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Motivational Interviewing (MI)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare Relevance Level:
Medium

See descriptions of 3 levels

Brief Description

The information in this program outline is provided by the program representative and edited by the CEBC staff. The Motivational Interviewing (MI) program has been rated by the CEBC in the areas of: Motivation and Engagement and Substance Abuse Treatment (Adult).

  • Types of Maltreatment: Does not target any specific kind of maltreatment
  • Target Population: Caregivers of children referred to the child welfare system.

MI is a client-centered, directive method designed to enhance client motivation for behavior change. It focuses on exploring and resolving ambivalence by increasing intrinsic motivation to change. MI has been shown to be effective in improving substance abuse recovery outcomes by itself, as well as in combination with other treatments.

Essential Components

The overarching goals of MI are:

  • to enhance internal motivation to change.
  • to reinforce this motivation.
  • to develop a plan to achieve change.

MI emphasizes two essential dimensions related to an individual's ambivalence to change:

  • the importance of the change.
  • the confidence that the change can be accomplished.

MI includes a number of open-ended questions encouraging the client to talk about circumstances surrounding his or her referral for evaluation, as opposed to the standard substance abuse evaluation that includes administering a number of structured interviews asking closed-ended questions. Examples of the types of open-ended questions that might be used are as follows:

  • What do you think are the reasons your caseworker referred you here today?
  • What worries you about your substance use?
  • How has your use of substances presented problems for you in the past?
  • What kinds of things would need to happen to make you consider changing your substance use?
  • What are the things that would prevent you from changing your substance use?
  • What are your concerns about entering substance abuse treatment at this time?

Child Component

Motivational Interviewing (MI) was not designed with a child component.

Parent / Caregiver Component

Motivational Interviewing (MI) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

  • Substance abuse or dependence and other health/lifestyle behavior change issues.

Group Format

Motivational Interviewing (MI) was designed to be conducted in a group setting, and has been tested for use in a group setting.

Recommended group size:

5-7 participants.

Testing References:

Van Horn, D. H. & Bux, D. A. (2001). A pilot test of motivational interviewing groups for dually diagnosed inpatients. Journal of Substance Abuse Treatment, 20, 191-195.

Bailey, K. A., Baker, A. L., Webster, R. A., & Lewin, T. J. (2004). Pilot randomized controlled trial of a brief alcohol intervention group for adolescents. Drug and Alcohol Review, 23(2), 157-166.

John, U., Veltrup, C., Driessen, M., Wetterling, T., & Dilling, H. (2003). Motivational intervention: An individual counseling vs. a group treatment approach for alcohol-dependent in-patients. Alcohol and Alcoholism, 38, 263-269.

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic
  • Residential Care Facility

Homework

This program does not include a homework component.

Languages

Motivational Interviewing (MI) has materials available in languages other than English:

Bulgarian, Chinese, Czech, Danish, Dutch, Estonian, French, German, Greek, Hebrew, Italian, Japanese, Korean, Portuguese, Romanian, Spanish, Swedish, Turkish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

A room to conduct the session.

Minimum Provider Qualifications

None. Efficacy does not appear to be related to the level of practitioner degree.

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:

Training can be provided on-site. Follow-up feedback and coaching can be delivered effectively by telephone. The website www.motivationalinterview.org contains a list of trainers by state.

Number of days/hours:

Please see http://motivationalinterview.org/trainers/side_bar/training_outlines.html

Implementation Information

Since Motivational Interviewing (MI) is highly 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 Assessments

To be given to organizations or providers in order to measure organizational or individual readiness:

There are no pre-implementation assessments to evaluate readiness; however for MI it is not about "readiness" so much as the skill level from which the person is starting in learning MI.

Implementation Tools — for the program (e.g., implementation guides or manuals)

The Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA-STEP) package is a collection of tools for mentoring counselors and other clinicians in the use of MI skills during clinical assessments. MIA-STEP was produced by The Addiction Technology Transfer Center (ATTC) Network under a cooperative agreement from the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) and the National Institute on Drug Abuse (NIDA). This document can be found at http://motivationalinterview.org/Documents/MIA-STEP.pdf.

