IMPORTANCE Despite the high prevalence of anxiety and depression in youths with chronic medical conditions (CMCs), physicians encounter substantial barriers in motivating these patients to access mental health care services. OBJECTIVE To determine the efficacy of motivational interviewing (MI) training for pediatricians in increasing youths' use of mental health care. DESIGN, SETTING, AND PARTICIPANTS The COACH-MI (Chronic Conditions in Adolescents: Implementation and Evaluation of Patient-Centered Collaborative Healthcare-Motivational Interviewing) study was a single-center cluster randomized clinical trial at the University Children's Hospital specialized outpatient clinics in Düsseldorf, Germany. Treating pediatricians were cluster randomized to a 2-day MI workshop or treatment as usual (TAU). Patient recruitment and MI conversations occurred between April 2018 and May 2020 with 6-month follow-up and 1-year rescreening. Participants were youths aged 12 to 20 years with CMCs and comorbid symptoms of anxiety and depression; they were advised by their MI-trained or untrained physicians to access psychological counseling services. Statistical analysis was performed from October 2020 to April 2021. INTERVENTIONS MI physicians were trained through a 2-day, certified MI training course; they recommended use of mental health care services during routine clinical appointments. MAIN OUTCOMES AND MEASURESThe primary outcome of uptake of mental health care services within the 6-month follow-up was analyzed using a logistic mixed model, adjusted for the data's cluster structure. Uptake of mental health services was defined as making at least 1 appointment by the 6-month follow-up. RESULTS Among 164 youths with CMCs and conspicuous anxiety or depression screening, 97 (59%) were female, 94 (57%) had MI, and 70 (43%) had TAU; the mean (SD) age was 15.2 (1.9) years.Compared with patients receiving TAU, the difference in mental health care use at 6 months among patients whose physicians had undergone MI training was not statistically significant (odds ratio [OR], 1.96; 95% CI, 0.98-3.92; P = .06). The effect was moderated by the subjective burden of disease (F 2,158 = 3.42; P = .04). Counseling with an MI-trained physician also led to lower anxiety symptom scores at 1-year rescreening (F 1,130 = 4.11; P = .045). MI training was associated with longer conversations between patients and physicians (30.3 [16.7] minutes vs 16.8 [12.5] minutes; P < .001), and conversation length significantly influenced uptake rates across conditions (OR, 1.03; 95% CI, 1.01-1.06; P = .005).

Background: Counseling adolescents with chronic medical conditions (CMCs) can be challenging regarding suitable interviewing skills and clinicians' attitudes toward the patient. Successful communication can be a key element of treatment. Motivational Interviewing (MI) is broadly applicable in managing behavioural problems and diseases by increasing patient motivation for lifestyle changes. However, data concerning the applicability, feasibility, and implementation of MI sessions in everyday practice are missing from the physicians' point of view. Purpose: Our aim was to explore clinicians' experiences of MI training and subsequent use of MI in the routine care of adolescents with CMCs. Therefore, we wanted to find out if and how MI can be integrated into clinical practice and how training in MI should be designed. Method:The present study has a descriptive and qualitative design. Twenty pediatricians were randomized to a 2-day MI course followed by MI consultations in a cluster-randomized controlled trial (COACH-MI). Data were collected one year after MI training using a questionnaire. Factors for effective training and possible barriers to successful use of MI were examined. Results: Completed questionnaires were returned by 19 of 20 pediatricians. The pediatricians' experiences with MI demonstrate that MI is regarded as a valuable tool when working with adolescents with CMCs. 95 % of all respondents reported that they found MI education necessary for their clinical work and were using it also outside the COACH-MI study context. 73.7 % percent saw potential to strengthen the connection to their patients by using MI. The doctors were already using more MI conversation techniques after a 2-day MI course. Obstacles were seen in the short training, the lack of time, and missing undisturbed environment (interruptions by telephone, staff, etc.) during clinical flow. Conclusions: MI techniques are not yet a regular part of medical training. However, a 2-day MI course was rated effective and providing a lasting impact by physicians caring for children and adolescents with chronic medical conditions (CMCs), although booster sessions should be offered regularly.