Cautionary tales regarding the dissemination of motivational interviewing

Abstract

drinking status, peer motivational interviewing microskills, and drinking outcomes in a brief alcohol intervention for matriculating college students: a replication. CAUTIONARY TALES REGARDING THE DISSEMINATION OF MOTIVATIONAL INTERVIEWINGThere is important work to be conducted to identify key elements of proficiency in motivational interviewing that are relevant to its goals, to develop appropriate assessment tools and to find effective ways of training practitioners to achieve a minimum standard of proficiency measured using these tools.Motivational interviewing (MI) has a strong claim as an evidence-based intervention for substance use [1]. As a result, effective training in MI should be a key concern for service providers and agencies in this domain, to achieve cost-effective use of training dollars and to maximize treatment outcomes. Unfortunately, the paper by Hall and colleagues [2] provides an important series of cautionary tales. Its most direct caution is that while most researchers who conduct training in MI assess the effectiveness of that training (15 of 20 studies in their review), the proficiency of trainees is assessed less commonly. The second major caution is that when a threshold is set for trainees to achieve beginning proficiency (75% in the Hall et al. paper), only a small proportion (two of 20 studies) can document such a training effect. The challenges embedded in these cautions are manifold. Is it that the training formats employed in most trials are inadequate, as Hall and colleagues suggest, and that more elaborate, time-consuming and expensive training protocols are needed to attain proficiency? Are the conceptualization and measurement of proficiency themselves at issue, given the various measures that exist, their relative emphasis in adherence to MI-consistent behaviours versus ratings of perceived competency, and the discrepancies in proficiency observed across measures? Or is there perhaps a practical limit on the percentage of trainees who can attain proficiency in MI? For example, in the most elaborate training method in their study (a combination of workshop, feedback and coaching), Miller et al. [3] were only able to attain a beginning proficiency level for 70% of trainees. Perhaps this level represents the asymptote of training outcomes and, if so, then perhaps there needs to be a focus in MI work on the evaluation of trainees and the 'licensing' or approval of only those who can attain a standard of proficiency that allows them to provide services.The above questions require a series of conceptual and pragmatic studies to consider how best to consider proficiency in MI, and then how to maximally train that proficiency. Trainers in other research areas sometimes discuss the issue of fidelity [4], which is a complex construct that involves both adherence to an identified treatment method (and non-adherence to conceptually incompatible models or methods), as well as the competence to apply the correct method at the correct time with an appropriate client. While adherence can...

Continuing the conversation: 30 years of motivational interviewing dissemination

“…Weisner concurred that further investigation and discourse around MI training is necessary to both sustain fidelity in real‐world service delivery, and contribute to positive client outcomes. We agree with Dobson that the field of MI would benefit from a more definitive statement of how to envision and measure fidelity constructs, such as adherence and competence. Miller & Moyers acknowledge that what constitutes ‘beginning’ proficiency in MI was determined through an arbitrary cut‐point along a continuum of skills and that MI Spirit is only one marker of fidelity.…”

Supervision of Substance Abuse Therapeutics Emphasizing the Discrimination Model of Supervision and Motivational Interview Practices

“…At the same time, there is some increasing concern about the ability to evaluate MI and transfer it among settings because of inconsistencies in practice and the ongoing changes to the underlying theory that have been articulated [37]. Scholarship of MI needs to become more transparent so that developments are better examined, replicated, and advanced [38]. Such enhanced scholarship will also solidify the impact of clinical trials and the resulting guidance for practitioners.…”