which aim to enhance health professionals' practice and improve patient outcomes, are offered to practitioners across the spectrum of health professions through both formal and informal learning activities. Various knowledge syntheses (or reviews) have attempted to summarize the CPD literature; however, these have primarily focused on continuing medical education or formal learning activities. Through this scoping review, the authors seek to answer the question, What is the current landscape of knowledge syntheses focused on the impact of CPD on health professionals' performance, defined as behavior change and/or patient outcomes? METHOD In September 2019, the authors searched PubMed, Embase, CINAHL, Scopus, ERIC, and PsycINFO for knowledge syntheses published between 2008 and 2019 that focused on independently practicing health professionals and reported outcomes at Kirkpatrick's level 3 and/or 4. RESULTS Of the 7,157 citations retrieved from databases, 63 satisfied the inclusion criteria. Of these 63 syntheses, 38 (60%) included multicomponent approaches, and 29 (46%) incorporated eLearning interventions-either standalone or in combination with other interventions. While a majority of syntheses (n = 42 [67%]) reported outcomes affecting health care practitioners' behavior change and/or patient outcomes, most of the findings reported at Kirkpatrick level 4 were not statistically significant. Ten of the syntheses (16%) mentioned the cost of interventions though this was not their primary focus. CONCLUSIONS Across health professions, CPD is an umbrella term incorporating formal and informal approaches in a multicomponent approach. eLearning is increasing in popularity but remains an emerging technology. Several of the knowledge syntheses highlighted concerns regarding both the financial and human costs of CPD offerings, and such costs are being increasingly addressed in the CPD literature.
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Affiliation(s)
- Anita Samuel
- A. Samuel is assistant professor, Department of Medicine and Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0001-9488-9565
| | - Ronald M Cervero
- R.M. Cervero is professor, Department of Medicine, and deputy director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Steven J Durning
- S.J. Durning is professor, Department of Medicine, and director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Lauren A Maggio
- L.A. Maggio is associate professor, Department of Medicine, and associate director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-2997-6133
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Hershberger PJ, Bricker DA, Conway K, Torcasio MH. Turning "Lose-Lose" into "Win-Win": What Is Good for Them Is Good for Us! MEDICAL SCIENCE EDUCATOR 2021; 31:1177-1181. [PMID: 34457961 PMCID: PMC8368257 DOI: 10.1007/s40670-021-01280-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 06/13/2023]
Abstract
Simply telling patients what to do with respect to medical recommendations or lifestyle changes often does not have the desired impact, contributing to frustration for both patients and physicians. Therefore, this "educate and advise" approach can be a "lose-lose" proposition-bad for the patient, and bad for the physician. Broader adoption of efficacious approaches to patient engagement, such as motivational interviewing, can help make the process of addressing patients' behavioral responsibilities regarding chronic disease prevention and management a "win-win" for the health and satisfaction of patients and physicians alike. Greater emphasis on evidence-based patient engagement skills is necessary in medical education.
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Affiliation(s)
- Paul J. Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, 725 University Blvd., Dayton, OH USA
| | - Dean A. Bricker
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH USA
| | - Katharine Conway
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, 725 University Blvd., Dayton, OH USA
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Sheen J, Sutherland‐Smith W, Thompson E, Youssef GJ, Dudley A, King R, Hall K, Dowling N, Gurtman C, McGillivray JA. Evaluating the impact of simulation-based education on clinical psychology students' confidence and clinical competence. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1923125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jade Sheen
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | | | - Emma Thompson
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - George J. Youssef
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amanda Dudley
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Ross King
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Nicki Dowling
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Clint Gurtman
- School of Psychology, Deakin University, Geelong, Victoria, Australia
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Larson E, Martin BA. Measuring motivational interviewing self-efficacy of pre-service students completing a competency-based motivational interviewing course. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 1:100009. [PMID: 35479507 PMCID: PMC9030277 DOI: 10.1016/j.rcsop.2021.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Improving health outcomes requires health care practitioners to work collaboratively with clients to make healthy lifestyle changes. Motivational interviewing (MI) is an evidence-based approach found to evoke and support behavior change. Objective The aim of this study was to examine changes over time in pre-service professional students' confidence in their MI skills after a 15-week interprofessional MI course. Methods Students (N = 22) completed a newly developed 24-item Motivational Interviewing Confidence Survey (MICS pre and post participation in the course). Summary statistics, initial scale reliability assessment and t-tests were carried out. Results MICS was a reliable measure (Cronbach's a = 0.98) and detected significant changes in students' self-perceived skill set. Using t-tests, significant differences were noted in pre- and post-assessments in students' confidence in their skills; students (p values<0.001) demonstrated significant gains in confidence on 23 of 24 MICS items. Conclusion After participating in the course, students' confidence in their MI skills improved significantly. Adding pre-service training in MI may increase future healthcare practitioners' confidence in their MI skills and improve their capacity to engage in individually tailored, client-driven practice.
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Affiliation(s)
- Elizabeth Larson
- University of Wisconsin Madison, Occupational Therapy Program, Department of Kinesiology, 2180 Medical Science Center, 1300 University Avenue, Madison, WI 53706, United States of America
| | - Beth A. Martin
- University of Wisconsin Madison, School of Pharmacy, 1022 Rennebohm Hall, 777 Highland Avenue, Madison, WI 53705, United States of America
- Corresponding author.
