Disseminating skills to carers of people with eating disorders: an examination of treatment fidelity in lay and professional carer coaches

Abstract

Family members of people with eating disorders (EDs) have high levels of stress and can use maladaptive methods of coping. We have developed an intervention, using motivational interviewing (MI) strategies that trains lay and professional carer coaches (CCs) to support carers of adolescents with EDs to use more adaptive coping procedures. The aim of this study is to measure treatment integrity in coaches with either academic or lived experience. Eleven coaches were trained and supervised by an expert trainer and an ‘expert by experience’ trainer. Six of the coaches had prior training in clinical work and/or psychology and five had personal experience of supporting a loved one with an ED. Two audio-taped sessions (Sessions 3 and 7) from each family coached (n = 22) were assessed for fidelity to MI. Half the sessions (50% n = 11) had a Motivational Interviewing Treatment Integrity global score above the suggested cut-off for recommended competency. Prior clinical training was related to higher treatment fidelity and experiential training (having coached a greater number of families) improved treatment fidelity in the lay carer group. These preliminary findings suggest that: “lay CCs” can be trained to deliver an intervention based on MI. Further exploration of a more effective means of training, monitoring and supervision is required to maximise the quality of the intervention.

A Pilot, Multicentre Pragmatic Randomised Trial to Explore the Impact of Carer Skills Training on Carer and Patient Behaviours: Testing the Cognitive Interpersonal Model in Adolescent Anorexia Nervosa

“…The guides had regular supervision. The quality of the sessions was judged for competency in motivational interviewing skills, and the majority were found to be adequate (Macdonald et al, ).…”

Two‐year Follow‐up of a Pragmatic Randomised Controlled Trial Examining the Effect of Adding a Carer's Skill Training Intervention in Inpatients with Anorexia Nervosa

“…Training and the measurement of quality assurance of the coaching has been previously described (Goddard, Raenker, et al, ). The majority of coaches (64%) attained the recommended skill level for motivational interviewing as defined by the standard measure of competence (Macdonald, Hibbs, et al, ).…”

Self-Help And Recovery guide for Eating Disorders (SHARED): study protocol for a randomized controlled trial

“…A key advantage of the current design is that we can examine how feasible and acceptable this intervention is in standard treatment settings. Although we have previously used peer support in the context of interventions for carers [ 38 ] and frequently employ such individuals in our inpatient setting to help with teaching and various aspects of the therapeutic environment, we have not yet employed recovered individuals exactly in the capacity as in the Recovery MANTRA intervention. We will thus examine whether this form of task-sharing is feasible.…”

“…Peer mentors will be assigned study participants only after they have demonstrated sufficient competence with training samples (that is, the training samples will have details of patients who will not be used within the study). Adherence and fidelity to the motivational interviewing model will be monitored by an analysis of a random selection of transcripts (sessions 2 to 5) using the Motivational Interviewing Treatment Integrity rating system, a validated and reliable behavioural coding system used to measure treatment integrity in motivational interviewing [ 38 ]. A simplified version of the Revised Cognitive Therapy Scale [ 39 ] will be adapted specifically for this intervention to address the more goal-driven aspects of the programme.…”

“…Indeed, research suggests that training of nonspecialized professionals is an important factor in enhancing feasibility of task-sharing interventions [ 37 ]. We have previously had success in training people with experience of eating disorders (mainly as caregivers) to provide a form of motivational interview-based support to other families [ 38 ] and will therefore follow the same strategy for training peer mentors in Recovery MANTRA.…”