Community Program Therapist Adherence and Competence in a Motivational Interviewing Assessment Intake Session

Abstract

Background: Teaching community program therapists to use motivational interviewing (MI) strategies for addictions treatment with sufficient frequency (i.e., adherence) and skill (i.e., competence) is a priority and challenge for the field. The development of psychometrically valid MI integrity measures that can be used for supervision and evaluation and be both sensitive and robust across clinical situations is needed. Objective: This article examines the performance of the Independent Tape Rating Scale (ITRS) () when used to evaluate the delivery of MI within a one-session assessment intake (). Methods: Audiotapes of 315 sessions of therapists in MI and counseling-as-usual conditions were rated according to the ITRS by raters blind to treatment condition. Results: Results indicate that community therapists were successfully trained and supervised to use MI within an assessment intake session, with MI adherence and competence that was discriminable from counseling-as-usual practices. Increased therapist MI adherence and competence was associated with increases in an index of client motivation for change, though unrelated to treatment outcome. Conclusions and Scientific Significance: The ITRS appears to be a valid instrument for measuring therapist MI adherence and competence within an assessment intake.

Keywords:

• motivational interviewing
• substance abuse treatment
• therapist adherence and competence
• therapist training and supervision

ACKNOWLEDGMENTS

National Institute on Drug Abuse grants (P50-DA09241, U10 DA13038, DA1025273, K05-DA00457 and K05-DA00089) supported this study. The authors are grateful to the individual who helped develop the rating manual (Joanne Corvino, MSW, Jon Morgenstern, Ph.D.), the MET/MI expert trainers and supervisors (Ken Bachrach, Ph.D., Jacqueline DeCarlo, Chris Farentinos, M.D., Melodie Keen, M.A., L.M.F.T., Terence McSherry, M.S.P.A., Jeanne Obert, M.S., Doug Polcin, Ed.D., Ned Snead, M.S., Richard Sockriter, M.S., M.B.A., Deborah Van Horn, Ph.D., Paulen Wrigley, R.N., M.S., Lucy Zammarelli, M.A, and Charlotte Chapman, Ph.D.) who provided valuable feedback while piloting the rating items, the independent tape raters (Luis Anez Nava, Psy.D., Theresa Babuscio, B.A., Declan Barry, Ph.D., Natalie Dumont, MSW, Lynn Ferrucci, M.A., Francis Giannini, LCSW, Rachel Hart, M.A., Karen Hunkele, B.A., Susan Kasserman, RN, M.Div., Brian Kiluk, B.A., Demetrios Kostas, LCSW, MBA, Mark Lawless, LCSW, Manuel Paris, Psy.D., Jane Stanton, LCSW, and Mary Ann Vail, LCSW) whose ratings provided the basis for this study's findings, and Julie Matthews, B.A. and Monica Canning-Ball, BA who administratively managed the tape rating project. The ITRS scale and rating manual are available from Dr. Martino.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article and the views they have expressed do not necessarily represent the official views of National Institute on Drug Abuse.

Notes

¹Nonsignificant (p > .05) chi-square goodness of fit index, a χ²/degrees of freedom ratio < 2, normed fit index (NFI), incremental fit index (IFI), and comparative fit index (CFI) > .9, and root mean square error of approximation (RMSEA) <.05. Because in larger models (n > 200), the chi-square test usually is significant and often detects trivial differences between sample covariance and fitted covariance matrices (20), we relied on the preponderance of evidence from the other indices in determining the best fitting model.