Richard N. Cloud PhD

University of Louisville, Louisville, Kentucky, United States

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Publications (16)4.46 Total impact

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    Lee Ridner · Michael Ostapchuk · Richard N. Cloud · John Myers · Anna Jorayeva · Jiying Ling ·
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    ABSTRACT: Objectives: To compare the effects of resident physician motivational interviewing (MI), resident physician MI plus registered nurse (RN), and the standard of care counseling approach--ask, advise, assess, assist, and arrange follow-up (5 As)--on current smokers' behaviors (readiness to quit, cigarettes smoked per day, current smoking rates), self-efficacy to quit smoking, and nicotine dependence. Methods: The study design was quasi-experimental pretest/posttest with a comparison group. Pencil/paper measures were completed in the clinic setting at baseline and via telephone approximately 1 and 2 months after the clinic visit. Results: There were no differences among the three groups in the proportion of participants who quit smoking, and the stages of change did not differ among the groups or over time. There was a significant time effect and a decrease in the number of cigarettes smoked per day (F2,160 = 41.04, P < 0.001). Significant group × time interactions were present for self-efficacy (F4,140 = 8.20, P < 0.001), nicotine dependence (F4,140 = 6.22, P < 0.001) and satisfaction with clinician (F4,160 = 3.81, P = 0.006). Post hoc analyses showed that participants in the MI groups smoked fewer cigarettes, had higher self-efficacy, and had lower nicotine dependence scores. Only participants in the MD-plus-RN follow-up group had significant positive changes in satisfaction scores. Conclusions: Resident physicians who use MI techniques have a tremendous effect on patients' smoking behaviors. When the resident physician and the RN worked together, participants achieved better outcomes.
    Southern Medical Journal 05/2014; 107(5):314-319. DOI:10.1097/SMJ.0000000000000106 · 0.93 Impact Factor
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    ABSTRACT: The purpose of this study was to determine the effect of a motivational interviewing intervention (MII) on regimen adherence and diabetes markers among African Americans with diabetes. Sixty-two participants were assigned to the usual care (UC; n = 36) or MII (n = 26) groups. UC participants received the usual clinic care. MII participants received a maximum of six motivational interviewing (MI) sessions over 3 months. Outcome variables were obtained at baseline and 3-month follow-up. Data were obtained using medical records, self-reports, and glucose monitor and accelerometer print-outs. MII significantly increased the odds of participants adhering to recommended physical activity level (66.7% vs. 38.8%, odds ratio = 2.92, 95% confidence interval = [1.6, 14.3], p = .018) and significantly decreased glucose levels (p = .043) and body mass index (p = .046) over time when compared with UC. Findings support using MI as an intervention for improving health outcomes and regimen adherence rates among the study population.
    Western Journal of Nursing Research 04/2014; 37(5). DOI:10.1177/0193945914530522 · 1.03 Impact Factor
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    ABSTRACT: We describe interventionist training procedures for a pilot intervention study that tested the effects of a nurse-delivered Motivational Interviewing (MI) intervention on diabetes self-care among adults diagnosed with type 2 diabetes mellitus. It reports on findings from MI fidelity assessments. Training consisted of didactic workshops plus practicum. Fidelity of MI was assessed using the MI Treatment Integrity (MITI) Scale. Fidelity assessments were conducted on 18 (25%) audiotaped MI sessions, which were randomly selected from a total of 72 sessions with 26 participants. Scores of the MITI were in the proficient and competent range. Results suggest that training strategies were sufficient to promote satisfactory interventionist fidelity to MI.
