Adoption of Motivational InterviewingMotivational Enhancement Therapy - PowerPoint PPT Presentation

Title: Adoption of Motivational InterviewingMotivational Enhancement Therapy


1
Adoption of Motivational Interviewing/Motivational
Enhancement Therapy
American Psychological Association August 18,
2007

• Joseph Guydish PhD, Sarah Turcotte Manser MA,
• Martha A. Jessup RN PhD, Barbara Tajima EdM
• Institute for Health Policy Studies, University
  of California,
• San Francisco
• This work was supported by National Institute on
  Drug Abuse (R01 DA-14470), by the
  California-Arizona research node of the NIDA
  Clinical Trials Network (U10 DA-105815), and by
  the NIDA San Francisco Treatment Research Center
  (P50 DA-09253)

2
MI/MET CTN Trials

• NIDA Clinical Trials Network (CTN)
• Randomized Clinical Trial of Motivational
  Interviewing (MI) and Motivational Enhancement
  Therapy (MET)
• 11 sites (MI5, MET6)
• 884 participants (MI423, MET461)
• Data points baseline, 28 day, 84 day

3
MAP Study Methods

• Studied adoption of MI/MET in clinics where
  it was tested
• 5 sites MI3, MET2
• 29 Key informant interviews
• Interviews on average 4.25 months after the
  treatment phase of the trials

4
Organizational Change
5
Multi Levels of Assessment
Interviews were completed 4 -13 months after
treatment phase completion
Includes project management, data management,
and training activities One clinic level
supervisor could not be located and two also had
the role of clinic director.
6
Data Analysis

• Organizational functioning
• Theoretical framework informed key domains
• Closed coding developed using analytic categories
• Concurrent data collection and analysis
• Analytic memos, team discussion, and on-going
  comparison of the data

7
Local Training Model
William Miller has been doing this
motivational interviewing network of trainer
thing for years once a year he offers this big
training of trainers it's a world-wide network.
So, being able to tap into that made a huge
difference in terms of sustainability... and
then that trainer was available to train the...
supervisor.... the idea is that it's a model
that builds in sustainability if you've got
somebody there who can supervise the treatment
... MI/MET Elite
8
A Champion
I never had heard the term motivational
interviewing until... a conference... we saw
something ...that fit our philosophy about how
you treat people. And, we trained our staff... in
MI. We ... did a chapter a month, had
different people leading the discussions each
time we met, and assigned people reading time and
reduced some of their workload in order to give
them time to do it... and then challenged the
staff ... to operationalize it ... and come up
with a model for doing treatment that would work
better than what we were doing... Clini
c Director
9
Difficulty Implementing the Trial
... I quite frankly did not foresee some of the
problems that we would have getting this trial
together. I think clear messages were needed
from high-level administratorsthey needed to
pull everyone together. Clinic Research
Supervisor
10
(No Transcript)
11
How is Adoption Measured ?
You never really know how people practice, when
theyre alone in a room. Clinic Director
And at times, they may forget that that's a tool
that they have ... I hope when you talk to them,
that the MI counselors are gonna say, "Yeah, that
was a good thing for me. I got a lot out of
that, and I use it." ... Do I absolutely know
that? Clinical Supervisor
12

A Range of Adoption Outcomes
13
Adoption of MI/MET at Clinic Sites (n5)
No opportunity to adopt
14
Adoption in Prior Studies

• Fals-Stewart study of Brief Couples Therapy
  (BCT) in 5 sites
• 1 site adopted
• Study of Matrix adoption in 6 sites
• 1 site adopted
• Study of MI/MET in 5 sites
• 2 sites adopted
• Rate of Adoption 25

15
Conclusions

• Post clinical trials rate of adoption is low
• Need infrastructure to support adoption
• Determine what kind of implementation is
  wanted (toolbox, partial, full, adaptation)
• Determine method to measure adoption