Computer-Assisted Motivational Intervention (CAMI)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Computer-Assisted Motivational Intervention (CAMI) has been rated by the CEBC in the area of: Teen Pregnancy Services.

Target Population: Pregnant and/or parenting adolescents ages 18 and younger

For children/adolescents ages: 13 – 18

Brief Description

The purpose of the CAMI is to increase motivation among adolescent mothers to consistently use condoms and contraception with the long-term goal of reducing rapid repeat births. CAMI consists of 60-minute sessions conducted in two-parts by trained counselors who meet one-on-one with pregnant and/or parenting adolescent mothers, ages 12 through 18 years old. During the first part of each session, participants use the computer-based CAMI program to answer questions about current sexual relationships and contraceptive use intentions and behaviors. Based on the responses generated, CAMI counselors conduct a stage-matched Motivational Interviewing session to enhance participants’ motivation to consistently use condoms and contraception in order to reduce the risk for a repeat pregnancy.

Program Goals:

The goals of Computer-Assisted Motivational Intervention (CAMI) are:

  • Encourage consistent condom and hormonal contraceptive use
  • Assist adolescent mothers to understand their own motivations and goals
  • Help them see the inconsistencies between their goals and current behaviors in a non-judgmental manner. CAMI counselors use Motivational Interviewing techniques to help adolescent mothers make healthier choices to reduce their risk for repeat pregnancies and sexually transmitted infections

Essential Components

The essential components of Computer-Assisted Motivational Intervention (CAMI) include:

  • Each 60-minute CAMI session is divided into three parts:
    • Computer-Based CAMI Program (20-25 min): The participant answers questions about her current sexual relationships and contraceptive use intentions and behaviors. Based on these responses, the CAMI Program assesses the participant’s risk of pregnancy and sexually transmitted infections (STIs), as well as her stage of readiness to change for contraceptive use.
    • Stage-Matched Motivational Interview (20-30 min): The counselor receives a summary printout containing all of the participant’s responses in addition to results indicating the participant’s pregnancy risk, STI risk, and stage of change for contraceptive use.

      Based on this summary printout, the counselor conducts a stage-matched Motivational Interviewing session that aims to help increase the participant’s motivation to consistently use condoms and contraception in order to prevent another pregnancy for at least two years after her previous birth.
    • Creating a Safe Plan (Optional) (5-10 min): The counselor offers the participant the opportunity to complete a Safe Plan that identifies specific steps that she will take to consistently use condoms and contraception in the near future. The participant will identify:
      • The reasons why her plan is important
      • Potential barriers to her plan
      • Possible solutions for overcoming these barriers
      • People who will help her with her plan
    • Both the participant and counselor will sign the plan and provide a copy to the participant for her to keep.

Child/Adolescent Services

Computer-Assisted Motivational Intervention (CAMI) directly provides services to children/adolescents and addresses the following:

  • Pregnant or parenting – having given birth to a child when under the age of 18 years old

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Community Agency
  • Outpatient Clinic

Homework

This program does not include a homework component.

Languages

Computer-Assisted Motivational Intervention (CAMI) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • At least one CAMI counselor who possesses empathetic qualities, rapport with adolescents, and knowledge of the community
  • Facilities for conducting one-on-one CAMI sessions (e.g., community-based setting, clinic, or participant’s home)
  • CAMI Software Program
  • Laptop or desktop computer
  • CAMI Counselor’s Manual
  • Set of four worksheets
  • User’s Guide

Minimum Provider Qualifications

When recruiting CAMI counselors, it is highly recommended that agencies seek individuals who possess empathetic qualities, excellent communication skills, experience working with adolescents, and a familiarity with the community. There is no set minimum educational requirement.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

On-site

Number of days/hours:

The length of the standard training for CAMI is one day. A two-day training is also available for agencies that would like to receive standard training plus an additional day for training in Motivational Interviewing techniques.

Implementation Information

Since Computer-Assisted Motivational Intervention (CAMI) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Computer-Assisted Motivational Intervention (CAMI).

Formal Support for Implementation

There is formal support available for implementation of Computer-Assisted Motivational Intervention (CAMI) as listed below:

Train-the-trainer training is offered. Support to create a subsequent training for individuals wishing to provide technical assistance is offered as well.

Fidelity Measures

There are no fidelity measures for Computer-Assisted Motivational Intervention (CAMI).

Implementation Guides or Manuals

There are implementation guides or manuals for Computer-Assisted Motivational Intervention (CAMI) as listed below:

A program package containing all of the program materials needed to implement CAMI is available for purchase through Sociometrics at www.socio.com/passp04.php. The program package includes the following:

  • User’s Guide: This booklet provides a general overview of the program and how the program has demonstrated positive impacts on reducing the risk of repeat births among adolescent mothers.
  • Counselor’s Manual: This manual provides information for counselors on how to conduct CAMI sessions with participants.
  • CAMI Program: The computer-based CAMI Program is available on an USB flash drive.
  • CAMI Worksheets: This packet includes a set of four worksheets that are used during CAMI sessions including: 1) Future Goals Worksheet, 2) Decisional Balance Worksheet, 3) Importance and Confidence Rulers, and 4) My Safe Plan.
  • Motivational Interviewing Training Workshop (PowerPoint Slides): This packet contains a printed slide set of a motivational interviewing training workshop presentation by Dr. Beth Barnet, principal investigator of the CAMI evaluation study.
  • CAMI Original Evaluation Instruments: This booklet contains copies of the original evaluation instruments used during the structured participant interviews conducted at baseline and at 2 years postpartum.