    Research in Nursing & Health 06/2012; 35(3):289-300. DOI:10.1002/nur.21472 · 1.27 Impact Factor
  • Andy Frey · Hill Walker · John Seeley · Ed Feil · Jon Lee · Jason Small · Richard N. Cloud · Annemeike Golly ·
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    ABSTRACT: Purpose & Background: The need for interventions that are effective with children who display severely challenging behavior is substantial. This presentation will focus on the results of an Institute of Education Sciences (IES) grant to bolster the First Step to Success program (Walker, et al. 1998). The program enhancements, designed to extend its applicability to students with severe behavior problems, include revisions to the home and class components; the enhancements were inspired by the theory and practices associated with applications of motivational interviewing in school based settings (Dishion & Stormshak, 2007; Miller and Rollnick's, 2002; Reinke, Lewis-Palmer, & Merrell, 2008). Consistent with the IES goal structure, the primary purpose was to develop a fully manualized intervention and measurement protocol, assess the social validity of the enhancement, and demonstrate the promise of the intervention in preparation for an efficacy trial. Methods: The iterative development process included several waves of revision following consultation with an advisory board; implementation; and analysis of screening, fidelity, process and outcome data. This presentation will highlight findings from the pilot phase, which involved implementing the initial version of the enhanced protocols via an open-case design (N = 9). Process data included measures of satisfaction, coach-parent alignment, and parental stress. Outcome measures, collected at baseline and posttest, consisted of teacher and parent reports of social skills and problem behaviors (Social Skills Improvement System rating scales (SSiS); Gresham & Elliott, 2008), and direct observation of children's academically engaged time and peer social interactions. Results: All children (100%) completed the school component eight parents (89%) completed the home component. Mean ratings across the 5-point parent satisfaction survey ranged from 4.4 to 4.8, with overall mean ratings of parent satisfaction of parents of children from self-contained (M = 4.6; SD = 0.5) and general education settings (4.8; SD = 0.3) were favorable. All seven respondents of the parent interviews identified benefits of the home services and more than half of the parents indicated that home activities were enjoyable and resulted in increased parent-child interaction. To examine responsiveness to the intervention we computed a reliable change index (RCI) to assess whether the change in functioning was statistically reliable (Jacobson & Truax, 1991). An RCI score was calculated for each student by computing the difference between observed baseline and post intervention scores and dividing by the standard error of measurement. Following the recommendations of Martinovich, Saunders, and Howard (1996), if an RCI score was greater than 1.96, the change was considered statistically reliable at p
    Society for Social Work and Research Sixteenth Annual Conference Research That Makes A Difference: Advancing Practice and Shaping Public Policy; 01/2012
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    ABSTRACT: This study compared the 40-item Alcohol Abstinence Self-Efficacy (AASE) scale with domains of confidence and temptation to a new 12-item version developed by the authors consisting of the same domains. There were 126 participants who completed the survey. Psychometric analysis demonstrated high reliability and validity consisting of high correlations between domains of confidence (α = .92) and temptation (α = .88) in the 40-item version of the scale compared to the briefer version. The 12-item version appears to provide a clinically reliable and valid measure of AASE domains of confidence and temptation, providing a more efficient tool for clinical practice.
    Journal of Social Work Practice in the Addictions 07/2011; 11(3):245-253. DOI:10.1080/1533256X.2011.593445
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    ABSTRACT: In recent years, the science of developing and implementing interventions addressing school-related risk factors has produced many advances. This article addresses the promise of a cross-disciplinary practice approach known as motivational interviewing in school settings. Specifically, the supporting evidence as well as the process and principles of motivational interviewing are described for those unfamiliar with motivational interviewing nomenclature. A description of recent school-based innovations using the principles of motivational interviewing is then provided. Next, some potential applications for applying the motivational interviewing approach in educational settings to enhance the adoption, development, and implementation of effective school-based interventions designed to promote academic achievement and prevent or ameliorate challenging behavior are proposed. The article concludes with a discussion of future directions of motivational interviewing approaches within the context of school mental health. KeywordsMotivational interviewing–Intervention research–Fidelity
    School Mental Health 03/2011; 3(1):1-12. DOI:10.1007/s12310-010-9048-z
  • R Lyle Cooper · Richard Cloud · Karl Besel · Amanda J Bennett ·
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    ABSTRACT: This paper presents the findings of a formative evaluation used to guide the implementation of programming funded by an HIV/Treatment Capacity Expansion grant received from Substance Abuse and Mental Health Administration. Data were gathered from programmatic records regarding access to treatment, individual interviews with persons with HIV referred to treatment that did not attend, and interviews with persons with HIV currently receiving substance abuse treatment. Findings connected to record review indicate that the program is functioning in accordance with current model standards, while interviews indicated several barriers to access. Suggestions are offered to improve the implementation of substance abuse treatment to persons living with HIV/AIDS.
