ArticlePDF Available

Training in motivational interviewing as a best training practice in pediatric psychology: Relationship to core competencies

Authors:

Abstract and Figures

This article describes an innovative Motivational Interviewing (MI) training that is included in the current training program for psychology interns and fellows (trainees) at 1 institution and outlines how this training experience aligns with multiple core training competencies for pediatric psychologists. MI is an evidence-based approach to behavior change counseling that is efficacious in motivating change in many health-risk behaviors. The training module adds systematic practice with simulated patients and objective feedback regarding adherence and fidelity to MI principles and strategies to traditional didactics. This state-of-the-art training is particularly beneficial to our pediatric psychology trainees, as it impacts treatment interventions with their patients and families and maps onto several of the new pediatric psychology competencies. Specific examples of training components are provided and demonstrate how the MI training module aligns with the pediatric psychology competencies in several clusters: crosscutting knowledge competencies in pediatric psychology, interpersonal, professionalism , and application. MI training is well-suited to be included in competency-based training in pediatric psychology.
Content may be subject to copyright.
Training in Motivational Interviewing as a Best Training Practice in
Pediatric Psychology: Relationship to Core Competencies
Stephen R. Gillaspy
and Catrina C. Litzenburg
University of Oklahoma
Thad R. Leffingwell
Oklahoma State University
Mary Beth Miller
Oklahoma State University and Brown University
This article describes an innovative Motivational Interviewing (MI) training that is
included in the current training program for psychology interns and fellows (trainees)
at 1 institution and outlines how this training experience aligns with multiple core
training competencies for pediatric psychologists. MI is an evidence-based approach to
behavior change counseling that is efficacious in motivating change in many health-risk
behaviors. The training module adds systematic practice with simulated patients and
objective feedback regarding adherence and fidelity to MI principles and strategies to
traditional didactics. This state-of-the-art training is particularly beneficial to our
pediatric psychology trainees, as it impacts treatment interventions with their patients
and families and maps onto several of the new pediatric psychology competencies.
Specific examples of training components are provided and demonstrate how the MI
training module aligns with the pediatric psychology competencies in several clusters:
crosscutting knowledge competencies in pediatric psychology, interpersonal, profes-
sionalism, and application. MI training is well-suited to be included in competency-
based training in pediatric psychology.
Keywords: competencies, motivational interviewing, pediatric psychology, training
The Society of Pediatric Psychology recently
proposed and defined six competencies that are
integral to training in pediatric psychology: sci-
ence, professionalism, interpersonal skills, ap-
plication of science, education, and systemic
approach, in addition to cross-cutting knowl-
edge (Palermo et al., 2014). Training in Moti-
vational Interviewing (MI) is particularly suited
to meeting these competencies and has been
successfully integrated into our pediatric train-
ing program for psychology interns and fellows
(trainees). Over the past seven years, this MI
training module has progressed from one to two
hours of didactic lectures; to a daylong work-
shop with live demonstrations of MI; to the
current module, which adds systematic practice
with simulated patients and objective feedback
regarding adherence and fidelity to MI princi-
ples and strategies to traditional didactics. The
current article describes this innovative MI
training and outlines how this experience aligns
with multiple core competencies for pediatric
psychologists.
Why Motivational Interviewing?
Obesity, tobacco use, and alcohol use have
been identified as significant problems contrib-
uting to poor health outcomes among pediatric
populations. Pediatric psychologists need to be
prepared to address these health behaviors in
primary care and specialty medical settings. The
Stephen R. Gillaspy and Catrina C. Litzenburg, Depart-
ment of Pediatrics, University of Oklahoma Health Sciences
Center, College of Medicine; Thad R. Leffingwell, Depart-
ment of Psychology, Oklahoma State University; Mary
Beth Miller, Department of Psychology, Oklahoma State
University and Department of Psychiatry and Human Be-
havior, Alpert Medical School of Brown University.
Correspondence concerning this article should be ad-
dressed to Stephen R. Gillaspy, Section of General & Com-
munity Pediatrics, University of Oklahoma Health Sciences
Center, College of Medicine, Department of Pediatrics,
1200 Children’s Avenue, Suite 12400, Oklahoma City, OK
73104. E-mail: Stephen-Gillaspy@ouhsc.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Clinical Practice in Pediatric Psychology © 2015 American Psychological Association
2015, Vol. 3, No. 3, 225–232 2169-4826/15/$12.00 http://dx.doi.org/10.1037/cpp0000106
225
American Academy of Pediatrics (AAP) has
issued position statements recommending that
pediatricians address obesity, tobacco, and al-
cohol use with patients (Barlow, 2007;Com-
mittee on Environmental Health, Committee on
Substance Abuse, Committee on Adolescence,
& Committee on Native American Child, 2009;
Committee on Substance Abuse, 2010). Brief
interventions utilizing the style of MI have been
featured in each of these policy recommenda-
tions as an evidence-based approach to address-
ing these health behaviors. The MI style is a
patient-centered approach that utilizes specific
interpersonal communication strategies to guide
patients toward an intrinsically motived and
committed decision to change health behaviors
while avoiding unsolicited advice, direct per-
suasion, or confrontation (Miller & Rollnick,
2013;Leffingwell, 2004). Although the core of
the MI style is a patient-centered approach uti-
lizing reflective listening and empathy within a
collaborative relationship, the style also in-
cludes a number of specific strategies and prin-
ciples.
MI has been found in adults to reduce sub-
stance misuse disorders (e.g., smoking, alcohol,
drug dependence) and enhance health behaviors
(e.g., exercise, diet; Burke, Arkowitz, & Men-
chola, 2003;Hettema, Steele, & Miller, 2005)
and in adolescents is effective addressing sub-
stance misuse (Jensen et al., 2011) and other
health behaviors (Cushing et al., 2014). The
opportunities for the pediatric psychologist to
utilize MI are numerous, including issues of
engagement and adherence to medical regimens
(e.g., diabetes, vaccinations, and transplant medi-
cations), and health-related lifestyle changes (diet
and physical activity).
