A Randomized Trial of Methods to Help Clinicians Learn Motivational Interviewing

Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM 87131-1161, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 01/2005; 72(6):1050-62. DOI: 10.1037/0022-006X.72.6.1050
Source: PubMed


The Evaluating Methods for Motivational Enhancement Education trial evaluated methods for learning motivational interviewing (MI). Licensed substance abuse professionals (N = 140) were randomized to 5 training conditions: (a) clinical workshop only; (b) workshop plus practice feedback; (c) workshop plus individual coaching sessions; (d) workshop, feedback, and coaching; or (e) a waiting list control group of self-guided training. Audiotaped practice samples were analyzed at baseline, posttraining, and 4, 8, and 12 months later. Relative to controls, the 4 trained groups showed larger gains in proficiency. Coaching and/or feedback also increased posttraining proficiency. After delayed training, the waiting list group showed modest gains in proficiency. Posttraining proficiency was generally well maintained throughout follow-up. Clinician self-reports of MI skillfulness were unrelated to proficiency levels in observed practice.

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Available from: Theresa B Moyers, Jan 08, 2015
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    • "The MI literature now provides some evidence for a causal chain in MI, in which client change language mediates the relationship between therapist behavior and treatment outcomes (Magill et al., 2014). Such client speech is influenced by the MI clinician (Moyers and Martin, 2006), and clinician training studies have demonstrated that specialized training in MI produces changes not only in therapist speech, but also in the speech of their clients (Miller et al., 2004). This research base suggests that clinicians can be trained to influence the in-session speech of their clients, with subsequent effects on treatment outcomes. "
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    ABSTRACT: Background: Within-session client speech is theorized to be a key mechanism of behavior change in motivational interviewing (MI), a directional, client-centered approach to behavior change. Client change talk (CT: speech indicating movement toward changing a problematic health behavior) and sustain talk (ST: speech supporting continuing a problematic health behavior) have each shown relationships with outcomes. However, it may be the case that patterns of within-session client speech, rather than counts of client speech, are important for producing change. Methods: Recorded initial MI/MET psychotherapy sessions from Project MATCH had been previously rated using the Motivational Interviewing Sequential Code for Observing Process Exchange (MI-SCOPE), a mutually exclusive and exhaustive sequential coding system. From these existing data, session conditional probabilities for transitions of interest (the transition from CT to more CT, and the transition from reflections of CT to CT) were analyzed as empirical Bayes estimates of log-normalized odds ratios. Results: CT frequencies and these log-normalized odds ratios were entered as independent variables into longitudinal generalized estimating equation (GEE) models predicting within-treatment and post-treatment drinking. While all variables were significant predictors of within-treatment drinking, only the CT-CT transition emerged as a significant predictor of decreased drinking after treatment. Conclusions: The momentum of a client’s speech about change during an MI session may be a better predictor of outcome than is a simple frequency count of it. Attending not only to the mere occurrence of CT, but also recognizing the importance of consecutive client statements of CT, may improve treatment outcomes.
    Full-text · Article · Dec 2015 · Drug and Alcohol Dependence
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    • "In one study, Miller and colleagues compared several motivational interviewing training strategies, including workshop only and consultation with and without session review. While consultation with and without session review produced similar changes in clinician fidelity, only the strategy that included session review resulted in client behaviors that were associated with better treatment outcomes (Miller et al. 2004). However, this study employed individual consultation strategies among a set of highly motivated clinicians who were not trained in their work setting. "
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    ABSTRACT: Despite the central role of training and consultation in the implementation of evidence-based psychological interventions (EBPIs), comprehensive reviews of research on training have highlighted serious gaps in knowledge regarding best practices. Consultation after initial didactic training appears to be of critical importance, but there has been very little research to determine optimal consultation format or interventions. This observational study compared two consultation formats that included review of session audio and feedback in the context of a program to train clinicians (n = 85) in community mental health clinics to deliver cognitive therapy (CT). A "gold standard" condition in which clinicians received individual feedback after expert consultants reviewed full sessions was compared to a group consultation format in which short segments of session audio were reviewed by a group of clinicians and an expert consultant. After adjusting for potential baseline differences between individuals in the two consultation conditions, few differences were found in terms of successful completion of the consultation phase or in terms of competence in CT at the end of consultation or after a 2 year follow-up. However, analyses did not support hypotheses regarding non-inferiority of the group consultation condition. While both groups largely maintained competence, clinicians in the group consultation condition demonstrated increases in competence over the follow-up period, while a sub-group of those in the individual condition experienced decreases. These findings, if replicated, have important implications for EBP implementation programs, as they suggest that observation and feedback is feasible in community mental health setting, and that employing this method in a group format is an effective and efficient consultation strategy that may enhance the implementation and sustainability of evidence-based psychotherapies.
    Full-text · Article · Nov 2015 · Administration and Policy in Mental Health and Mental Health Services Research
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    • "Ongoing consultation calls, which are a standard part of some training models after an initial training in an EBP, might also have the potential to fill this role. The tendency for behaviors to shift back to original models of care in the absence of continued support (Deane et al. 2014; Miller et al. 2004) and the findings of this study suggest that effective, sustained mechanisms to support use when consultation calls end need to be developed. Particularly when the service context is characterized by multiple demands and many new initiatives, as is the case in child welfare settings, new practices may be lost quickly after the implementation period. "
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    ABSTRACT: Children's service systems are faced with a critical need to disseminate evidence-based mental health interventions. Despite the proliferation of comprehensive implementation models, little is known about the key active processes in effective implementation strategies. This proof of concept study focused on the effect of change agent interactions as conceptualized by Rogers' diffusion of innovation theory on providers' (N = 57) use of a behavioral intervention in a child welfare agency. An experimental design compared use for providers randomized to training as usual or training as usual supplemented by change agent interactions after the training. Results indicate that the enhanced condition increased use of the intervention, supporting the positive effect of change agent interactions on use of new practices. Change agent types of interaction may be a key active process in implementation strategies following training.
    Full-text · Article · Oct 2015 · Administration and Policy in Mental Health and Mental Health Services Research
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