Psychometric properties of the Motivational Interviewing Treatment Integrity coding system 4.2 with jail inmates

Abstract

Motivational Interviewing (MI) is an evidence-based approach shown to be helpful for a variety of behaviors across many populations. Treatment fidelity is an important tool for understanding how and with whom MI may be most helpful. The Motivational Interviewing Treatment Integrity coding system was recently updated to incorporate new developments in the research and theory of MI, including the relational and technical hypotheses of MI (MITI 4.2). To date, no studies have examined the MITI 4.2 with forensic populations. In this project, twenty-two brief MI interventions with jail inmates were evaluated to test the reliability of the MITI 4.2. Validity of the instrument was explored using regression models to examine the associations between global scores (Empathy, Partnership, Cultivating Change Talk and Softening Sustain Talk) and outcomes. Reliability of this coding system with these data was strong. We found that therapists had lower ratings of Empathy with participants who had more extensive criminal histories. Both Relational and Technical global scores were associated with criminal histories as well as post-intervention ratings of motivation to decrease drug use. Findings indicate that the MITI 4.2 was reliable for coding sessions with jail inmates. Additionally, results provided information related to the relational and technical hypotheses of MI. Future studies can use the MITI 4.2 to better understand the mechanisms behind how MI works with this high-risk group.

Is fidelity to motivational interviewing associated with alcohol outcomes in treatment-seeking 60+ year-old citizens?

“…Additionally, 80% of the rated sessions fulfilled the benchmark for good MI on the relational summary score, 67% for the technical summary score, 76% of the rated sessions fulfilled benchmarks for the summary score of percent complex reflections, and 47% of rated session the reflection to question ratio. All in all, these indicate high levels of fidelity and are comparable to other studies with high levels of fidelity to MI (Boman et al, 2018;Freira et al, 2018;Magill, Graves, et al, 2018;Owens et al, 2017;Serrano et al, 2017) and substantially higher than studies with expected lower fidelity to MI (Copeland et al, 2018;Simper, Breckon, and Kilner, 2017). The ratings indicated use of MIA's, but the general low ratings of emphasize autonomy questions the use of this important MI-technique in this study.…”

“…The fourth revision of the MITI incorporated the empirical literature, indicating the importance of the therapist's role in both encouraging change, favoring language from the client (Change Talk) and decreasing language opposing change (Sustain Talk) in MI treatment sessions. The new measures of the MITI 4 has acceptable reliability (Moyers et al, 2016;Copeland et al, 2018;Kramer Schmidt, Andersen, Nielsen, and Moyers, 2019;Owens, Rowell, and Moyers, 2017;Serrano et al, 2017) and validity when comparing them to the golden standard, the MISC (Motivational Interviewing Skills Code) (Moyers et al, 2016).…”

“…Early evidence indicates that the MITI 4 measures fidelity to elements of the MI process: Owens et al (2017), assessed associations between MITI 4 global ratings and motivation and confidence to decrease drug use by the end of treatment among incarcerated individuals. In particular, significant associations were found between the technical score of the MITI 4 and motivation to decrease drug use by the end of treatment (Owens et al, 2017). The technical score is based on how well the therapist is cultivating and evoking client change talk, and simultaneously softening client sustain talk (Moyers et al, 2014).…”

Differences in the delivery of motivational interviewing across three countries

“…The MITI is recently refined to reflect the developments in the theory of MI and to improve reliability of the measures (MITI 4) (Moyers et al, 2014). The MITI 4 has been applied in some studies so far supporting the reliability to MI and to some extend the validity (Copeland et al, 2019;Moyers et al, 2016;Owens et al, 2017;Serrano, 2018). The MITI 4 provides information on the technical elements of MI by means of a measure of the therapist's ability to cultivate change talk and soften sustain talk; the relational elements empathy and partnership; in addition, detailed information on MI-adherent therapist behavior (affirmation, seeking collaboration, emphasizing autonomy) and MI-non-adherent therapist adherent (confront and persuade) (Moyers et al, 2014) is collected.…”

“…Even though this could be due to differences within the therapist as well, it is in line with the findings of participant characteristics affecting MI delivery. For instance, participant characteristics like criminal history (Owens et al, 2017), severity of addiction (Imel et al, 2011), and level of motivation for change (Gibbons et al, 2010;Imel et al, 2011) have been found to affect how MI is delivered. Thus, in order to attempt to compare the delivery of MI across countries, the therapists in the various nations should, as a minimum, treat individuals with similar characteristics and problems.…”