Both theory and research indicate structured
practice with ongoing supervision and training
are integral to MI proficiency (Barwick et al.,
2012;Fu et al., 2015;Madson, Loignon, &
Lane, 2009;Miller & Rollnick, 2013), although
the importance of continued training may vary
based on baseline performance (Martino et al.,
2011). The majority of MI training programs
focus primarily on didactics and introductory
MI skills practice (Barwick et al., 2012;Madson
et al., 2009). The long-term impact of such
trainings is difficult to determine, as studies
vary considerably in methodology (Barwick et
al., 2012). However, in a randomized controlled
trial, Miller and colleagues (2004) demonstrated
that including feedback and individual coaching
to a more traditional workshop enhanced clini-
cians’ maintenance of clinical proficiency at 4,
8, and 12 months posttraining. Therefore, the
current training module incorporated MI coding
of structured practice sessions in order to pro-
vide trainees with feedback on their use of MI
skills and suggested areas for continued im-
provement.
MI Training Module
Training began with a 4-hr module aimed to
enhance psychology trainees’ understanding
and use of brief motivational interventions.
Content includes the evidence-base for MI in
medical settings, fundamental concepts of MI
theory and practice (including both global skills
and specific behaviors), and video examples of
MI-consistent and MI-inconsistent patient en-
counters. Trainees were provided with a copy of
workshop slides, transcripts of video examples,
a list of skills and behaviors that would be
coded during the simulated encounters, relevant
policy statements from the AAP, and several
peer-reviewed articles regarding the efficacy
and implementation of MI in health care set-
tings.
Training also included live practice using MI
and personalized feedback on MI adherence
during the simulated practice encounters. Be-
fore and immediately after the workshop, train-
ees participated in a brief (10 minutes) en-
counter with a professionally trained simulated
patient presenting with one of three medical
concerns, which are randomly assigned: child-
hood ear infections secondary to parental to-
bacco use, childhood obesity, or adolescent al-
cohol abuse. Simulated patients were given
limited information regarding the purpose of the
encounter in order to prevent expectations from
influencing their behavior. They were, however,
instructed to be ambivalent regarding the target
behavior (i.e., neither completely resistant nor
highly motivated to change).
After the encounter, trainees were provided
with detailed personalized feedback on MI per-
formance. Feedback included adherence based
on the MI Treatment Integrity (MITI) coding
scheme (Moyers et al., 2010) and self-report
measures completed by the trainee, the simu-
lated patient, and the trained observer. Within
the MITI code, cut-points for both beginning
226 GILLASPY, LITZENBURG, LEFFINGWELL, AND MILLER
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
proficiency and expert competence were pro-
vided. Beginning proficiency is indicated by
global MI ratings above 3.5, 90% MI adher-
ence, at least 50% open (vs. closed) questions,
at least 40% complex (vs. simple) reflections, a
1:1 reflection to question ratio, and allowing the
patient’s responses to constitute at least 40% of
the conversation. Competency is indicated by
global ratings above 4.0, 100% MI adherence,
at least 70% open questions, at least 50% com-
plex reflections, a 2:1 reflection to question ra-
tio, and patients’ talking at least 50% of the
time.
Advanced doctoral students with training in
the MITI system reviewed and coded the pre-
and posttraining encounters. They then pro-
vided trainees with detailed written feedback
1
regarding their adherence to MI in each encoun-
ter via electronic mail. Written feedback in-
cluded adherence to the five global MI skills
and use of specific MI behaviors (e.g., open
questions, complex reflections) in comparison
with proficiency and competency standards.
The global skills are intended to capture the
proscribed “spirit” or attitude of the MI conver-
sation: Evocation (vs. imparting or inserting
knowledge); Collaboration (vs. one-up, author-
itarian relationship); Autonomy-supportive (vs.
controlling); Direction (vs. avoidant, dis-
tracted); and Empathy (vs. dismissive, disre-
spectful).
Feedback also included self-ratings of behav-
ior change counseling skill (Lane et al., 2005)in
comparison with simulated patients’ and obser-
vational coders’ ratings of their performance.
Trainees received written positive reinforce-
ment for MI-consistent behaviors and were pro-
vided with suggestions for strategies to use in
future practice. Trainees also had the opportu-
nity to view additional coder comments as
pop-up notes within the video recording itself.
MI Training Module in Relation to
Pediatric Psychology Competencies
MI is well-suited to be included in compe-
tency-based training in pediatric psychology,
relating to cross-cutting knowledge competen-
cies in pediatric psychology, interpersonal
skills, professionalism, and application of sci-
ence (see Table 1). To further illustrate how this
training aligns with specific competencies, one
trainee’s practice encounters with simulated pa-
tients targeting childhood obesity are described
below. The trainee completed the encounter be-
fore (pretraining) and immediately after (post-
training) the didactic portion of the MI training.
The trainee was given the following instruc-
tions:
You are seeing Mary Jones, the single parent of Brandy
Jones, an 8 year-old female. They are visiting the
Pediatric clinic today for Brandy’s yearly well-child
visit. The encounter will begin at a transition point
during the clinical visit. The physician has completed
the evaluation, including charting of Brandy’s BMI
(96.3 percentile), and asked you to speak with Ms.
Jones about Brandy’s weight.