Fidelity Measures

The Motivational Interviewing Treatment Integrity (MITI) is an instrument that yields feedback that can be used to increase clinical skill in the practice of motivational interviewing. The MITI measures how well or how poorly a practitioner is using MI and can be found on casaa.unm.edu/download/miti.pdf.

Additional information about MI fidelity measures is available at: www.usm.edu/MIConsortium/Resources.html.

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Safety

Show relevant research...

Baer, J. S., Marlett, G. A., Kivlahan, D. R., Fromme, K., Larimer, M. E., & Williams, E. (1992). An experimental test of three methods of alcohol risk reduction with young adults. Journal of Consulting and Clinical Psychology, 60(6), 974-979.

Type of Study: Randomized controlled trial
Number of Participants: 134

Population:

  • Age range — 21.2 years on average
  • Race/Ethnicity — 91% White, 4.5% Asian, less than 1% Black, Latin American, or Native American.
  • Gender — Not Specified
  • Status — Student volunteers recruited through the media.

Location / Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Volunteers were required to report at least one alcohol-related problem on the Michigan Alcoholism Screening Test (MAST). Participants were randomly assigned to receive meetings in a classroom format (six 90-minute sessions), six self-help reading units, or Motivational Interviewing (MI). After the interventions, drinking was monitored with the Daily Drinking Questionnaire at 3, 6, 12, and 24 months. Compliance varied across treatment conditions, with the fewest participants completing the self-help condition, and the most completing the MI condition. Due to lack of compliance, the self-help condition was not included in the final analysis. Participants in both of the remaining conditions showed reductions in drinking rates, which were maintained at two years, with the exception of a temporary increase when 20-year-old participants reached the legal drinking age. This study is limited by lack of an assessment-only control group.

Length of post-intervention follow-up: 2 years.

Baer, J. S., Kivlahan, D. R., Blume, A. W., McKnight, P., & Marlatt, G. A. (2001). Brief intervention for heavy drinking college students: 4-year follow-up and natural history. American Journal of Public Health, 91(8), 1310-1316.

Type of Study: Randomized controlled trial
Number of Participants: 461

Population:

  • Age range — Younger than 19 years at baseline
  • Race/Ethnicity — 84% White and 16% Other
  • Gender — Not Specified
  • Status — Students recruited through a mailed questionnaire.

Location / Institution: University of Washington

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Students completing the questionnaire were included if they reported having 5 to 6 drinks on at least one occasion in the preceding month and reported at least 3 negative consequences from drinking on the Rutgers Alcohol Problems Inventory. An additional randomly selected set of respondents served as a comparison group. Participants in the intervention condition received individualized feedback sessions (Motivational Interviewing), and written information comparing their drinking patterns and consequences with their peers. Groups did not differ in drinking frequency, but the intervention group showed significant reductions in drinking quantity and negative consequences from drinking over the follow-up period. The authors note that the study is limited by the use of self-report measures of drinking.

Length of post-intervention follow-up: 4 years.

Carroll, K. M., Libby, B., Sheehan, J., & Hyland, N. (2001). Motivational interviewing to enhance treatment initiation in substance abusers: An effectiveness study. The American Journal on Addictions, 10, 335-339.

Type of Study: Randomized controlled trial
Number of Participants: 60

Population:

  • Age range — 34 years on average
  • Race/Ethnicity — Standard: 86.2% Caucasian, 10.3% Hispanic, and 3.4% African American. MI: 80.6% Caucasian, 9.7% Hispanic, 6.5% African American, and 3.2% Other.
  • Gender — Not Specified
  • Status — Individuals referred by child welfare caseworkers for a substance abuse evaluation.

