Evaluating the Validity of the Client Evaluation of Motivational Interviewing Scale in a Brief Motivational Intervention for College Student Drinkers

Monitoring Motivational Interviewing Strategies: Creating Provider and Client Reports to Encourage Implementation

BACKGROUND

Motivational interviewing (MI) is an evidence-based practice that has been successfully applied to at-risk youth. Well-validated measures that track MI integrity may not be used in practice settings due to the time to complete them, recording requirements and training involved. A simpler, less resource-intensive instrument may encourage programs and providers to attend more to the quality of MI use during implementation.

PURPOSE

To validate a method involving two measures, Youth and Provider Logs, to assist in monitoring MI use.

METHODS

Clients and providers reported on provider behaviors consistent and inconsistent with MI during the session. Factor analyses were conducted to examine whether measures showed clear scales assessing MI use and analyses were conducted to assess validity of these measures.

RESULTS

Both Youth and Provider Logs showed a clear and consistent 3-factor structure assessing MI-consistent behavior, MI-inconsistent behavior, and alcohol-related topics. Significant correlations were found between Youth Logs and youth reports of rapport with providers, and satisfaction with services. Provider MI-inconsistent scores were significantly inversely predictive of observer fidelity scores over time.

CONCLUSION

This study offers provider and client measures for tracking use of MI in sessions, which are a simpler, less resource-intensive method for monitoring MI, and may encourage fidelity during implementation.

Dynamic social network analysis of a brief alcohol intervention trial in heavy-drinking college students shows spillover effects

BACKGROUND

Heavy-drinking college students tend to have close social networks, and there is theoretical and empirical support for the idea that behavior change can spread through those networks via close ties. The objective of this research was to determine whether intervention-induced behavior change in a subset of heavy drinkers in a sociometric (whole) college class-year social network is transmitted to other heavy drinkers in the network, resulting in reduced behavioral risk and change in network ties.

METHODS

We conducted a controlled trial in which most of a first-year college class (N = 1236; 56.9% female) was enrolled, with alcohol use and social network ties measured early in each of three semesters. Following a baseline assessment, the network was divided into two groups, brief motivational intervention (BMI) and natural history control (NHC) according to dormitory residence location. A subset of heavy drinkers in each group was selected, and those in the BMI group received an in-person intervention.

RESULTS

Using stochastic actor-oriented modeling, we found a significant tendency for participants in the BMI group to shed ties with individuals with similar drinking behaviors between the first and second semesters, relative to the NHC group. Furthermore, heavy drinkers with reciprocal ties to intervention recipients in the BMI group showed a significant reduction in drinks per week.

CONCLUSIONS

Individual alcohol interventions appear to have effects both on behavior and network connections among individuals who did not receive the intervention. Continued research is needed to identify the optimal conditions for the diffusion of behavior change.

Can a pure motivational interviewing intervention be manualized and still efficacious? A test of feasibility and initial efficacy

The importance of attending to the therapeutic process despite the challenges in manualizing it is demonstrated in the empirical evolution of motivational interviewing (MI). Whereas manuals exist for adaptations of MI, no manual has been developed and tested for MI in its pure form (pure MI). This study evaluated the feasibility and initial efficacy of a pure MI intervention manual - MI for risky social drinking (MI-RSD) - designed to target risky social drinking behaviors in college students with social anxiety. A pilot sample of 42 college students completed measures of alcohol use and mental health symptoms and the MI-RSD intervention. We developed a manual for the 2-session MI-RSD intervention, trained 4 clinical doctoral students, and used observer-, therapist- and participant-completed measures to evaluate fidelity. Therapists met beginner proficiency in MI fidelity and participant gave high ratings of therapist adherence to MI and working alliance, demonstrating intervention feasibility. Also, participants reported significant reductions in hazardous drinking and evaluation fears, but not in social interaction anxiety. We offer preliminary evidence that pure MI can be manualized and effective. Specifically, MI-RSD represents an alternative to MI adaptations in mitigating alcohol-related harm for young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Motivational interviewing quality assurance: A systematic review of assessment tools across research contexts

The need for sustained skill development and quality assurance when executing behavioral interventions is best demonstrated in the empirical evolution of Motivational Interviewing (MI). As a brief behavioral intervention that identifies the therapeutic process as an active treatment ingredient, it is critical for researchers, trainers, and administrators to use psychometrically sound and theoretically congruent tools to evaluate provider skills and fidelity when executing MI. Yet, no prior work has evaluated the breadth of MI tools employed across research contexts. Therefore, this review identified MI fidelity and skill development tools across measurement, training and efficacy/effectiveness studies and evaluated their psychometric strength and fit with current MI theory. We identified 199 empirical studies that employed an MI fidelity/skill tool and we found 21 tools with varying degrees of empirical support and theoretical congruence. Specifically, we identified five observer-, two trainee- and one client-rated tool with strong empirical support, and nine observer- and two client-rated tools with preliminary empirical support. We detailed the empirical strength, including the extent to which tools were linked to trainee/client outcomes across research contexts and offer recommendations on which MI tools to use in training, efficacy, and effectiveness trials.

Assessing competence in health professionals' use of motivational interviewing: A systematic review of training and supervision tools

OBJECTIVE

To conduct a systematic review of instruments for assessing the competency of therapists in motivational interviewing (MI) for training purposes.

METHODS

A search of Medline, Emcare, CINAHL, Scopus, Proquest, and Web of Science databases yielded 20,313 articles, of which 105 were included in the review. Data were summarised in terms of the instruments' development, adherence to MI principles, administration characteristics, psychometric properties, advantages, and disadvantages.

RESULTS

Twelve instruments were identified. Tools tended to be better at covering simpler MI techniques. Differences in administration burden allow users to choose between briefer but cheaper and more detailed yet costly tools. Psychometric testing was often limited, and even if more extensive, the quality was often inconsistent. Although each tool tended to have relatively unique advantages (e.g. use of client ratings), they shared common disadvantages (e.g. lack of psychometric testing).

CONCLUSION

A number of tools can be used to assess MI competency, each with their own strengths but notable weaknesses that should be considered by potential users.

PRACTICE IMPLICATIONS

There is a need to further test existing tools before creating new ones, due to the repetition of the same limitations. Standardised guidelines should also be created to ensure each tool meets the same quality standards.

Motivational interviewing training of substance use treatment professionals: A systematic review

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.

Effects of motivational interviewing fidelity on substance use treatment engagement in primary care

OBJECTIVE

Primary care (PC) may be an opportune setting to engage patients with opioid and alcohol use disorders (OAUDs) in treatment. We examined whether motivational interviewing (MI) fidelity was associated with engagement in primary care-based OAUD treatment in an integrated behavioral health setting.

METHODS

We coded 42 first session therapy recordings and examined whether therapist MI global ratings and behavior counts were associated with patient engagement, defined as the patient receiving one shot of extended-release injectable naltrexone or any combination of at least two additional behavioral therapy, sublingual buprenorphine/naloxone prescriptions, or OAUD-related medical visits within 30days of their initial behavioral therapy visit.

RESULTS

Autonomy/support global ratings were higher in the non-engaged group (OR=0.28, 95%CI: 0.09-0.93; p=0.037). No other MI fidelity ratings were significantly associated with engagement.

CONCLUSION

We did not find positive associations between MI fidelity and engagement in primary care-based OAUD treatment. More research with larger samples is needed to examine how providing autonomy/support to patients who are not ready to change may affect engagement.

PRACTICE IMPLICATIONS

Training providers to strategically use MI to reinforce change as opposed to the status quo is needed. This may be especially important in primary care where patients may not be specifically seeking help for their OAUDs.