Cross-Cutting Knowledge
The MI training module allows psychology
trainees to apply knowledge of concepts in clin-
ical child psychology (e.g., family systems) and
pediatric psychology (e.g., common barriers to
maintaining healthy weight). Within the MI
training module, trainees learn about the evi-
dence-base of MI interventions. They are pre-
sented with meta-analyses reporting effect sizes
and various practice guidelines that recommend
use of MI (Barlow, 2007;Committee on Envi-
ronmental Health, Committee on Substance
Abuse, Committee on Adolescence, & Commit-
tee on Native American Child, 2009;Commit-
tee on Substance Abuse, 2010). Completing
training in MI provides trainees the option of
choosing an empirically supported intervention
in instances when they may otherwise rely on
skills that are less effective (e.g., nondirective
empathic listening). This is particularly trouble-
some within a fast-paced, outcome-oriented
health care environment in which pediatric psy-
chologists work.
Psychology trainees are informed that at this
institution pediatric medical residents have
completed a similar training as part of a Resi-
dency Training Grant awarded to the first author
by the Health Resources and Services Admin-
istration (HRSA) but are reminded that, as ex-
perts in human behavior, psychologists are par-
ticularly well-suited to implement health
behavior change interventions. In the encounter,
a physician has already determined that Bran-
dy’s weight is a concern and identified a need
for behavioral health intervention. This scenario
1
Sample feedback forms are available from the first
author or at http://tinyurl.com/MIlearnerfeedback.
227MOTIVATIONAL INTERVIEWING BEST TRAINING PRACTICE
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
is common in pediatric psychology settings and
requires trainees to understand the roles of other
disciplines and interprofessional teams, which
prepares them for clinical practice because pe-
diatric psychologists do not work in isolation.
Interpersonal
Although the encounter described above is
common in pediatric psychology, these encoun-
ters may quickly become difficult, uncomfort-
able, and even damaging to the relationship
between not only the patient/family and psy-
chologist, but also the interprofessional team as
a whole. The MI training module provides psy-
chology trainees with specific instruction on
how to facilitate effective communication that
is tailored to the needs and understanding of all
parties involved. This goal is accomplished via
not only instruction on the microskills (or spe-
cific behaviors) of MI, but also the global rat-
ings or dimensions that are consistent with an
MI approach (i.e., being collaborative, evoca-
tive, autonomy supportive, directive, and em-
pathic). Trainees learn and demonstrate how to
“roll with resistance” rather than using a con-
frontational approach. This approach allows for
maximum preservation of the relationship while
also being evidence-based. Unlike with more
confrontational approaches, brief interventions
utilizing the MI approach are likely to
strengthen working relationships between pa-
tients and clinical staff.
Before the encounter the simulated patient
(Ms. Jones) was given the following instruc-
tions: “You are generally cooperative and open,
but may become defensive if you feel like you
are being told what to do or being caused to feel
guilt or shame about Brandy’s weight and lack
of regular exercise.” During the pretraining en-
counter (i.e., before the didactic portion of MI
training), the trainee began the encounter by
saying, “I understand Dr. Smith is concerned
Table 1
Pediatric Psychology Competencies Associated With Motivational Interviewing Training Module
Crosscutting
knowledge
1.1 Values and understands the scientific foundation underlying the practice of pediatric psychology
1.8 Understands the roles of other disciplines in health service delivery systems
Professionalism
3.1.A Exhibits professionalism in interactions with patients, research participants, and their families
3.2.A Provides clinical care to children and families, implementing appropriate personal boundaries
3.3.A Works effectively with colleagues from other disciplines to maintain a climate of mutual
respect and shared values
3.1.B Works effectively with diverse patients and families, as well as diverse professionals in
providing coordinated care
Interpersonal
4.1.A Uses and facilitates accurate, clear, and effective communication with and between patients,
their families, other health-care professionals, community institutions, and systems involving
the patient
4.1.B Supports a team approach to the maintenance and promotion of health and treatment of disease
4.2.B Develops and maintains relationships with patients, their families, other professionals,
communities, and other systems involving patients
4.3.B Effectively manages challenging relationships and interactions
Application
5.1.A Applies the concept and value of evidence-based practice and its role in scientific and applied
psychology
5.3.C Implements evidence-based wellness, health promotion, and prevention interventions appropriate
to the health concern
5.1.D Provides consultative/liaison services to health-care professionals across disciplines and systems
related to health and behavior
5.2.D Translated and communicates relevant clinical findings as they bear on health-care consultation/
liaison questions
Note. From “Recommendations for Training in Pediatric Psychology: Defining Core Competencies Across Training
Levels,” by T. M. Palermo et al., 2014,Journal of Pediatric Psychology, 39, pp. 969, 972, 974, 976. Copyright 2014 by
Oxford University Press. Reprinted with permission.
228 GILLASPY, LITZENBURG, LEFFINGWELL, AND MILLER
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
about Brandy’s weight. Let me share some
ideas of things you can do to help with that.”
This response was counter to the MI approach
and was met with defensiveness and frustration
on the part of the simulated patient. Similarly,
the psychology trainee spent 72% of the en-
counter time talking and focused on the physi-
cian’s reasons for addressing Brandy’s weight,
rather than evoking the parent’s concerns or
reasons for change.
During the posttraining encounter, when the
trainee has learned to demonstrate respect or
autonomy and desire for collaboration immedi-
ately, the trainee began the encounter with, “I
understand you and Dr. Smith briefly discussed
Brandy’s BMI. Would it be OK if we spent a
little time today visiting about Brandy’s
weight?” The psychology trainee spent 58% of
the encounter time talking and asked open-
ended questions to elicit how Ms. Jones thinks
and feels about Brandy’s weight while also ac-
knowledging challenges to behavior changes
she faces. This psychology trainee’s demonstra-
tion of increased competence in MI skills illus-
trates improved ability to navigate conversa-
tions about behavior change, which is a primary
component of work as a pediatric psychologist.
Professionalism
As a patient-centered approach, the spirit of
MI is explicitly one of respect and cultural
sensitivity. By participating in the MI training
module, trainees learn a way of being with
people that allows psychologists to serve as
models of professionalism for other disciplines
within interprofessional teams. Psychology
trainees learn that evoking the patient’s own
values and reasons for change prevents the im-
posing of the trainee’s values on the patient,
which is an important component of profession-
alism.