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Hershberger PJ, Martensen LS, Crawford TN, Bricker DA. Promoting Motivational Interviewing in Primary Care: More Than Intention. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2021; 5:7. [PMID: 33860162 DOI: 10.22454/primer.2021.287928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction Interacting with patients in a manner that furthers self-responsibility for health is an important skill for primary care clinicians. Motivational interviewing (MI) is such an approach to patient engagement, but it remains to be more widely implemented. In a program training health professionals and health professions students in MI, we examined posttraining attitudes and intentions regarding the utilization of MI. Of particular interest was how posttraining intentions were associated with self-reported action 1 month later. Methods We obtained immediate posttraining and 30-day follow-up data from 209 participants regarding intent to utilize the MI approach (self-reported implementation at the follow-up interval), impact on confidence with patient interaction, and perceived importance of the training. We analyzied frequencies and percentages for all categorical/ordinal variables to describe the participants and the survey question responses. Results While 91.5% of participants intended to incorporate MI into their approach with patients (to a moderate or great extent) at posttraining, only 48.7% reported that they had actually implemented the MI approach (to a moderate or great extent) 30 days later. However, another 32.1% indicated that they had occasionally utilized MI. Attitudes toward the importance of MI training and the impact of training on confidence remained strong over the 30 days. Conclusion Achieving more widespread implementation of the MI approach in the primary care setting is likely to be less dependent on convincing clinicians about its importance for patient engagement, but rather on the translation of intent to actual practice and implementation.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Lori S Martensen
- Department of Medical Education, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Timothy N Crawford
- Departments of Population and Public Health Sciences & Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Dean A Bricker
- Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH
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Reger GM, Norr AM, Rizzo A“S, Sylvers P, Peltan J, Fischer D, Trimmer M, Porter S, Gant P, Baer JS. Virtual Standardized Patients vs Academic Training for Learning Motivational Interviewing Skills in the US Department of Veterans Affairs and the US Military: A Randomized Trial. JAMA Netw Open 2020; 3:e2017348. [PMID: 33057643 PMCID: PMC7563071 DOI: 10.1001/jamanetworkopen.2020.17348] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Despite the need for effective and scalable training in motivational interviewing (MI) that includes posttraining coaching and feedback, limited evidence exists regarding the effectiveness of using virtual (computerized) standardized patients (VSPs) in such training. OBJECTIVE To evaluate the efficacy of training with a VSP on the acquisition and maintenance of MI skills compared with traditional academic study. DESIGN, SETTING, AND PARTICIPANTS This study was a 2-group, parallel-training randomized trial of 120 volunteer health care professionals recruited from a Department of Veterans Affairs and Department of Defense medical facility. Motivational interviewing skill was coded by external experts blinded to training group and skill assessment time points. Data were collected from October 17, 2016, to August 12, 2019. INTERVENTIONS After a computer course on MI, participants trained during two 45-minute sessions separated by 3 months. The 2 randomized training conditions included a branching storyline VSP, which provided MI skill rehearsal with immediate and summative feedback, and a control condition, which included academic study of content from the computerized MI course. MAIN OUTCOMES AND MEASURES Measurement of MI skill was based on recorded conversations with human standardized patients, assessed using the Motivational Interviewing Treatment Integrity 4.2.1 coding system, measured at baseline, after training, and after additional training in the randomized condition 3 months later. RESULTS A total of 120 volunteers (83 [69%] women), with a mean (SD) of 13.6 (10.3) years of health care experience, participated in the study; 61 were randomized to receive the intervention, and 59 were randomized to the control group. Those assigned to VSP training had significantly greater posttraining improvement in technical global scores (0.23; 95% CI, 0.03-0.44; P = .02), relational global scores (0.57; 95% CI, 0.33-0.81; P = .001), and the reflection-to-question ratio (0.23; 95% CI, 0.15-0.31; P = .001). Differences were maintained after the 3-month additional training session, with more improvements achieved after the 3-month training for the VSP trainees on the reflection-to- question ratio (0.15; 95% CI, 0.07-0.24; P = .001). CONCLUSIONS AND RELEVANCE This randomized trial demonstrated a successful transfer of training from a VSP to human standardized patients. The VSP MI skill outcomes were better than those achieved with academic study and were maintained over time. Virtual standardized patients have the potential to facilitate dissemination of MI and may be useful for training in other evidence-based skills and treatments. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04558060.
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Affiliation(s)
- Greg M. Reger
- Veterans Affairs (VA) Puget Sound Healthcare System, Seattle and Tacoma, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Aaron M. Norr
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Veterans Integrated Services Network 20 Northwest Network Mental Illness Research, Education, and Clinical Center, Seattle, Washington
| | - Albert “Skip” Rizzo
- Institute for Creative Technologies, University of Southern California, Marina del Rey
| | - Patrick Sylvers
- Veterans Affairs (VA) Puget Sound Healthcare System, Seattle and Tacoma, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jessica Peltan
- Veterans Affairs (VA) Puget Sound Healthcare System, Seattle and Tacoma, Washington
- VA Sierra Nevada Health Care System, Reno
| | - Daniel Fischer
- Veterans Affairs (VA) Puget Sound Healthcare System, Seattle and Tacoma, Washington
| | - Matthew Trimmer
- Institute for Creative Technologies, University of Southern California, Marina del Rey
| | - Shelan Porter
- Veterans Affairs (VA) Puget Sound Healthcare System, Seattle and Tacoma, Washington
| | - Pamela Gant
- Veterans Affairs (VA) Puget Sound Healthcare System, Seattle and Tacoma, Washington
| | - John S. Baer
- Veterans Affairs (VA) Puget Sound Healthcare System, Seattle and Tacoma, Washington
- Department of Psychology, University of Washington, Seattle
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Fidelity of Motivational Interviewing in School-Based Intervention and Research. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:712-721. [PMID: 32926300 DOI: 10.1007/s11121-020-01167-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Educational researchers and school-based practitioners are increasingly infusing motivational interviewing (MI) into new and existing intervention protocols to provide support to students, parents, teachers, and school administrators. To date, however, the majority of the research in this area has focused on feasibility of implementation rather than fidelity of implementation. In this manuscript, we will present MI fidelity data from 245 audio-recorded conversations with 113 unique caregivers and 20 coaches, who implemented a school-based, positive parenting intervention. The aggregate fidelity scores across coaches, parents, and sessions provide evidence the training and support procedures were effective in assisting school-based personnel to implement MI with reasonable levels of fidelity in practice settings. Further, results suggest that MI fidelity varied between sessions and coaches and that within-coach variation (e.g., session-level variation in the quality of MI delivered) greatly exceeded between-coach variation. Implications for practice and future research are discussed.