    Journal of Evidence-Based Social Work 02/2010; 7(1):115-29. DOI:10.1080/15433710903175999
  • Richard N Cloud · J B Kingree ·
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    ABSTRACT: Researchers have observed that a majority of addicted persons who are encouraged and facilitated by treatment providers to attend twelve-step (TS) programs either drop out or sporadically use twelve-step programs following treatment. This is troubling given considerable evidence of TS program benefits associated with regular weekly attendance and ubiquitous reliance by treatment professionals on these programs to provide important support services. This chapter reviews and advances theory of TS utilization and dose that is supported by prior research, multivariate models, and scales that predict risk of TS meeting underutilization. Advancing theory should organize and clarify the process of initial utilization, guide intervention development, and improve adherence of TS program referrals, all of which should lead to improved treatment planning and better outcomes. Three theories are integrated to explain processes that may influence TS program dose: the health belief model, self-determination theory (motivational theory), and a person-in-organization cultural fit theory. Four multidimensional scales developed specifically to predict participation are described. Implications for practice and future research are considered in a final discussion. Information contained in this chapter raises awareness of the need for TS-focused treatments to focus on achieving weekly attendance during and after treatment.
    Recent developments in alcoholism: an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism 02/2008; 18:283-301. DOI:10.1007/978-0-387-77725-2_16

  • Richard N. Cloud PhD · Noell Rowan PhD · Dan Wulff PhD · Seana Golder PhD ·
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    ABSTRACT: Treatment outcome research has repeatedly demonstrated that involvement in twelve-step (TS) programs (e.g., Alcoholics Anonymous or Narcotics Anonymous) following treatment is associated with improved substance use outcomes. Treatment providers widely encourage TS program attendance during treatment and for aftercare; yet, evidence suggests that minimal and sporadic attendance or complete dropout is the more common occurrence. Providers would benefit from knowledge that would contribute to a greater understanding of factors that influence posttreatment TS program affiliation or dropout to guide treatment strategies. This article reviews the literature on TS affiliation, advances theory and a model to explain affiliation, and reports findings from a qualitative research study focused on understanding what people in TS facilitative treatment report as good (the pros) and not so good (the cons) about TS program involvement. Results suggest that unresolved ambivalence as well as socio-cultural barriers to support contribute to poor TS program utilization.
    Journal of Social Work Practice in the Addictions 01/2007; 7(4):49-74. DOI:10.1300/J160v07n04_04
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    ABSTRACT: Recent twelve-step (TS) program research has suggested a dose threshold consisting of minimum weekly TS meeting attendance that is necessary to derive substantial benefit. Unfortunately, other research has observed the vast majority of patients do not attend meetings or attend sporadically in the period following treatment. As another example of research advancing our understanding of recovery processes, numerous studies have refined adaptations of Motivational Interviewing (MI) into a change theory with proven practice methods. This paper reviews related literature and provides rationale for the use of a brief motivational intervention to increase TS program attendance. The paper concludes by addressing two possible problems to implementing such an intervention: (1) Resistance within the culture of the addiction counseling field and (2) a lack of objective and normative TS program feedback data. We respond to this latter gap in the literature by advancing possible specimen feedback data.