During the previously described pretraining
encounter, the trainee stated, “I know it must be
important to you as a mother that Brandy is at a
healthy weight.” This statement, while likely
true, is not consistent with an MI approach. It is
presumptive and lacks respect for Ms. Jones’
perspective. Conversely, during the posttraining
encounter, the trainee asked Ms. Jones a scaled
question: “Ona1to10scale, how important is
it to you today to get Brandy’s weight under
control?” In response to the trainee’s follow-up
question—“Why did you say a 6 and not a
3?”—Ms. Jones offered her sense of responsi-
bility as a mother as a consideration. The trainee
then demonstrated further curiosity by asking,
“Why else are you a 6 and not a 3?” Ms. Jones
then discussed her concerns regarding Brandy’s
increased risk of negative weight-related health
effects as an African American female. This
exchange allowed the trainee to gather a lot of
useful information that likely would not have
otherwise been available. The trainee would
then have the opportunity to share this informa-
tion, using Ms. Jones’ own words, with the
other members of the interprofessional team.
These are skills that psychology trainees will
apply across settings and populations.
Application
The MI training module closely relates to the
application cluster, as it requires psychology
trainees to demonstrate fidelity to MI via en-
counters that are videotaped and coded. The
feedback provided to trainees illustrates how
they are taught to use skills that are consistent
with MI, but also to be flexible in implementing
those skills. For example, the trainee discussed
earlier received feedback that s/he asked nine
questions during the encounter, 60% of which
were open questions and the “best example”
being, “How did you make the decision to
maintain a healthy weight for Brandy in the
past?” A second trainee also demonstrated be-
ginning proficiency in using open-ended ques-
tions (50% to 70%), but discussed completely
different values with Ms. Jones than the first
trainee. Both trainees demonstrated fidelity to
an evidence-based intervention (MI), but did so
in a flexible manner.
Innovation
The MI training module utilizes the Clinical
Skills Education and Testing Center (CSETC).
The CSETC is a state-of-the art facility that
features a suite of training exam rooms
equipped with audio and video observing and
recording equipment, as well as simulated pa-
tients demonstrating the most common health
behavior targets (obesity, tobacco use, binge
drinking, or other behavioral health issues).
This facility allows trainees to practice the MI
style in a setting very similar to the real-life
229MOTIVATIONAL INTERVIEWING BEST TRAINING PRACTICE
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
clinical setting. The technology of the CSETC
also allows for high-quality feedback to be pro-
vided via coding of recorded interactions. This
program makes innovative use of the availabil-
ity of the Motivational Interviewing Treatment
Integrity (MITI) coding system, a psychometri-
cally sound observational coding system for
evaluating fidelity to the MI style. The MITI has
been found to be a reliable and valid measure of
MI competency, and is sensitive to changes
resulting from training (Moyers et al., 2005).
The MITI is highly useful as a training tool
because the outputs of the coding provide very
specific feedback about well-specified behav-
iors including aspects of the “spirit” of MI (evo-
cation, collaboration, autonomy/support, direc-
tion, and empathy) as well as the use of specific
strategies by the interviewer (including open-
ended questions and reflections). This feedback
is useful to a trainee in making attempts to
modify their behavior over the course of multi-
ple trials to demonstrate greater competence
with the MI style.
Recommendations
The MI training described above is the result
of several years of training and modifications
aimed to better meet the needs of our trainees.
We recognize that use of the CSETC and its
resources (e.g., simulated patients, videotaping)
is unique and may not be available to other
training sites. Nevertheless, we propose that
implementing an MI training module that sim-
ilarly adheres to the core competencies for pe-
diatric psychologists is feasible at any training
site. We consider the following components es-
sential to any MI training module.
First, to achieve the cross-cutting knowledge
competency, trainings must include presenta-
tion of the evidence-base for MI along with
presentation of relevant practice guidelines.
Second, emphasize the role of pediatric psy-
chologists within interprofessional teams. For
example, although MI training is also recom-
mended for our physician colleagues, pediatric
psychologists are particularly well-suited to
successfully implement MI techniques because
we are behavioral health specialists. Third,
stress MI as not only an efficacious behavior-
change technique, but also as an interpersonal
strategy that fosters professionalism. This may
be accomplished by focusing on the global
skills of MI. Fourth, provide opportunity for
trainees to practice MI skills. This may be done
in varying degrees of real-world application.
For example, trainees may engage in practice
with other trainees or presenters who may take
on the role of patient/caregiver. We are in the
process of evaluating the efficacy of our MI
training module in its current iteration; how-
ever, we consider opportunity to practice skills
learned during traditional didactics to be vital to
achieving the application competency. Fifth,
provide trainees with feedback on their applica-
tion of MI skills. Again, this does not require
resources akin to those of the CSETC, but may
be accomplished by providing live MITI coding
either by a trained coder or the trainees them-
selves. The purpose of providing feedback is
not necessarily for coders to demonstrate fidel-
ity to the coding system, which requires exten-
sive training, but for trainees to obtain concrete
examples of how they were/were not faithful to
the spirit of MI.
In addition to defining competencies integral
to training in pediatric psychology, the Society
of Pediatric Psychology Task Force (Palermo et
al., 2014) defined behavioral anchors based on
three developmental/training periods: (a) early
graduate training or readiness for practicum; (b)
end of graduate training or readiness for intern-
ship; and (c) end of internship/ postdoctoral
fellowship or readiness for entry to practice.
Although we believe that trainees should re-
ceive MI training in graduate school, we think
the training module described is best suited at
the internship/fellowship level. To continue to
improve one’s MI skills and develop compe-
tency, there must be the opportunity to fre-
quently use the skills and receive feedback. As
clinical training is the primary focus of intern-
ship and fellowship, the current training module
appears most appropriate at this time.