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Beck AK, Baker AL, Carter G, Wratten C, Bauer J, Wolfenden L, McCarter K, Britton B. Assessing Adherence, Competence and Differentiation in a Stepped-Wedge Randomised Clinical Trial of a Complex Behaviour Change Intervention. Nutrients 2020; 12:E2332. [PMID: 32759848 PMCID: PMC7469004 DOI: 10.3390/nu12082332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A key challenge in behavioural medicine is developing interventions that can be delivered adequately (i.e., with fidelity) within real-world consultations. Accordingly, clinical trials should (but tend not to) report what is actually delivered (adherence), how well (competence) and the distinction between intervention and comparator conditions (differentiation). PURPOSE To address this important clinical and research priority, we apply best practice guidelines to evaluate fidelity within a real-world, stepped-wedge evaluation of "EAT: Eating As Treatment", a new dietitian delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. METHODS Dietitians (n = 18) from five Australian hospitals delivered a period of routine care and following a randomly determined order each site received training and began delivering the EAT Intervention. A 20% random stratified sample of audio-recorded consultations (control n = 196; intervention n = 194) was coded by trained, independent, raters using a study specific checklist and the Behaviour Change Counselling Inventory. Intervention adherence and competence were examined relative to apriori benchmarks. Differentiation was examined by comparing control and intervention sessions (adherence, competence, non-specific factors, and dose), via multiple linear regression, logistic regression, or mixed-models. RESULTS Achievement of adherence benchmarks varied. The majority of sessions attained competence. Post-training consultations were clearly distinct from routine care regarding motivational and behavioural, but not generic, skills. CONCLUSIONS Although what level of fidelity is "good enough" remains an important research question, findings support the real-world feasibility of integrating EAT into dietetic consultations with HNC patients and provide a foundation for interpreting treatment effects.
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Affiliation(s)
- Alison Kate Beck
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Gregory Carter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Chris Wratten
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Judith Bauer
- Centre for Dietetics Research, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kristen McCarter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Ben Britton
- Hunter New England Health, New Lambton 2305, Australia
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Hall MT, Sears J, Walton MT. Motivational Interviewing in Child Welfare Services: A Systematic Review. CHILD MALTREATMENT 2020; 25:263-276. [PMID: 31826663 DOI: 10.1177/1077559519893471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Families in the child welfare (CW) system who cannot be engaged in services are at high risk of negative outcomes. As motivational interviewing (MI) has been shown to improve engagement in similar contexts. This study aimed to systematically review MI with CW families as well as MI training with CW workers and social work students training to become CW workers. The review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched multiple databases in June 2018. In September 2019, the initial search was repeated with additional searches to identify gray literature. Eight studies described the acquisition of MI among CW workers or student trainees, and 11 studies evaluated the impact of MI on families in CW. MI's impact on some family outcomes, such as engagement in services, was mixed, though MI paired with other evidence-based treatments showed positive effects. With regard to training CW workers and students in MI, differences in training duration, intensity, and modality make conclusions difficult, though trainees generally described MI favorably and some studies showed training increased worker empathy and self-efficacy. Importantly, few published studies have evaluated whether MI-trained CW workers impact out-of-home-care placement, and no studies have evaluated their impact on maltreatment.
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How can primary care practitioners address substance use by adolescents? A position paper of the EUROPEAN academy of PAEDIATRICS. Eur J Pediatr 2020; 179:1297-1305. [PMID: 32076808 DOI: 10.1007/s00431-020-03596-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 01/25/2023]
Abstract
The objective of this article is to review how primary care providers - paediatricians, family practitioners, nurse practitioners - could address the use of substances by adolescents and respond to problematic behaviours and situations. Given the highly addictive properties of nicotine, adolescents should be supported in avoiding any consumption of tobacco or quitting if they already do so. Screening and investigation of substance use is usually not difficult, provided that it is processed in a neutral and empathetic atmosphere and securing confidentiality if the adolescent asks for it. Any type of substance use is potentially linked with adverse events such as injuries, violence, unplanned and unsafe sexual experience, alcoholic coma, 'bad trips' or unpleasant psychological experiences. As such, substance use should be identified and openly discussed with the adolescent. Moderate intermittent recreational use of legal and illegal substances (mainly alcohol and cannabis) should be carefully monitored over time, as it can lead to problematic use. Problematic use and substance use disorder require various interventions, including motivational interviewing, family counselling and psychotherapy, especially when substance use is linked with mental health disorders. Despite the importance of confidential care, parents or caregivers should be involved in problematic situations as much as possible. What is known: • While problematic use of substances is transient amongst many adolescents, it may be a threat to health and school/professional functioning • Primary care providers (PCPs) can address queries or offer preventive interventions to adolescents who use substances What is new: • Some interview tools can assist PCPs efficiently to identify problematic users of substances • There are effective approaches that PCPs can use to address problematic use by adolescent patients.
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Frey AJ, Lee J, Small JW, Sibley M, Owens JS, Skidmore B, Johnson L, Bradshaw CP, Moyers TB. Mechanisms of Motivational Interviewing: a Conceptual Framework to Guide Practice and Research. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:689-700. [PMID: 32666269 DOI: 10.1007/s11121-020-01139-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reviews of the motivational interviewing (MI) training literature demonstrate MI is a nuanced skill set that takes carefully planned didactic training, application of skills in context-specific practice settings, and ongoing support to promote reflective practice and sustained proficiency. Despite the robust knowledge base related to training and how MI works to achieve favorable outcomes, these two literature bases are not well integrated. In an effort to inform and guide future research, we propose the mechanisms of motivational interviewing (MMI) conceptual framework, which expands upon previous work. Specifically, the framework adds training as an ongoing process consistent with Bennett-Levy's (Behav Cogn Psychother 34:57-78, 2006) model of skill development and acquisition to the existing two-path framework that helps us to understand how MI works to achieve its desired effects (Magill et al., J Consult Clin Psychol 82:973-983, 2014). Herein, we describe measures used to evaluate the mechanisms within the four MMI framework links: initial training to competency, competency to proficiency, proficiency to talk about change, and talk about change to behavior change. Next, we synthesize the literature associated with each of the mechanisms of the MMI. We conclude by discussing implications for practice and research. This framework offers a more complete path structure to understand the mechanisms of change associated with MI that could improve our understanding of inconsistent effect sizes observed across prior trials evaluating MI effectiveness.
