Motivational Interviewing Title

							Training Clinicians in Motivational
     Interviewing Using Tele-
    Conferencing Technology
           Bruce Goldman
                and
          Kenneth Carpenter
Training Clinicians in Motivational
     Interviewing Using Tele-
    Conferencing Technology

       Principal Investigator: E.V. Nunes, M.D.
       Project Director: Jennifer L. Smith, Ph.D.

   Carpenter, K.M., Brooks A., Amrhein, P., Levin, D.,
            Schreiber, E.A., Travaglini, L.A.
                   Overview
• Disseminating new treatment techniques into
  community based practices remains a
  significant challenge.

• Traditional dissemination techniques include:
  – Distribution of printed materials
  – Didactic interactions: conferences, lectures, and
    workshops
        Didactic Dissemination
• Outcome of Didactic Strategies:
  – BEST: increase knowledge and produce short term
    shifts in counseling behaviors.
  – WORST: have no effect on counselor behavior but
    strengthen an individual’s belief that they are
    proficient in the use of an intervention strategy.
        Enhancement Strategies
• Sustained development of new counseling
  skills is more likely to be accomplished with:
  – Practice opportunities in a context that best
    approximates actual clinical encounters.
  – Post-instruction supervision.
  – The provision of direct feedback and coaching.
                 Study Aims

• Develop and test the efficacy of a post-
  instruction supervisory method that includes:
  – Training in a clinician’s clinical context
  – The provision of real time feedback and coaching
  – The use of standard communication technology
    (Telephone).
               Participants
• Recruited from 26 community treatment
  programs
• 100 Counselors (94 completed training: MMTP
  n=50; Drug free outpatient n=32; Residential
  n=12).
• The focus of the training was on developing
  Motivational Interviewing counseling skills
                               Design

Pre- Wks         Post- Wks         Training                 FU1               FU2

      Patients                      Actors                         Patients




                             5 Tele-Conference Sessions



    Workshop                  5 Taped-Based Sessions


                                  No Supervision


  Week 1-2                      Weeks 3 to 7              Week 8         Week 20
              Target Behaviors
•   MI Spirit
•   MI Empathy
•   Percentage of Open Questions
•   Percentage of Complex Reflections
•   Reflection to Question Ratio
•   MI Non-adherent behaviors
                 % Open Questions                                         Reflection/Questions                               % Complex Reflections




                                                        0.9 1.0
        60



                                                                                                                                  WKSHP




                                                                                                                   50
                                                                                                                                  TCS
        55




                                                                                                                                  Tape




                                                        0.6 0.7 0.8




                                                                                                                   45
                                              refques
pctoq




                                                                                                           pctrc
        50




                                                                                                                   40
        45




                                     WKSHP                                                        WKSHP
                                     TCS                                                          TCS




                                                        0.5
        40




                                                                                                                   35
                                     Tape                                                         Tape

             1        2          8    20                              1         2             8       20                     1      2          8     20

                          time                                                       time                                               time



                  MI non-adherent*                                                  Spirit*                                         Empathy*




                                                                                                                   5.4
                                                                                                                                  WKSHP
        4




                                                                              WKSHP




                                                                                                                   5.0 5.2
                                      WKSHP                                                                                       TCS
                                                        5.2




                                      TCS                                     TCS                                                 Tape
                                      Tape                                    Tape
        3




                                                        4.8
mina




                                              spirit




                                                                                                           emp

                                                                                                                   4.8
        2




                                                                                                                   4.4 4.6
                                                        4.4
        1




                                                        4.0




                                                                                                                   4.2
             1        2          8    20                              1         2             8       20                     1      2          8     20

                          time                                                       time                                               time




                  *TCS demonstrated better performance
                 Conclusion
• TCS demonstrated better performance on
  measures of:
  – MI Spirit
  – MI Empathy
  – Lower MI non-adherent behavior (compared to
    workshop only).
  – Tape supervision demonstrated a trend for better
    performance on complex reflections.