In the current MI training module we did not
adjust or modify the training based on baseline
performance as suggested by Martino and col-
leagues (2011). Rather, we believe the person-
alized feedback trainees receive based on com-
pletion of the pre- and post-practice encounters
with standardized patients serves to represent a
measure of their baseline performance. Such
personalized feedback should provide the level
of proficiency of MI skills and highlight areas
need for improvement. Ideally, this feedback
should be reviewed with the trainee’s supervisor
230 GILLASPY, LITZENBURG, LEFFINGWELL, AND MILLER
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
so that training plans can be adjusted to ensure
further development of MI skills. In the future
as MI training becomes more standard in grad-
uate school and trainees present to internship
and fellowship with more extensive MI experi-
ence, our current training model may need to be
modified to account for a higher baseline per-
formance.
Conclusions
MI is an evidence-based approach to behav-
ior change counseling that is effective in moti-
vating change in many health-risk behaviors.
Given the numerous opportunities for applica-
tion and strong evidence base with common
clinical problems, competency in MI is one skill
every pediatric psychologist should have in
their “clinical tool box.” Not only is MI an
evidence-based approach that can be used to
benefit treatment interventions with patients and
families, the training module also maps onto
several of the new pediatric psychology compe-
tencies. Specifically, the module relates to
cross-cutting knowledge competencies in pedi-
atric psychology, interpersonal, professional-
ism, and application. Finally, the training mod-
ule takes advantage of innovative technology
through the use of a state-of-the-art clinical
skills training center, a resource that should be
more frequently utilized in pediatric psychology
training.
References
Barlow, S. E., & the Expert Committee. (2007).
Expert committee recommendations regarding the
prevention, assessment, and treatment of child and
adolescent overweight and obesity: Summary re-
port. Pediatrics, 120, S164 –S192. http://dx.doi
.org/10.1542/peds.2007-2329C
Barwick, M. A., Bennett, L. M., Johnson, S. N.,
McGowan, J., & Moore, J. E. (2012). Training
health and mental health professionals in motiva-
tional interviewing: A systematic review. Children
and Youth Services Review, 34, 1786 –1795. http://
dx.doi.org/10.1016/j.childyouth.2012.05.012
Burke, B. L., Arkowitz, H., & Menchola, M. (2003).
The efficacy of motivational interviewing: A meta-
analysis of controlled clinical trials. Journal of
Consulting and Clinical Psychology, 71, 843– 861.
http://dx.doi.org/10.1037/0022-006X.71.5.843
Committee on Environmental Health, Committee on
Substance Abuse, Committee on Adolescence, &
Committee on Native American Child. (2009).
From the American Academy of Pediatrics: Policy
statement—Tobacco use: A pediatric disease. Pe-
diatrics, 124, 1474 –1487.
Committee on Substance Abuse. (2010). Alcohol use
by youth and adolescents: A pediatric concern.
Pediatrics, 125, 1078 –1087. http://dx.doi.org/
10.1542/peds.2010-0438
Cushing, C. C., Jensen, C. D., Miller, M. B., &
Leffingwell, T. R. (2014). Meta-analysis of moti-
vational interviewing for adolescent health behav-
ior: Efficacy beyond substance use. Journal of
Consulting and Clinical Psychology, 82, 1212–
1218. http://dx.doi.org/10.1037/a0036912
Fu, S. S., Roth, C., Battaglia, C. T., Nelson, D. B.,
Farmer, M. M., Do, T.,...Zillich, A. J. (2015).
Training primary care clinicians in motivational
interviewing: A comparison of two models. Pa-
tient Education and Counseling, 98, 61– 68. http://
dx.doi.org/10.1016/j.pec.2014.10.007
Hettema, J., Steele, J., & Miller, W. R. (2005). Mo-
tivational interviewing. Annual Review of Clinical
Psychology, 1, 91–111. http://dx.doi.org/10.1146/
annurev.clinpsy.1.102803.143833
Jensen, C. D., Cushing, C. C., Aylward, B. S., Craig,
J. T., Sorell, D. M., & Steele, R. G. (2011). Effec-
tiveness of motivational interviewing interventions
for adolescent substance use behavior change: A
meta-analytic review. Journal of Consulting and
Clinical Psychology, 79, 433– 440. http://dx.doi
.org/10.1037/a0023992
Lane, C., Huws-Thomas, M., Hood, K., Rollnick, S.,
Edwards, K., & Robling, M. (2005). Measuring
adaptations of motivational interviewing: The de-
velopment and validation of the behavior change
counseling index (BECCI). Patient Education and
Counseling, 56, 166 –173. http://dx.doi.org/
10.1016/j.pec.2004.01.003
Leffingwell, T. R. (2004). Motivational enhancement
interventions and health behaviors. In L. M. Co-
hen, D. E. McChargue, & F. L. Collins (Eds.), The
health psychology handbook: Practical issues for
the behavioral medicine specialist (pp. 42–53).
Thousand Oaks, CA: Sage.
Madson, M. B., Loignon, A. C., & Lane, C. (2009).
Training in motivational interviewing: A system-
atic review. Journal of Substance Abuse Treat-
ment, 36, 101–109. http://dx.doi.org/10.1016/j.jsat
.2008.05.005
Martino, S., Canning-Ball, M., Carroll, K. M., &
Rounsaville, B. J. (2011). A criterion-based step-
wise approach for training counselors in motiva-
tional interviewing. Journal of Substance Abuse
Treatment, 40, 357–365. http://dx.doi.org/10.1016/
j.jsat.2010.12.004
Miller, W. R., & Rollnick, S. (2013). Motivational
interviewing: Helping people change (3rd ed.).
New York, NY: Guilford Press.