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Affiliation(s)
- Andy J Frey
- University of Louisville Kent School of Social Work, Patterson Hall, Louisville, KY, 40292, USA.
| | - Jon Lee
- University of Northern Arizona College of Education, PO Box 5774, Flagstaff, AZ, 86001, USA
| | - Jason W Small
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR, 97403-1983, USA
| | - Margaret Sibley
- University of Washington/Seattle Children's Hospital/Center for Child Health, Behavior, and Development, 2001 8th Ave., Suite 400, Seattle, WA, 98121, USA
| | | | - Blake Skidmore
- University of Louisville Kent School of Social Work, Patterson Hall, Louisville, KY, 40292, USA
| | - Laura Johnson
- University of Louisville Kent School of Social Work, Patterson Hall, Louisville, KY, 40292, USA
| | - Catherine P Bradshaw
- University of Virginia, Curry School of Education & Human Development, 112-D Bavaro Hall, 417 Emmet Street South, PO Box 400260, Charlottesville, VA, 22904-4260, USA
| | - Theresa B Moyers
- Center on Alcoholism, Substance Abuse, & Additions, University of New Mexico, 2650 Yale SE MSC11-6280, Albuquerque, NM, 87106, USA
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Yonkers KA, Dailey JI, Gilstad-Hayden K, Ondersma SJ, Forray A, Olmstead TA, Martino S. Abstinence outcomes among women in reproductive health centers administered clinician or electronic brief interventions. J Subst Abuse Treat 2020; 113:107995. [PMID: 32359666 PMCID: PMC8372233 DOI: 10.1016/j.jsat.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, and referral to treatment (SBIRT) for substance use among women seeking reproductive healthcare services. Women who screened positive for substance use were randomly assigned to either clinician-administered SBIRT, an electronically-administered brief intervention (e-SBIRT), or an enhanced usual care condition. At a 6-month follow-up assessment, compared to enhanced usual care, the clinician-administered SBIRT increased 1-month point prevalence of abstinence from the primary substance by 7.7%, and e-SBIRT increased abstinence by 12.8%. Both brief interventions were more useful than enhanced usual care and could increase substance use abstinence rates among women in reproductive healthcare clinics. The electronic brief intervention is particularly attractive given that it appears as efficacious as, but requires fewer resources than, clinician-delivered brief interventions.
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Affiliation(s)
- Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06510, USA.
| | - Jason I Dailey
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Steven J Ondersma
- Wayne State University, Merrill Palmer Skillman Institute, 71 E. Ferry Ave, Detroit, MI 48202, USA.
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Todd A Olmstead
- University of Texas at Austin, PO Box Y, Austin, TX 78713, USA.
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Svensson C, Wickström H, Emanuelson U, Bard AM, Reyher KK, Forsberg L. Training in motivational interviewing improves cattle veterinarians' communication skills for herd health management. Vet Rec 2020; 187:191. [PMID: 32303667 PMCID: PMC7509394 DOI: 10.1136/vr.105646] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 02/22/2020] [Accepted: 03/08/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Communication skills to promote changes in management routines are especially important in veterinary herd health management (VHHM). Motivational interviewing (MI) is a communication methodology shown to be effective in stimulating client behaviour change. This study aimed to evaluate a 6-month MI-training programme for veterinarians. METHODS Thirty-eight cattle veterinarians gathered in groups of four to eight at six workshops separated by 3-4 weeks, during which they read literature and practised their skills. MI skills were evaluated before and after training using audio recordings of role-play conversations with professional actors. Recordings were coded using the MI Treatment Integrity Code (MITI) V.4.2.1. The effect of training was evaluated by 16 regression models. Participants filled in questionnaires about their experiences. RESULTS All participants improved their MI skills after training in at least one parameter and significant improvements were found in all but 3 of the 16 statistically evaluated MITI variables. The mean (25th-75th percentiles) ratings of the veterinarians' perceived relevance of MI skills in their work was 4.9 (4.0-6.0) and of their satisfaction with the programme was 5.1 (5.0-6.0) on a 6-point Likert scale. CONCLUSIONS Results show that MI training was perceived to be useful and relevant and successfully improved veterinarians' communication skills in VHHM.
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Affiliation(s)
- Catarina Svensson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Ulf Emanuelson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Alison M Bard
- Bristol Veterinary School, University of Bristol, Bristol, UK
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Sheen J, Sutherland‐Smith W, Thompson E, Youssef GJ, Dudley A, King R, Hall K, Dowling N, Gurtman C, McGillivray JA. Evaluating the impact of simulation‐based education on clinical psychology students' confidence and clinical competence. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jade Sheen
- School of PsychologyDeakin University Geelong Victoria Australia
| | | | - Emma Thompson
- School of PsychologyDeakin University Geelong Victoria Australia
| | - George J. Youssef
- School of PsychologyDeakin University Geelong Victoria Australia
- Centre for Adolescent HealthMurdoch Children's Research Institute Melbourne Victoria Australia
| | - Amanda Dudley
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Ross King
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Kate Hall
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Nicki Dowling
- School of PsychologyDeakin University Geelong Victoria Australia
- Melbourne Graduate School of EducationThe University of Melbourne Melbourne Victoria Australia
| | - Clint Gurtman
- School of PsychologyDeakin University Geelong Victoria Australia
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Minen MT, Sahyoun G, Gopal A, Levitan V, Pirraglia E, Simon NM, Halpern A. A Pilot Randomized Controlled Trial to Assess the Impact of Motivational Interviewing on Initiating Behavioral Therapy for Migraine. Headache 2020; 60:441-456. [PMID: 31981227 DOI: 10.1111/head.13738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Relaxation, biofeedback, and cognitive behavioral therapy are evidence-based behavioral therapies for migraine. Despite such efficacy, research shows that only about half of patients initiate behavioral therapy recommended by their headache specialists. OBJECTIVE Motivational interviewing (MI) is a widely used method to help patients explore and overcome ambivalence to enact positive life changes. We tested the hypothesis that telephone-based MI would improve initiation, scheduling, and attending behavioral therapy for migraine. METHODS Single-blind randomized controlled trial comparing telephone-based MI to treatment as usual (TAU). Participants were recruited during their appointments with headache specialists at two sites of a New York City medical center. INCLUSION CRITERIA ages from 16 to 80, migraine diagnosis by United Council of Neurologic Subspecialty fellowship trained and/or certified headache