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MOTIVATIONAL INTERVIEWING: Theory, Treatment, Training, and

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MOTIVATIONAL INTERVIEWING: Theory, Treatment, Training, and Targeting Special Populations Samuel A. Ball, Ph.D. Yale University School of Medicine – PowerPoint PPT presentation

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Title: MOTIVATIONAL INTERVIEWING: Theory, Treatment, Training, and


1
MOTIVATIONAL INTERVIEWINGTheory, Treatment,
Training, and TargetingSpecial Populations
  • Samuel A. Ball, Ph.D.
  • Yale University School of Medicine
  • Department of Psychiatry
  • Division of Substance
  • Presentation at NHSN 4th Annual Conference
    10/14/04

2
BACKGROUNDTheory and Research
  • Experimental Social Psychology
  • Motivational Stages of Change
  • Humanistic Psychology

3
BACKGROUNDExperimental Social Psychology
  • Causal Attributions
  • Cognitive Dissonance
  • Psychological Reactance
  • Self-Efficacy

4
BACKGROUNDMotivational Stages of Changes
  • Precontemplation
  • Contemplation
  • Determination/Preparation
  • Action
  • Maintenance
  • Prochaska DiClemente (1984)

5
BACKGROUNDHumanistic Psychology
  • Individual, not Label
  • Empathy, not Direction
  • Client-centered, not Therapist-Driven
  • Acceptance, not Confrontation

6
MOTIVATIONAL INTERVIEWINGPrinciples
  • Express empathy
  • Develop discrepancy
  • Avoid argumentation
  • Roll with resistance
  • Support self-efficacy
  • Miller Rollnick (1991)

7
MOTIVATIONAL INTERVIEWINGTechniques
  • Open-ended questions
  • Affirmation
  • Reflective listening
  • Summary Statements
  • Personal feedback
  • Decision balance
  • Eliciting self-motivational statement
  • Develop alternatives and options
  • Miller Rollnick (2002)

8
MODEL DEVELOPMENT TESTINGStages of Research
  • Stage I (Development)
  • -1960s Supportive referral encouragement
    (Chafetz)
  • -1970s Simple advice and referral (Edwards)
  • Stage II (Efficacy)
  • -1980s Motivational Interviewing (Miller
    Rollnick)
  • Drinkers Check-up (Miller
    Sovereign)
  • Stage III (Effectiveness/Multisite)
  • -1990s Motivational Enhancement Therapy (MATCH
    Miller et al)
  • -2000s WHO, Marijuana Treatment, Clinical Trials
    Network

9
EFFICACY EFFECTIVENESS Subpopulations
  • Heavy or Problem Drinkers
  • Alcohol Abuse or Dependence Patients
  • Heroin, Cocaine, Methamphetamine, Marijuana, and
    Polydrug Patients
  • Dually Diagnosed Patients
  • Other Health Risk Behavior Groups

10
MI TRAINING RESEARCHCurrent Projects
  • Motivational Interviewing Network of Trainers
    (MINT)
  • University of New Mexico Center on Alcoholism,
    Substance Abuse and Addictions (CASAA)
  • NIDA Behavioral Therapy Training Projects
  • NIDA Clinical Trials Network Protocols
  • Therapy Training Integrity Procedures

11
MI TRAINING RESEARCHCurrent State of Knowledge
  • Two-day training results in increased knowledge
    of MI and satisfaction with training procedures
  • Training improves MI skills better than it
    suppresses non-MI skills
  • MI skills learned are lost over time unless
    intensive and/or ongoing supervision provided
  • (Baer et al, 2003
    Miller Mount, 2001 Rubel et al, 2000)

12
Motivation Interviewing (MI) and Enhancement
Therapy (MET)Clinical Trials Network
  • Motivational Interviewing (one session)
  • Motivational Enhancement (three sessions)
  • MET for Pregnant Women (ongoing)
  • MET for Spanish Speaking Clients (ongoing)
  • MET for African American Clients (proposed)

13
MET/MI CTN STUDY DESIGN
  • Multisite randomized clinical trial in 11
    community-based drug treatment programs
  • Clinician characteristics and skill acquisition
    assessed
  • Treatment fidelity and discriminability monitored
  • Training plan designed to facilitate sustained
    changes in practice and dissemination
  • Participants assigned to Motivational
    Intervention vs. Standard Care evaluation/counseli
    ng followed by regular outpatient treatment

14
Did clients assigned to MI complete more sessions
than those in standard assessment?
YES
15
Did MI retain more participants in treatment at
the 1-month point?
YES
16
Abstinence Rates at 1 Month by Site
17
MET for Spanish Speaking ClientsNIDA Clinical
Trials Networks
  • Jose Szapocznik, Ph.D., Lead Investigator
  • Lourdes Suarez, Ph.D., Study Coordinator
  • University of Miami
  • Kathleen Carroll, Ph.D., Lead Investigator
  • Julie Matthews, Study Coordinator
  • Samuel Ball, Ph.D., Training Director
  • Yale University

18
MET for Spanish Speaking ClientsStudy Rationale
  • Little known about outpatient drug abuse
    treatment outcomes for Hispanic/Latino
    populations
  • Spanish speaking clients typically excluded from
    clinical research studies and underserved in most
    programs
  • Perceived need for treatment, motivation to
    change, use of denial, and drop out appear to be
    especially problematic in Hispanic/Latino groups
    (Longshore et al 1992, 1993, 1997)
  • MET/MI most widely studied and disseminated, but
    very limited attention to Spanish speaking
    populations despite its relevance and promise for
    this group

19
MET for Spanish Speaking ClientsKey Design
Implementation Features
  • Treatments conducted in Spanish
  • Independent determination of counselor
    bilingualism
  • MET manual and handouts translated
  • Bilingual national expert trainers and
    supervisors
  • Translation of standard research assessments and
    inclusion of Bicultural Involvement Questionnaire

20
CONCLUSIONSKey Effectiveness Research Questions
  • Efficacy in Subpopulations (ethnicity, gender,
    treatment circumstances, psychopathology, drugs)
  • Clinician Attributes (for learning and fidelity)
  • Optimal Training and Disssemination Strategies
    (to ensure sustained changes in practice)
  • Mechanisms of Action (change talk, motivational
    stages, empathy)
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