231MOTIVATIONAL INTERVIEWING BEST TRAINING PRACTICE
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez,
J., & Pirritano, M. (2004). A randomized trial of
methods to help clinicians learn motivational in-
terviewing. Journal of Consulting and Clinical
Psychology, 72, 1050 –1062. http://dx.doi.org/
10.1037/0022-006X.72.6.1050
Moyers, T. B., Martin, T., Manuel, J. K., Hendrick-
son, S. M., & Miller, W. R. (2005). Assessing
competence in the use of motivational interview-
ing. Journal of Substance Abuse Treatment, 28,
19 –26. http://dx.doi.org/10.1016/j.jsat.2004.11
.001
Moyers, T. B., Martin, T., Manuel, J. K., Miller,
W. R., & Ernst, D. (2010). Revised global scales:
Motivational interviewing treatment integrity 3.1.1
(MITI 3.1.1). Unpublished manuscript, University
of New Mexico, Albuquerque, NM.
Palermo, T. M., Janicke, D. M., McQuaid, E. L.,
Mullins, L. L., Robins, P. M., & Wu, Y. P. (2014).
Recommendations for training in pediatric psy-
chology: Defining core competencies across train-
ing levels. Journal of Pediatric Psychology, 39,
965–984. http://dx.doi.org/10.1093/jpepsy/jsu015
Received November 30, 2014
Revision received May 20, 2015
Accepted May 24, 2015
Members of Underrepresented Groups:
Reviewers for Journal Manuscripts Wanted
If you are interested in reviewing manuscripts for APA journals, the APA Publications
and Communications Board would like to invite your participation. Manuscript reviewers
are vital to the publications process. As a reviewer, you would gain valuable experience
in publishing. The P&C Board is particularly interested in encouraging members of
underrepresented groups to participate more in this process.
If you are interested in reviewing manuscripts, please write APA Journals at
Reviewers@apa.org. Please note the following important points:
To be selected as a reviewer, you must have published articles in peer-reviewed
journals. The experience of publishing provides a reviewer with the basis for preparing
a thorough, objective review.
To be selected, it is critical to be a regular reader of the five to six empirical journals
that are most central to the area or journal for which you would like to review. Current
knowledge of recently published research provides a reviewer with the knowledge base
to evaluate a new submission within the context of existing research.
To select the appropriate reviewers for each manuscript, the editor needs detailed
information. Please include with your letter your vita. In the letter, please identify
which APA journal(s) you are interested in, and describe your area of expertise. Be as
specific as possible. For example, “social psychology” is not sufficient—you would
need to specify “social cognition” or “attitude change” as well.
Reviewing a manuscript takes time (1– 4 hours per manuscript reviewed). If you are
selected to review a manuscript, be prepared to invest the necessary time to evaluate
the manuscript thoroughly.
APA now has an online video course that provides guidance in reviewing manuscripts. To
learn more about the course and to access the video, visit http://www.apa.org/pubs/
authors/review-manuscript-ce-video.aspx.
232 GILLASPY, LITZENBURG, LEFFINGWELL, AND MILLER
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
... Both students and examiners have also recommended that incorporating OSCEs into clinical training in psychology would be beneficial (Sheen, McGillvray, Gurtman, & Boyd, 2015). Similarly, following positive reports from other health professional education providers, incorporating the use of simulated patients (SPs) in psychology training has been advocated (Gillaspy, Litzenburg, Leffingwell, & Miller, 2015;Johnson, Mastroyannopoulou, Beeson, Fisher, & Ononaiye, 2018). While simulation in medicine is recognised as core to highquality education (McGaghie, Issenberg, Petrusa, & Scalese, 2016), psychology as a profession, in Australia and internationally, has lagged behind other health professions, in utilising simulation to facilitate learning and to supplement practical experience in fieldwork placements. ...
Article
Objective Structured Clinical Examinations (OSCEs) involving simulated patients (SPs) are being incorporated into professional psychology training to teach and assess competencies. However, students' perceptions of SP use in their education are mixed. Moreover, there are limited reports of student perceptions of OSCEs in psychology beyond quantitative measures. This is the first report of extensive use of feedback in an OSCE in psychology. We report a content analysis of the reflection task completed by all students, focusing on student perceptions of aspects of the OSCEs that impacted their learning. Postgraduate psychology students' (n = 18) descriptions of OSCEs were content analysed, with 11 themes reported. Findings support the use of multiple sources of feedback to assess student competencies and support students' learning. In particular, verbal feedback from SPs and educators in addition to the use of recording and marking technology and opportunity to engage with an academic mentor when undertaking OSCEs were highlighted as important learning strategies. Overall, SPs were perceived as useful and valuable in preparing students for clinical fieldwork. Incorporating OSCEs into postgraduate training, both to assess competencies but also to support student learning, was perceived positively by students.
... MT is a patient-centred approach whose aim is to guide the patients with different strategies, towards behavioral changes. [3] This treatment option leads to satisfying results, lasting sometimes even more than one year after treatment and it can be used by different professional figures, including medical providers. [4] Motivational therapy can differ for each patient because it is a tailored intervention whose aim is to encourage motivation, self-esteem, capacity of problem solving and enhancement. ...
Article
Full-text available
Objective: The aim of this study is to determine the impact of a motivational therapy (MT) on the outcomes for individuals diagnosed with nocturnal enuresis (NE). Material and methods: We enrolled 158 patients with NE referred to the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome, from January 2013 to September 2017. Of these, 21 were excluded because they didn't meet the inclusion criteria. The study was carried out in compliance with the Helsinki Declaration. Results: A hundred and thirty seven enuretic patients [100 (72.9%) male and 37 (27.1%)] female patients with a median age of 8.8 years were included in the study. The patients were assigned to receive pharmacological therapy with desmopressin (dDAVP) (G1) (n=51), MT (G2) (n=33) and both of them (G3) (n=53). The three groups were homogeneous, with no significant differences in gender, age and family history of NE. In G1, 30/51 (58.82%) children achieved response vs. 1/33 (3.0%) children in G2 vs. 35/53 (66.04%) children in G3. About these results, The differences between G2 vs. G1 (p<0.01) and vs. G3 (p<0.01) were statistically significant while the difference between G1 vs G3 was not statistically significant (p=0.45). Conclusion: Our study underlines the importance of MT in the management of NE and highlights the safety of treatment and the positive effect of MT on the compliance and the adherence to pharmacological therapy. Considering the importance of the impact of such evidence on children's lifestyle, we expect that further study with a larger sample size may confirm our hypothesis.