specialist, and referral for behavioral therapy for prevention in the appointment of recruitment. EXCLUSION CRITERIA having done behavioral therapy for migraine in the past year. Participants in the MI group received up to 5 MI calls. TAU participants were called after 3 months for general follow-up data. The prespecified primary outcome was scheduling a behavioral therapy appointment, and secondary outcomes were initiating and attending a behavioral therapy appointment. RESULTS 76 patients were enrolled and randomized (MI = 36, TAU = 40). At baseline, the mean number of headache days was 12.0 ± 9.0. Self-reported anxiety was present for 36/52 (69.2%) and depression for 30/52 (57.7%). Follow-up assessments were completed for 77.6% (59/76, MI = 32, TAU = 27). The mean number of MI calls per participant was 2.69 ± 1.56 [0 to 5]. There was a greater likelihood of those in the MI group to initiating an appointment (22/32, 68.8% vs 11/27, 40.7%, P = .0309). There were no differences in appointment scheduling or attendance. Reasons stated for not initiating behavioral therapy were lack of time, lack of insurance/funding, prioritizing other treatments, and travel plans. CONCLUSIONS Brief telephone-based MI may improve rates of initiation of behavioral therapy for migraine, but other barriers appear to lessen the impact on scheduling and attending behavioral therapy appointments.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Gabriella Sahyoun
- Department of Neuroscience, Barnard College, Columbia University, New York, NY, USA
| | - Ariana Gopal
- Department of Biology, The City College of New York, City University of New York, New York, NY, USA
| | - Valeriya Levitan
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Elizabeth Pirraglia
- Department of Population, Biostatistics Division, New York University Langone Health, New York, NY, USA
| | - Naomi M Simon
- Department of Psychiatry, New York University Langone Health, New York, NY, USA
| | - Audrey Halpern
- Department of Neurology, New York University Langone Health, New York, NY, USA
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Satre DD, Anderson AN, Leibowitz AS, Levine-Hall T, Slome S, Flamm J, Hare CB, McNeely J, Weisner CM, Horberg MA, Volberding P, Silverberg MJ. Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: Protocol for the Promoting Access to Care Engagement (PACE) trial. Contemp Clin Trials 2019; 84:105833. [PMID: 31446142 PMCID: PMC6760257 DOI: 10.1016/j.cct.2019.105833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) and psychiatric disorders are common among people with HIV (PWH) and lead to poor outcomes. Yet these conditions often go unrecognized and untreated in primary care. METHODS The Promoting Access to Care Engagement (PACE) trial currently in process examines the impact of self-administered electronic screening for SUD risk, depression and anxiety in three large Kaiser Permanente Northern California primary care clinics serving over 5000 PWH. Screening uses validated measures (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]; and the Adult Outcomes Questionnaire [AOQ], which includes the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-2]) delivered via three modalities (secure messaging, tablets in waiting rooms, and desktop computers in exam rooms). Results are integrated automatically into the electronic health record. Based on screening results and physician referrals, behavioral health specialists embedded in primary care initiate motivational interviewing- and cognitive behavioral therapy-based brief treatment and link patients to addiction and psychiatry clinics as needed. Analyses examine implementation (screening and treatment rates) and effectiveness (SUD, depression and anxiety symptoms; HIV viral control) outcomes using a stepped-wedge design, with a 12-month intervention phase implemented sequentially in the clinics, and a 24-month usual care period prior to implementation in each clinic functioning as sequential observational phases for comparison. We also evaluate screening and treatment costs and implementation barriers and facilitators. DISCUSSION The study examines innovative, technology-facilitated strategies for improving assessment and treatment in primary care. Results may help to inform substance use, mental health, and HIV services. TRIAL REGISTRATION NCT03217058.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Alexandra N Anderson
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Amy S Leibowitz
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Sally Slome
- Kasier Permanente Oakland Medical Center, 3801 Howe St, Oakland, CA 94611, United States of America
| | - Jason Flamm
- Kaiser Permanente Sacramento Medical Center, 2025 Morse Ave, Sacramento, CA 95825, United States of America
| | - C Bradley Hare
- Kaiser Permanente San Francisco Medical Center, 2238 Geary Blvd, San Francisco, CA 94115, United States of America
| | - Jennifer McNeely
- New York University School of Medicine, 550 1st Ave., New York, NY 10016, United States of America
| | - Constance M Weisner
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 East Jefferson, Rockville, MD 20852, United States of America
| | - Paul Volberding
- AIDS Research Institute, University of California San Francisco, San Francisco, CA, 94158, United States of America
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
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Lim D, Schoo A, Lawn S, Litt J. Embedding and sustaining motivational interviewing in clinical environments: a concurrent iterative mixed methods study. BMC MEDICAL EDUCATION 2019; 19:164. [PMID: 31118005 PMCID: PMC6529989 DOI: 10.1186/s12909-019-1606-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/13/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Motivational interviewing (MI) is internationally recognised as an effective intervention to facilitate health-related behaviour change; although, how it is best implemented and maintained in everyday clinical practice is not so clear. The aim of this study is to understand how MI as an intervention can be embedded and sustained in the clinical practice and learning environments. METHODS A concurrent iterative mixed methodology was utilised. Data collection occurred in two parts: a scoping review to identify reported barriers and enablers to embedding and sustaining MI in healthcare settings, and a survey of health professionals at an international clinical educator workshop on the topic. Results from both methods were integrated at the analysis phase ('following a thread') to understand how MI is embedded and the fidelity sustained in the clinical environments. Complexity theory as a conceptualising framework was utilised. RESULTS Eleven studies were included, and 30 health professionals were surveyed. Sustainability of MI at micro-clinical levels can be fostered through use of enabling technology, focus on patient-centred care, personnel development and process improvement. At the meso-organisational level, developing shared vision, creating opportunities and an organisational culture supportive of continuous learning are relevant issues. At the macro levels, adopting systems thinking and a learning organisation approach is important for sustaining MI. CONCLUSIONS In addressing the recognised barriers to embedding and sustaining MI in health service provisions, clinical educators could potentially play a central role as change agents within and across the complex clinical system.
