Evaluating motivational enhancement therapy adherence and competence among Spanish-speaking therapists

Abstract

Despite the fact that the number of Hispanic individuals in need of treatment for substance use problems is increasing internationally, no studies have investigated the extent to which therapists can provide empirically supported treatments to Spanish-speaking clients with adequate fidelity. Twenty-three bilingual Hispanic therapists from five community outpatient treatment programs in the United States were randomly assigned to deliver either three sessions of motivational enhancement therapy (MET) or an equivalent number of drug counseling-as-usual sessions (CAU) in Spanish to 405 Spanish-speaking clients randomly assigned to these conditions. Independent ratings of 325 sessions indicated the adherence/competence rating system had good to excellent interrater reliability and indicated strong support for an a priori defined fundamental MET skill factor. Support for an advanced MET skill factor was relatively weaker. The rating scale indicated significant differences in therapists' MET adherence and competence across conditions. These findings indicate that the rating system has promise for assessing the performance of therapists who deliver MET in Spanish and suggest that bilingual Spanish-speaking therapists from the community can be trained to implement MET with adequate fidelity and skill using an intensive multisite training and supervision model.

Informal discussions in substance abuse treatment sessions with Spanish-speaking clients

“…Relative to therapeutic strategies used during the sessions, counselors talked informally with their clients less often than they used MET consistent strategies or techniques to assess substance use or related psychosocial factors. In contrast, on average informal discussion occurred more frequently than any of the MET inconsistent strategies (e.g., direct confrontation) or strategies involving treatment approaches from other theoretical orientations (e.g., coping skills training) (see Santa Ana et al, 2009 for details about ITRS item frequencies in the Spanish MET trial).…”

“…Thus, informal discussion was measured by the frequency of its use (adherence), not the competence in which it was rendered. Psychometric analyses of the ITRS used in the Spanish MET trial (Santa Ana et al, 2009) and the English MET trial (Martino et al, 2008) confirmed good to excellent levels of interrater reliability (ICCs ranging from .60 to .96 in the Spanish MET trial and from .66 to .99 in the English MET trial) and a two-factor model among the MET consistent items: a) fundamental skills that underpin the empathic and collaborative stance of MET such as open-ended questions, reflective statements, and motivational interviewing style or spirit; and b) advanced skills for evoking client motivation for behavior change, such as heightening discrepancies and change planning (Martino et al, 2008; Santa Ana et al, 2009). …”

“…The remaining 30% of tapes selected for analysis came from participants who completed 1 to 2 sessions. This sample included all 23 counselors and 152 of the 379 (40.1%) clients who received at least one protocol session (see Santa Ana et al, 2009 for details about adherence and competence rating procedures).…”

“… Note: The Spanish MET trial included 23 counselors and 325 audiotaped sessions (Santa Ana et al, 2009). The English MET trial included 35 counselors and 421 audiotaped sessions (Martino et al, 2008).…”

“…Counselors who delivered MET in both protocols received extensive training and supervision and successfully delivered MET with significantly higher adherence (frequent use of MI consistent strategies) and competence (skillful implementation) than the CAU counselors across the three sessions (see Martino, Ball, Nich, Frankforter, & Carroll, 2008 and Santa Ana et al, 2009 for details). An interesting caveat to these integrity findings within the English MET protocol was that CAU counselors talked more often with their clients about issues that were unrelated to the clients’ treatment needs and this higher frequency of informal discussion (i.e., ‘chat’) was significantly related to less counselor MET adherence and competence and less in-session change in client motivation, though unrelated to client program retention and substance use outcomes (Martino, Ball, Nich, Frankforter, & Carroll, 2009).…”