... Calls are only just being made in the UK for OSCEs (using role plays with actors) to be introduced into professional psychology training programmes to assess clinical competencies (McManus & Bennett, 2015). Similarly, in the US, the use of simulated patients in training has been advocated, with Gillaspy, Litzenburg, Leffingwell and Miller (2015) suggesting that motivational interviewing (MI) provides an excellent opportunity for students to develop and demonstrate a range of core competencies required in psychology training, including professionalism, interpersonal skills and application of evidence-based practice. ...
Article
Introduction: There is limited research on the use of objective structured clinical examinations (OSCEs) in psychology despite their extensive use in medicine. This pilot study extended the evidence base by assessing the impact on student learning of OSCEs focused on motivational interviewing. Methods: A mixed-methods approach was used with quantitative and qualitative data analysed. Data were collated from all 14 professional psychology students enrolled in a health psychology course. Results: Findings suggest that OSCEs are a feasible, reliable and valid method for professional psychology trainees to demonstrate competencies in complex, interventional skills. Conclusions: Implications for incorporating OSCEs into professional psychology training are described. Future work addressing issues including optimal approaches to provision of feedback for learning is needed.
... Specifically, providers ask, listen, and inform their patients when attempting to elicit motivation to change [15]. Notably, this process includes the provider centering on the patient through implementing patient-centered communication principles and skills including expressing empathy, reflective listening [16], developing discrepancies between patient's current behaviors and goals, rolling with resistance, and supporting patient's self-efficacy to change health behaviors [17]. ...
Article
Full-text available
Inflammatory bowel disease (IBD) is a condition accompanied by several physical and often psychological symptoms (e.g., depression). Treatments generally involve dietary modifications and prescription medications. Of concern, non-adherence rates with prescription medications for this population have been reported to be between 30% and 45%. In order to examine an intervention that has shown promise in improving adherence, researchers systematically reviewed the literature in order to determine the impact of a motivational interviewing (MI) intervention on outcomes for individuals diagnosed with IBD. The outcomes assessed were broad and included, among others, the target behaviors of medication adherence and advice-seeking, and also patient-perceived provider empathy. Results suggest that MI can be effective in improving outcomes for individuals with IBD since patients experienced improved adherence rates, displayed greater advice-seeking behavior, and perceived providers as having more empathy and better communication skills. Further research is required since the pool of retained studies is small, evidencing a paucity of literature focusing on this evidence-based health behavior intervention for the behaviors needed to optimally manage IBD. Further, only adults were examined in these studies, so generalizations to children and adolescents are limited.
Article
Full-text available
Introduces the special issue on best training practices in pediatric psychology. The purpose of this special issue is to provide illustrations of how training programs are achieving and evaluating specific competencies at the doctoral, internship, and postdoctoral level as well as discussion of issues pertaining to best practices in training. The special issue includes eight articles that highlight a range of best practices.
Article
Full-text available
Tobacco use and secondhand tobacco-smoke (SHS) exposure are major national and international health concerns. Pediatricians and other clinicians who care for children are uniquely positioned to assist patients and families with tobacco-use prevention and treatment. Understanding the nature and extent of tobacco use and SHS exposure is an essential first step toward the goal of eliminating tobacco use and its consequences in the pediatric population. The next steps include counseling patients and family members to avoid SHS exposures or cease tobacco use; advocacy for policies that protect children from SHS exposure; and elimination of tobacco use in the media, public places, and homes. Three overarching principles of this policy can be identified: (1) there is no safe way to use tobacco; (2) there is no safe level or duration of exposure to SHS; and (3) the financial and political power of individuals, organizations, and government should be used to support tobacco control. Pediatricians are advised not to smoke or use tobacco; to make their homes, cars, and workplaces tobacco free; to consider tobacco control when making personal and professional decisions; to support and advocate for comprehensive tobacco control; and to advise parents and patients not to start using tobacco or to quit if they are already using tobacco. Prohibiting both tobacco advertising and the use of tobacco products in the media is recommended. Recommendations for eliminating SHS exposure and reducing tobacco use include attaining universal (1) smoke-free home, car, school, work, and play environments, both inside and outside, (2) treatment of tobacco use and dependence through employer, insurance, state, and federal supports, (3) implementation and enforcement of evidence-based tobacco-control measures in local, state, national, and international jurisdictions, and (4) financial and systems support for training in and research of effective ways to prevent and treat tobacco use and SHS exposure. Pediatricians, their staff and colleagues, and the American Academy of Pediatrics have key responsibilities in tobacco control to promote the health of children, adolescents, and young adults. Pediatrics 2009; 124: 1474-1487
Article
Full-text available
Objective: We sought to systematically review and meta-analyze the literature comparing motivational interviewing (MI) with a control condition for adolescent health behavior change. In the current article, we reviewed only studies targeting health behaviors other than substance use (e.g., sexual risk behavior, physical activity, diet). Method: Systematic literature searches of PsycINFO, PubMed/Medline, and ERIC were conducted through June 2013. Databases were combined, and studies were screened for inclusion or exclusion. To be included in the current review, studies were required to (a) compare the efficacy of at least 1 session of MI intervention with a control condition using a between-groups design and (b) examine a non-substance-use health behavior in adolescents. Fifteen studies met criteria for inclusion and were described qualitatively and quantitatively. Results: Using a fixed-effects model, we found that MI interventions produced a small, but significant, aggregate effect size for short-term postintervention effects-g = .16; 95% confidence interval (CI) [.05, .27]-compared with control conditions. Moreover, this effect was sustained at follow-up assessments averaging 33.6 weeks postintervention, n = 8, g = .18, 95% CI [.05, .32]. Conclusions: MI interventions for adolescent health behavior appear to be effective. In addition, the magnitude of the aggregate effect size does not appear to differ meaningfully from reports of interventions targeting only substance use in adolescents. However, significant lack of clarity exists regarding interventionist training requirements necessary to ensure intervention effectiveness.