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Affiliation(s)
- David Lim
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
- Centre for Remote Health: a Johanna Briggs Institute Affiliated Group, Flinders University, Alice Spring, Australia
| | - Adrian Schoo
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - John Litt
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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Arkkukangas M, Hultgren S. Implementation of motivational interviewing in a fall prevention exercise program: experiences from a randomized controlled trial. BMC Res Notes 2019; 12:270. [PMID: 31088557 PMCID: PMC6518683 DOI: 10.1186/s13104-019-4309-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/08/2019] [Indexed: 11/27/2022] Open
Abstract
Objective The elderly population over 65 is increasing globally, and interventions promoting health and preventive work, especially fall prevention, will constitute a large part of physiotherapists’ duties in the near future. To address the challenges of promoting effective and sustainable health behavior changes among older persons, physiotherapists need support when it comes to how to apply behavior change strategies, especially in fall prevention. Therefore, the aim of this study was to describe implementation of motivational interviewing in a fall prevention exercise program. This study is a side product of another project. Results Data from a recently performed three-armed randomized controlled trial were used to describe the implementation of motivational interviewing in the exercise group (n = 58). Level of motivation (priorities) and self-efficacy for both the physiotherapist and the participant in treatment, and to use a guide targeted towards the planned treatment are recommended actions. Regular meetings and follow ups as well as updates of motivational interviewing skills during a treatment period, should also be considered to achieve treatment fidelity. Trial registration NCT01778972, Retrospectively registered January 29, 2013
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Affiliation(s)
- Marina Arkkukangas
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593, 751 24, Uppsala, Sweden. .,Center for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
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Fortune J, Breckon J, Norris M, Eva G, Frater T. Motivational interviewing training for physiotherapy and occupational therapy students: Effect on confidence, knowledge and skills. PATIENT EDUCATION AND COUNSELING 2019; 102:694-700. [PMID: 30482468 DOI: 10.1016/j.pec.2018.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/01/2018] [Accepted: 11/17/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine the effectiveness of a three-day training programme on knowledge, confidence and fidelity to Motivational Interviewing (MI) delivery in an undergraduate occupational therapy and physiotherapy cohort (n = 25). METHODS Training outcomes were assessed pre-training, post-training and following a subsequent clinical placement. The Motivational Interviewing Knowledge and Attitudes Test (MIKAT) and an 8-item survey assessed knowledge, attitudes and confidence respectively. MI fidelity was evaluated by a simulated patient interview rated with the Motivational Interviewing Treatment Integrity scale (MITI). Analysis was by one-way repeated measures ANOVA. RESULTS Self-report measurements indicated increased confidence but no effect on knowledge or attitude. MITI analysis showed superior performance in all four global criteria and an increased frequency of MI adherent behaviours post-training. Positive changes were maintained following clinical placement. MITI summary scores indicated an improvement in question to reflection ratio in line with beginner competency. CONCLUSION(S) Participation in a three-day MI training programme significantly improved student confidence and MI skilfulness. PRACTICE IMPLICATIONS Where feasible, MI training should be embedded within the curriculum. Further research is needed elucidate the best practices to incorporate teaching this skill set within the curriculum in order to best prepare students to counsel clients in behaviour change in their applied settings.
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Affiliation(s)
- Jennifer Fortune
- Department of Clinical Sciences, Brunel University London, Middlesex, UB8 3PH, UK.
| | - Jeff Breckon
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP, UK.
| | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, Middlesex, UB8 3PH, UK.
| | - Gail Eva
- Department of Clinical Sciences, Brunel University London, Middlesex, UB8 3PH, UK.
| | - Tai Frater
- Department of Clinical Sciences, Brunel University London, Middlesex, UB8 3PH, UK.
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Igniting activation: Using unannounced standardized patients to measure patient activation in smoking cessation. Addict Behav Rep 2019; 9:100179. [PMID: 31193839 PMCID: PMC6544561 DOI: 10.1016/j.abrep.2019.100179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction Despite a decline, smoking rates have remained high, especially in communities with lower income, education, and limited insurance options. Evidence shows that physician-initiated counseling on smoking cessation is effective and saves lives, and that specific skills are needed to appropriately lead this type of patient-physician communication. Residency is a critical moment for future physicians and may be the optimal time to learn, practice, and refine this skillset. Unannounced Standardized Patients (USPs) have been found to be effective, incognito evaluators of resident practices. Methods This study introduced rigorously trained actors (USPs) into two urban, safety-net clinics to assess resident ability to engage, activate, and counsel a pre-contemplative smoker. A complementary chart review assessed appropriate documentation in the patient's electronic health record (EHR) and its relationship to counseling style and prescribing practices. Results Resident scores (% well done) on patient education and engagement were low (33% and 23%, respectively). Residents who coupled cessation advice with an open discussion style activated their patients more than those who solely advised cessation across all comparable measures. On EHR documentation, residents who accurately documented smoking history were more likely to directly advise their patient to quit smoking when compared to residents who did not document (t(97) = 2.828, p = .006, Cohen's D = 0.56). Conclusions Results highlight the need to reinforce training in patient-centered approaches including motivational interviewing, counseling, and shared decision-making. Future research should focus on the effects of smokers in pre-contemplation on physician counseling style and examine the relationship between medical training and provider communication to guide interventions. Counseling, documentation, and prescribing all vary when residents meet an Unannounced Standardized Patient (USP) smoker. Patients are activated to quit smoking when a provider couples cessation advice with an open discussion of pros and cons. Training in motivational interviewing and shared decision-making can enhance patient-provider cessation communication.
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Braillon A. Care for Smoking Cessation Must Be Proactive and Based on a Combination of Pharmacology and Psychology. Oncologist 2019; 24:e607. [PMID: 30890625 DOI: 10.1634/theoncologist.2018-0817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/18/2019] [Indexed: 11/17/2022] Open
Abstract
This letter to the editor comments on a recently published article calling for more effective smoking cessation methods for cancer patients and suggests that smoking cessation must be a priority for all, not just for patients with cancer.