Research on How to Implement the Program

Research has not been conducted on how to implement Computer-Assisted Motivational Intervention (CAMI).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Barnet, B., Liu, J., DeVoe, M., Duggan, A. K., Gold, M. A., & Pecukonis, E. (2009). Motivational intervention to reduce rapid subsequent births to adolescent mothers: A community-based randomized trial. Annals of Family Medicine, 7(5), 436–445. doi:10.1370/afm.1014

Type of Study: Randomized controlled trial
Number of Participants: 235

Population:

  • Age — 12-18 years
  • Race/Ethnicity — 97% African American
  • Gender — 100% Female
  • Status — Participants were pregnant teenagers recruited from urban prenatal clinics serving low-income, predominantly African American communities.

Location/Institution: Baltimore, Maryland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effectiveness of the Computer-Assisted Motivational Intervention (CAMI) in preventing adolescent mothers from having rapid subsequent births. Teenagers were randomly assigned to 3 groups: (1) those in CAMI plus enhanced home visit received a multi-component home-based intervention (CAMI+); (2) those in CAMI-only received a single component home-based intervention; (3) and those in the usual care control received standard usual care. Teens in both intervention groups received CAMI sessions at quarterly intervals until 2 years postpartum. Measures utilized include the Decision-Making-Competency Inventory (DMCI) and the Center for Epidemiologic Studies Depression Scale (CES-D). Results indicated that the CAMI+ group compared with the usual-care control group exhibited a non-significant trend toward lower birth rates, whereas the CAMI-only group did not. Controlling for baseline group differences, the hazard ratio (HR) for repeat birth was significantly lower for the CAMI+ group than it was in the usual care group. Complier average causal effects models were used to produce unbiased estimates of intervention effects accounting for differences in participation across the groups. Analyses showed that completing 2 or more CAMI sessions significantly reduced the risk of repeat birth in both groups. Limitations include differences in subject participation across the intervention groups and concerns about the generalizability of the sample to other populations. Note: Significant effects were seen in the CAMI-only group for those teens who received 2 or more sessions of CAMI.

Length of postintervention follow-up: None.

Barnet, B., Rapp, T., DeVoe, M., & Mullins, C. D. (2010). Cost-effectiveness of a motivational intervention to reduce rapid repeated childbearing in high-risk adolescent mothers: A rebirth of economic and policy considerations. Archives of Pediatrics & Adolescent Medicine, 164(4), 370–376. doi:10.1001/archpediatrics.2010.16

Type of Study: Randomized controlled trial
Number of Participants: 235

Population:

  • Age — 12-18 years
  • Race/Ethnicity — 97% African American
  • Gender — 100% Female
  • Status — Participants were pregnant teenagers aged 18 years and older.

Location/Institution: Baltimore, Maryland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilized participants from Barnet, B., Liu, J., DeVoe, M., Duggan, A. K., Gold, M. A., & Pecukonis, E. (2009). This study evaluated the effectiveness of the Computer-Assisted Motivational Intervention (CAMI) in preventing adolescent mothers from having rapid subsequent births. Teenagers were randomly assigned to 3 groups: (1) those in CAMI plus enhanced home visit received a multi-component home-based intervention (CAMI+); (2) those in CAMI-only received a single component home-based intervention; (3) and those in the usual care control received standard usual care. Teens in both intervention groups received CAMI sessions at quarterly intervals until 2 years’ postpartum. Results indicated that, compared to usual care, subjects in the combined group of CAMI+ and CAMI-only had significantly reduced repeated births. However, significant differences were not seen for the CAMI-only group. Study limitations include generalizablity due to population and ethnicity, lack of post-intervention follow-up, and relatively small sample size.

Length of postintervention follow-up: None.

Gold, M. A., Tzilos, G. K., Stein, L. A. R., Anderson, B. J., Stein, M. D., Ryan, C. M., ... & DiClemente, C. (2015). A randomized controlled trial comparing Computer-Assisted Motivational Intervention to Didactic Educational Counseling to reduce unprotected sex in female adolescents. Journal of Pediatric and Adolescent Gynecology, 29(1), 26–32. doi:10.1016/j.jpag.2015.06.001

Type of Study: Randomized controlled trial
Number of Participants: 572

Population:

  • Age — 13-21 years (Mean=17 years)
  • Race/Ethnicity — 59% African American
  • Gender — 100% Female
  • Status — Participants were females at risk for pregnancy and sexually transmitted diseases (STDs).

Location/Institution: Pittsburgh, Pennsylvania

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effectiveness of the Computer-Assisted Motivational Intervention (CAMI) at reducing the risk of unprotected sexual intercourse. Participants were randomized to either the CAMI or Didactic Educational Counseling (DEC) condition stratified by age, race, and sexual history. Measures utilized included 90-day Timeline Follow-back calendar and a computerized assessment to collect demographic information, sexual, contraceptive, pregnancy and STD history, and other variables. Results indicated the CAMI was rated easy to use. Compared to the DEC, there was a significant effect of the intervention suggesting that the CAMI helped reduce unprotected sex among participants who completed the study. However, due to the high attrition rate, the intent-to-treat analysis did not demonstrate a significant effect of the CAMI on reducing unprotected sex. Limitations include high attrition rate, limited generalizability due to predominantly minority sample of female adolescents, reliability on self-reported measures, and length of follow-up.

Length of postintervention follow-up: 3 months.

References

No reference materials are currently available for Computer-Assisted Motivational Intervention (CAMI).

Contact Information

Name: Josefina J. Card, PhD
Title: CEO/President
Agency/Affiliation: Sociometrics Corporation
Website: www.socio.com/pasha.php
Email:
Phone: (650) 949-3282
Fax: (650) 949-3299

Date Research Evidence Last Reviewed by CEBC: July 2017

Date Program Content Last Reviewed by Program Staff: May 2017

Date Program Originally Loaded onto CEBC: March 2014