Reliability and Validity of an Observational Measure of Client Decision-Making: The Client Language Assessment – Proximal/Distal (CLA-PD)

Abstract

Overview The Client Language Assessment – Proximal/Distal (CLA-PD) is a language rating system for measuring client decision-making in interventions that target a specified behavior change (e.g., alcohol or other drug use). In the CLA-PD, there are five dimensions of change language (Reason, Ability, Commitment, Taking Steps, Other) adapted from the client portion of the Motivational Interviewing Skill Code (MISC). For the CLA-PD, language codes are sub-divided to discriminate statements regarding the primary, or target behavior change (distal change) from the intermediate coping activities (proximal change) that are prescribed to facilitate that target behavior change. The goal of the CLA-PD is to allow for higher specificity than existing client language measures, when process studies consider interventions that are multi-session and skill-based (e.g., Cognitive Behavioral Therapy). Method Three raters received 40 hours of training on the use of the CLA-PD. The data were a sample of therapy session audio-files from a completed clinical trial (N = 126), which enabled examination of client language across four sessions (i.e., first three and final attended) of three evidence-based alcohol interventions (Cognitive Behavioral Therapy, Twelve-Step Facilitation Therapy, Motivational Enhancement Therapy). Results Inter-rater reliability results for summary scores showed “excellent” reliability for the measure. Specifically, two-way mixed Intraclass Coefficients ranged from .83 to .95. Internal consistency reliability showed alphas across sessions that ranged from “fair” to “good” (α = .74 to.84). In convergent and discriminant validity analyses using data independently measured with MISC-based ratings, the pattern of results was as would be expected. Specifically, convergent correlations, by valence (i.e., change and sustain talk), between CLA-PD Distal and MISC-based language scores were moderate (r = .46 to .55, p < .001) while discriminant correlations by valence for CLA-PD Proximal and MISC-based language scores were small (r = .22 to .24, p < .05). Finally, proportion Change Talk Proximal predicted subsequent session coping behaviors (i.e., Processes of Change) as well as 3-month Alcoholics Anonymous involvement and attendance (ps < .05 – .005), but not 3-month alcohol abstinence self-efficacy. Further, analyses of criterion predictive validity showed that proportion Change Talk Distal predicted 3- and 12-month drinking frequency and quantity measures (ps < .05 – .005). Conclusions When behavior change treatments are multi-session and/or skill-based, the present analyses suggest the CLA-PD is a promising, psychometrically sound observational rating measure of client verbalized decision-making.

The In-Session and Long-Term Role of a Significant Other in Motivational Enhancement Therapy for Alcohol Use Disorders

“…The former label represents steps towards behavior change (such as attendance at a self-help meeting), whilst the latter relates directly to engaging or not engaging in alcohol use. The CLA-PD has sound psychometric properties, including “excellent” (Cicchetti, 1994) inter-rater agreement for the Change Talk and Sustain Talk summary scores as well as promising predictive validity for up to 12 months post-treatment (Magill et al, 2013; Magill et al, 2015). …”

Motivational interviewing technical process and moderated relational process with underage young adult heavy drinkers.

“…The five CLA-PD items (i.e., Reasons, Commitments, Abilities, Taking Steps, Other) are derived from the client portion of the Motivational Interviewing Skill Code (MISC 2.5; Houck et al, 2010), but are adapted to distinguish statements regarding Proximal-Coping (e.g., "I will tell my friends that I am trying to cut down on my drinking" = Commitment-Proximal towards change) from Distal-Drinking (e.g., "I will cut down on my drinking" = Commitment-Distal towards change) behaviors. The intent of the CLA-PD is to allow for assessment of language in behavior change interventions that incorporate some type of coping skills training (Magill et al, 2016). Each distal or proximal code requires a subsequent valence (i.e., toward or away from change) that is coded for frequency and strength (3-point scale).…”

Therapist and client discussions of drinking and coping: a sequential analysis of therapy dialogues in three evidence-based alcohol use disorder treatments

“…In contrast to the MISC, each of these codes have been subdivided to discriminate speech regarding the primary behavior change (distal Change and Sustain Talk) from those regarding the intermediate coping skills (proximal Change and Sustain Talk) that are hypothesized to facilitate that behavior change. The CLA-PD has shown good reliability (reported here; Table 1) as well as predictive validity in relation to client post-session mechanisms and post-treatment drinking behaviors [43].…”