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Vallabhan MK, Jimenez EY, Nash JL, Gonzales-Pacheco D, Coakley KE, Noe SR, DeBlieck CJ, Summers LC, Feldstein-Ewing SW, Kong AS. Motivational Interviewing to Treat Adolescents With Obesity: A Meta-analysis. Pediatrics 2018; 142:peds.2018-0733. [PMID: 30348753 PMCID: PMC6317566 DOI: 10.1542/peds.2018-0733] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Successful treatment approaches are needed for obesity in adolescents. Motivational interviewing (MI), a counseling approach designed to enhance behavior change, shows promise in promoting healthy lifestyle changes. OBJECTIVE Conduct a systematic review of MI for treating overweight and obesity in adolescents and meta-analysis of its effects on anthropometric and cardiometabolic outcomes. DATA SOURCES We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, Web of Science, Cochrane Library, and Google Scholar from January 1997 to April 2018. STUDY SELECTION Four authors reviewed titles, abstracts, and full-text articles. DATA EXTRACTION Two authors abstracted data and assessed risk of bias and quality of evidence. RESULTS Seventeen studies met inclusion criteria; 11 were included in the meta-analysis. There were nonsignificant effects on reducing BMI (mean difference [MD] -0.27; 95% confidence interval -0.98 to 0.44) and BMI percentile (MD -1.07; confidence interval -3.63 to 1.48) and no discernable effects on BMI z score, waist circumference, glucose, triglycerides, cholesterol, or fasting insulin. Optimal information size necessary for detecting statistically significant MDs was not met for any outcome. Qualitative synthesis suggests MI may improve health-related behaviors, especially when added to complementary interventions. LIMITATIONS Small sample sizes, overall moderate risk of bias, and short follow-up periods. CONCLUSIONS MI alone does not seem effective for treating overweight and obesity in adolescents, but sample size and study dose, delivery, and duration issues complicate interpretation of the results. Larger, longer duration studies may be needed to properly assess MI for weight management in adolescents.
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Affiliation(s)
- Monique K. Vallabhan
- Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, and
| | - Elizabeth Y. Jimenez
- Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, and,Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Jacob L. Nash
- University of New Mexico Health Sciences Library and Informatics Center, Albuquerque, New Mexico
| | | | - Kathryn E. Coakley
- Nutrition Program, Department of Individual, Family, and Community Education
| | - Shelly R. Noe
- School of Nursing, New Mexico State University, Las Cruces, New Mexico; and
| | - Conni J. DeBlieck
- School of Nursing, New Mexico State University, Las Cruces, New Mexico; and
| | - Linda C. Summers
- School of Nursing, New Mexico State University, Las Cruces, New Mexico; and
| | - Sarah W. Feldstein-Ewing
- Division of Clinical Psychology, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Alberta S. Kong
- Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, and
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Frost H, Campbell P, Maxwell M, O’Carroll RE, Dombrowski SU, Williams B, Cheyne H, Coles E, Pollock A. Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS One 2018; 13:e0204890. [PMID: 30335780 PMCID: PMC6193639 DOI: 10.1371/journal.pone.0204890] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 09/17/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The challenge of addressing unhealthy lifestyle choice is of global concern. Motivational Interviewing has been widely implemented to help people change their behaviour, but it is unclear for whom it is most beneficial. This overview aims to appraise and synthesise the review evidence for the effectiveness of Motivational Interviewing on health behaviour of adults in health and social care settings. METHODS A systematic review of reviews. Methods were pre-specified and documented in a protocol (PROSPERO-CRD42016049278). We systematically searched 7 electronic databases: CDSR; DARE; PROSPERO; MEDLINE; CINAHL; AMED and PsycINFO from 2000 to May 2018. Two reviewers applied pre-defined selection criteria, extracted data using TIDIER guidelines and assessed methodological quality using the ROBIS tool. We used GRADE criteria to rate the strength of the evidence for reviews including meta-analyses. FINDINGS Searches identified 5222 records. One hundred and four reviews, including 39 meta-analyses met the inclusion criteria. Most meta-analysis evidence was graded as low or very low (128/155). Moderate quality evidence for mainly short term (<6 months) statistically significant small beneficial effects of Motivational Interviewing were found in 11 of 155 (7%) of meta-analysis comparisons. These outcomes include reducing binge drinking, frequency and quantity of alcohol consumption, substance abuse in people with dependency or addiction, and increasing physical activity participation. CONCLUSIONS We have created a comprehensive map of reviews relating to Motivational Interviewing to signpost stakeholders to the best available evidence. More high quality research is needed to be confident about the effectiveness of Motivational Interviewing. We identified a large volume of low quality evidence and many areas of overlapping research. To avoid research waste, it is vital for researchers to be aware of existing research, and the implications arising from that research. In the case of Motivational Interviewing issues relating to monitoring and reporting fidelity of interventions need to be addressed.
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Affiliation(s)
- Helen Frost
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Scotland, United Kingdom
| | - Pauline Campbell
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), Glasgow Caledonian University, Glasgow, United Kingdom
| | - Margaret Maxwell
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Ronan E. O’Carroll
- School of Health Sciences, Division of Psychology, University of Stirling, Stirling, Scotland, United Kingdom
| | - Stephan U. Dombrowski
- School of Health Sciences, Division of Psychology, University of Stirling, Stirling, Scotland, United Kingdom
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Scotland, United Kingdom
| | - Helen Cheyne
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Emma Coles
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Alex Pollock
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), Glasgow Caledonian University, Glasgow, United Kingdom
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Madson MB, Villarosa-Hurlocker MC, Schumacher JA, Williams DC, Gauthier JM. Motivational interviewing training of substance use treatment professionals: A systematic review. Subst Abus 2018; 40:43-51. [PMID: 29949449 DOI: 10.1080/08897077.2018.1475319] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Through evaluations of training programs, systematic reviews, and meta-analyses, advances in identifying best practices for disseminating motivational interviewing (MI) have emerged. To advance this work further, inclusion of thorough descriptions of the following is needed in research publications: study (design, trainee characteristics, setting characteristics), training and coaching methods (if applicable), trainer qualifications, and evaluation of MI skills. Methods: The purpose of this study was to systematically evaluate the research on MI training of substance use treatment professionals for the inclusion of such descriptions. Twenty-five studies were reviewed using a scoring rubric developed by the authors. Results: Just over two thirds of the studies (68%) were randomized controlled trials of MI training. The majority of studies provided information about (a) trainee characteristics (professional background = 76%, education = 60%, experience = 56%); (b) setting characteristics (80%); (c) training methods (format = 96%, length = 92%); (d) coaching (76%); and (e) evaluation of MI skills (92%). Conclusion: Findings suggest advancements in MI training studies since previous reviews, especially in regards to the inclusion of feedback and coaching. However, this review also found that inconsistencies in methods and reporting of training characteristics, as well as limited follow-up assessment of trainees' skill, continue to limit knowledge of effective training methods.