    Alcoholism Treatment Quarterly 10/2006; 24(3-3):31-53. DOI:10.1300/J020v24n03_03
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    ABSTRACT: Social workers often need a larger range of assessment scales to be used in education, research, and practice. The Higher Power Relationship Scale (HPRS) is a new brief instrument designed for easy administration and scoring that may be of use to social work educators, researchers, and practitioners, particularly those who work in the field of addictions. This paper describes the HPRS; provides information about its administration, scoring, and interpretation; and describes the initial research conducted to validate the scale. The results clearly indicate that the scale (1) has good reliability, (2) is strong enough in terms of its measurement error traits to recommend it for use in educational, research, and clinical settings, and (3) appears to be acceptable in terms of its content and construct validity. Preliminary use in chemically dependent settings illustrated the value of the scale in understanding respondents' relationships with a higher power and Alcoholics Anonymous affiliation.
    Journal of Social Work Practice in the Addictions 09/2006; 6(3-3):81-95. DOI:10.1300/J160v06n03_07
  • Richard N Cloud · Craig H Ziegler · Richard D Blondell ·
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    ABSTRACT: An increasing body of research evidence supports the use of 12-step program affiliation as an effective adjunct and aftercare for formal treatment. Recently, three brief (9- or 10-item) measures of affiliation have been developed. However, the brief scales are difficult to interpret, and the question of exactly what is affiliation (or disaffiliation) remains unclear. This analysis examines the question of what is the essence of affiliation vs. disaffiliation. Data from the Project MATCH 1-year posttreatment Alcoholics Anonymous Involvement (AAI) scale (N=1506) are used to identify the most salient items of Alcoholics Anonymous (AA) affiliation predicting 1-year posttreatment drinking outcomes. Analysis using stepwise regression suggests that a three-item solution can explain a similar amount of variance in the proportion of days abstinent in months 9 through 12 posttreatment, as does using the nine items. These three "core items predicting recovery" include AA attendance, sum of steps completed, and identifying self as an AA member. As an affiliation composite scale, these three items are easier to interpret and administer than the full AAI scale, and when combined, possess adequate reliability (alpha=0.72).
    Substance Use &amp Misuse 07/2004; 39(7):1117-36. DOI:10.1081/JA-120038032 · 1.23 Impact Factor
  • Richard N. Cloud · Patrick McKiernan · Lyle Cooper ·
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    ABSTRACT: Treatment systems within the U.S. are almost exclusively focused on abstinence as the goal of treatment for alcohol use disorders. This article reviews literature on the natural course of recovery from alcohol disorders and examines the role of testing control over drinking in the course of successful resolution of alcohol problems. Theory, quantitative and qualitative evidence support controlled drinking trials under certain conditions as a necessary and normal stage in the natural course of recovery. Empirical evidence suggests that some who are younger; who have less severe history of alcohol use; who have never been treated or diagnosed for alcohol disorders; who possess no family history of addiction; and who believe in self-efficacy over alcohol use could benefit from a single and well conceived controlled drinking trial. This article concludes with a summary of a controlled drinking treatment protocol that can coexist in abstinence-based treatment programs.
    Alcoholism Treatment Quarterly 09/2003; 21(4):67-82. DOI:10.1300/J020v21n04_06

    International Journal of Self Help and Self Care 02/2003; 2(2):135-153. DOI:10.2190/W3BX-9CUJ-9PGL-HW43
  • Pilot Study · Richard N. Cloud PhD · Patricia L. Peacock PhD ·
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    ABSTRACT: The alcohol screening and brief intervention literature suggest that many individuals become concerned about their drinking, seek help and are often aided with brief and simple interventions. The Internet provides an increasingly accessible, confidential, and low cost medium to deliver these services. A pilot Web site was developed to provide anonymous, confidential and fully automated screening and brief interventions. The test consisted of the AUDIT (screening), SOCRATES (readiness for treatment measures), and demographic and alcohol history questions. During the initial 172 day trial, over 10,000 individuals visited the Web site, of these, 2,813 took the screening and limited assessment test. Results generally suggest (1) that there is a sizable population seeking help on the Internet for drinking problems; (2) that AUDIT scores are surprisingly high; and (3) that most (94%) have not been professionally diagnosed.
    Alcoholism Treatment Quarterly 06/2001; 19(2-2):23-44. DOI:10.1300/J020v19n02_02