Article
Full-text available
As a field, pediatric psychology has focused considerable efforts on the education and training of students and practitioners. Alongside a broader movement toward competency attainment in professional psychology and within the health professions, the Society of Pediatric Psychology commissioned a Task Force to establish core competencies in pediatric psychology and address the need for contemporary training recommendations. The Task Force adapted the framework proposed by the Competency Benchmarks Work Group on preparing psychologists for health service practice and defined competencies applicable across training levels ranging from initial practicum training to entry into the professional workforce in pediatric psychology. Competencies within 6 cluster areas, including science, professionalism, interpersonal, application, education, and systems, and 1 crosscutting cluster, crosscutting knowledge competencies in pediatric psychology, are presented in this report. Recommendations for the use of, and the further refinement of, these suggested competencies are discussed.
Article
Full-text available
Objective This systematic review sought to determine the current state of the literature on the effectiveness of training health and mental health professionals in motivational interviewing (MI).Method Data sources: The following databases were searched: MEDLINE/PreMEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and CENTRAL Cochrane Central Trials Register. Inclusion criteria were empirical studies of any year that employed any research design to evaluate the effectiveness of training health or mental health professionals in MI. Studies with main outcomes other than behavioral or organizational were excluded. To minimize bias, dual review was employed. Full data abstraction was conducted independently by two reviewers. A qualitative synthesis of the findings and risk of bias data are reported.ResultsA total of 22 studies were included in this review. Seventeen of the 22 studies reported significant practitioner behavior change relative to motivational interviewing skills, notwithstanding variation in training approach, population, outcome measures, and study quality.Conclusion This review demonstrates practitioner behavior change on MI skills utilizing a variety of training and outcome methods. Future work of high methodological rigor, clear reporting, and that attends to training as one part of the implementation process will help to elucidate the factors that lead to the uptake of new practices.
Article
Full-text available
This study was designed to quantitatively evaluate the effectiveness of motivational interviewing (MI) interventions for adolescent substance use behavior change. Literature searches of electronic databases were undertaken in addition to manual reference searches of identified review articles. Databases searched include PsycINFO, PUBMED/MEDLINE, and Educational Resources Information Center. Twenty-one independent studies, representing 5,471 participants, were located and analyzed. An omnibus weighted mean effect size for all identified MI interventions revealed a small, but significant, posttreatment effect size (mean d = .173, 95% CI [.094, .252], n = 21). Small, but significant, effect sizes were observed at follow-up suggesting that MI interventions for adolescent substance use retain their effect over time. MI interventions were effective across a variety of substance use behaviors, varying session lengths, and different settings, and for interventions that used clinicians with different levels of education. The effectiveness of MI interventions for adolescent substance use behavior change is supported by this meta-analytic review. In consideration of these results, as well as the larger literature, MI should be considered as a treatment for adolescent substance use.
Article
Full-text available
Motivational interviewing (MI), an evidence-based counseling approach, has received much recognition from a wide variety of health care professionals. Because of the rising interest in MI, there is increasing demand for training in this counseling approach. The MI training community has answered this call and as a result placed much emphasis on studying the MI training process. The purpose of this article is to provide a systematic review of the published research on MI training. Our goal is to provide a consolidated account of MI trainings outlining the populations receiving training, methods used, and training outcomes. We also identify which aspects of the (W. R. Miller & T. B. Moyers, 2006) eight stages of learning MI each study addressed. Recommendations for advancing the MI training research are highlighted.
Article
Alcohol use continues to be a major problem from preadolescence through young adulthood in the United States. Results of recent neuroscience research have substantiated the deleterious effects of alcohol on adolescent brain development and added even more evidence to support the call to prevent and reduce underaged drinking. Pediatricians should be knowledgeable about substance abuse to be able to recognize risk factors for alcohol and other substance abuse among youth, screen for use, provide appropriate brief interventions, and refer to treatment. The integration of alcohol use prevention programs in the community and our educational system from elementary school through college should be promoted by pediatricians and the health care community. Promotion of media responsibility to connect alcohol consumption with realistic consequences should be supported by pediatricians. Additional research into the prevention, screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents continues to be needed to improve evidence-based practices. Pediatrics 2010; 125: 1078-1087
Article
To evaluate implementing two training models for motivational interviewing (MI) to address tobacco use with primary care clinicians. Clinicians were randomized to moderate or high intensity. Both training modalities included a single ½ day workshop facilitated by MI expert trainers. The high intensity (HI) training provided six booster sessions including telephone interactions with simulated patients and peer coaching by MI champions over 3 months. To assess performance of clinicians to deliver MI, an objective structured clinical evaluation (OSCE) was conducted before and 12 weeks after the workshop training. Thirty-four clinicians were enrolled; 18 were randomly assigned to HI. Compared to the moderate intensity group, the HI group scored significantly higher during the OSCE for three of six global Motivational Interviewing Treatment Integrity scale scores. There was also significant improvement for three of the four measures of MI counseling knowledge, skills and confidence. Using champions and telephone interactions with simulated patients as enhancement strategies for MI training programs is feasible in the primary care setting and results in greater gains in MI proficiency. Results confirm and expand evidence for use of booster sessions to improve the proficiency of MI training programs for primary care clinicians. Published by Elsevier Ireland Ltd.