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Affiliation(s)
- Michael B Madson
- a Department of Psychology , The University of Southern Mississippi , Hattiesburg , Mississippi, USA
| | - Margo C Villarosa-Hurlocker
- a Department of Psychology , The University of Southern Mississippi , Hattiesburg , Mississippi, USA.,b Center on Alcoholism , Substance Abuse, and Addictions, Albuquerque, New Mexico, USA
| | - Julie A Schumacher
- c University of Mississippi Medical Center, Jackson, Mississippi, USA.,d Prevention Research Institute, Lexington, Kentucky, USA
| | - Daniel C Williams
- c University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jami M Gauthier
- c University of Mississippi Medical Center, Jackson, Mississippi, USA
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Kinney AY, Howell R, Ruckman R, McDougall JA, Boyce TW, Vicuña B, Lee JH, Guest DD, Rycroft R, Valverde PA, Gallegos KM, Meisner A, Wiggins CL, Stroup A, Paddock LE, Walters ST. Promoting guideline-based cancer genetic risk assessment for hereditary breast and ovarian cancer in ethnically and geographically diverse cancer survivors: Rationale and design of a 3-arm randomized controlled trial. Contemp Clin Trials 2018; 73:123-135. [PMID: 30236776 PMCID: PMC6214814 DOI: 10.1016/j.cct.2018.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although national guidelines for cancer genetic risk assessment (CGRA) for hereditary breast and ovarian cancer (HBOC) have been available for over two decades, less than half of high-risk women have accessed these services, especially underserved minority and rural populations. Identification of high-risk individuals is crucial for cancer survivors and their families to benefit from biomedical advances in cancer prevention, early detection, and treatment. METHODS This paper describes community-engaged formative research and the protocol of the ongoing randomized 3-arm controlled Genetic Risk Assessment for Cancer Education and Empowerment (GRACE) trial. Ethnically and geographically diverse breast and ovarian cancer survivors at increased risk for hereditary cancer predisposition who have not had a CGRA are recruited through the three statewide cancer registries. The specific aims are to: 1) compare the effectiveness of a targeted intervention (TP) vs. a tailored counseling and navigation(TCN) intervention vs. usual care (UC) on CGRA utilization at 6 months post-diagnosis (primary outcome); compare the effectiveness of the interventions on genetic counseling uptake at 12 months after removal of cost barriers (secondary outcome); 2) examine potential underlying theoretical mediating and moderating mechanisms; and 3) conduct a cost evaluation to guide dissemination strategies. DISCUSSION The ongoing GRACE trial addresses an important translational gap by developing and implementing evidence-based strategies to promote guideline-based care and reduce disparities in CGRA utilization among ethnically and geographically diverse women. If effective, these interventions have the potential to reach a large number of high-risk families and reduce disparities through broad dissemination. TRIAL REGISTRATION NUMBER NCT03326713; clinicaltrials.gov.
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Affiliation(s)
- Anita Y Kinney
- Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, Jersey; Cancer Institute of New Jersey, Rutgers University, New Brunswick, Jersey.
| | - Rachel Howell
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Rachel Ruckman
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Jean A McDougall
- Department of Internal Medicine, University of New Mexico, Albuquerque, Mexico; Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Tawny W Boyce
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Belinda Vicuña
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico; Department of Psychology, University of New Mexico, Albuquerque, Mexico
| | - Ji-Hyun Lee
- Department of Internal Medicine, University of New Mexico, Albuquerque, Mexico; Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Dolores D Guest
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Randi Rycroft
- Colorado Central Cancer Registry, Colorado Department of Public Health and Environment, Denver, CO, United States
| | - Patricia A Valverde
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | | | - Angela Meisner
- New Mexico Tumor Registry, University of New Mexico, Albuquerque, Mexico
| | - Charles L Wiggins
- Department of Internal Medicine, University of New Mexico, Albuquerque, Mexico; Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico; New Mexico Tumor Registry, University of New Mexico, Albuquerque, Mexico
| | - Antoinette Stroup
- Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, Jersey; Cancer Institute of New Jersey, Rutgers University, New Brunswick, Jersey
| | - Lisa E Paddock
- Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, Jersey; Cancer Institute of New Jersey, Rutgers University, New Brunswick, Jersey
| | - Scott T Walters
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, School of Public Health, Fort Worth, TX, United States
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Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training and Implementation: Perspectives from 4 Health Professions. J Addict Med 2018; 12:262-272. [DOI: 10.1097/adm.0000000000000410] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Implementing Motivational Interviewing (MI) in primary care settings has been problematic due in part to persistent gaps in knowledge. Examples include poor understanding of how to effectively train persons to conduct MI, or of which aspects of MI-related communication are associated with better outcomes for patients. This review describes how recent research findings addressing the knowledge gaps support a growing role for MI in primary care. RECENT FINDINGS Two trials of MI training combined classroom time with ongoing coaching and feedback, resulting in enhanced MI ability relative to a control arm where PCPs received minimal or no MI training. A third MI training trial excluded coaching and feedback, failing to increase use of MI. Adding to a growing list of behavioral health-related problems for which MI training has shown some effectiveness, a trial of training PCPs to use MI with depressed patients was associated with significantly improved depressive symptoms. Moreover, aspects of the PCPs' MI-related language and patients' arguments for positive behavior changes, "change talk," appeared to explain the positive effects of MI training on depression outcome. MI-training approaches have improved such that PCPs and possibly other clinic staff may want to consider MI training as a way to more effectively support their patients as they address behavioral health-related problems (e.g., tobacco use). MI training should focus on eliciting "change talk" from patients. Researchers and funding agencies might collaborate to continue closing knowledge gaps in the MI literature.
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