Location / Institution: Connecticut

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomly assigned to receive either standard treatment or enhanced (MI) treatment. Results showed that significantly more participants in the MI group went on to attend treatment sessions than in the standard group (59.3% versus 29.2%). However, this advantage did not persist beyond treatment initiation.

Length of post-intervention follow-up: None.

Mullins, S. M., Suarez, M., Ondersma, S. J., & Page, M. C. (2004). The impact of motivational interviewing on substance abuse treatment retention: A randomized control trial of women involved with child welfare. Journal of Substance Abuse Treatment, 27, 51-58.

Type of Study: Randomized controlled trial
Number of Participants: 71

Population:

  • Age range — 27.1 on average
  • Race/Ethnicity — 47.9% Caucasian, 32.4% African American, 12.7% Native American, and 7.0% Hispanic
  • Gender — Not Specified
  • Status — Women enrolled in a 12-month treatment program for pregnant women using drugs following Child Protective Services referral.

Location / Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomly assigned to the Motivational Interviewing (MI) condition or to an education control condition. All participants also attended weekly psycho-educational and substance abuse groups and received random weekly urine testing. No differences were found between the MI and control conditions. The authors suggest that MI may have limited effectiveness with a coerced population.

Length of post-intervention follow-up: None.

Freyer-Adam, J., Coder, B., Baumeister, S. E., Bischof, G., Riedel, J, Paatsch, K. ... Hapke, U. (2008). Brief alcohol intervention for general hospital inpatients: A randomized controlled trial. Drug and Alcohol Dependence, 93(3), 233-243.

Type of Study: Randomized controlled trial
Number of Participants: 595

Population:

  • Age range — 18 to 64 years
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Hospital inpatients with alcohol problems based on a positive screening result.

Location / Institution: Germany

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomly assigned to a control group, or to one of two Motivational Interviewing (MI)groups: liaison service group or a physician-based group. Analysis showed that all groups reduced drinking and that there were no significant group differences. The MI treatment groups reported an increase in motivation to change drinking behavior.

Length of post-intervention follow-up: 12 months after baseline.

Osterman, R. L., & Dyehouse, J. (2011). Effects of a motivational interviewing intervention to decrease prenatal alcohol use. Western Journal of Nursing Research. Advance online publication. doi: 10.1177/0193945911402523

Type of Study: Randomized controlled trial
Number of Participants: 67

Population:

  • Age range — 18 to 44 years
  • Race/Ethnicity — 67% African American, remainder not specified
  • Gender — Females
  • Status — Participants were pregnant women with previous year alcohol use who were referred from three prenatal clinics.

Location / Institution: Three mid-western U.S. prenatal clinics

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of Motivational Interviewing (MI) in decreasing prenatal alcohol use in a sample of pregnant women. Participants were randomly assigned to an intervention or comparison group and were assessed at baseline and 4 to 6-week follow-up using the Alcohol Use Disorders Identification Test (AUDIT), Basic Psychological Needs Scale (BPNS), and the Treatment Self-Regulation Questionnaire (TSRQ). Results indicated that MI was not effective in decreasing prenatal drinking behaviors in this study; however, nonspecific factors were identified, such as treatment structures, participant motivation for improvement, and provider qualities, which may have influenced these results. Study limitations included the relatively small sample size and a higher attrition in the intervention group than the comparison group.

Length of post-intervention follow-up: 4-6 weeks.

The following studies were not included in rating MI on the Scientific Rating Scale...

Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91-111.

This article contains a meta-analysis of over 70 controlled trials of motivational interviewing. The review shows particularly strong evidence for the efficacy of MI with alcohol/drug abuse.

References

Show references...

Chanut, F., Brown, T., & Dongier, M. (2005). Motivational interviewing and clinical psychiatry. Canadian Journal of Psychiatry, 50(9), 548-554.

Hohman, M., & Salsbury, L. (2009). Motivational interviewing and child welfare: What have we learned? ASPAC Advisor, 21(2), 2-6.

Moyers, T., Martin, T., Manuel, J., Hendrickson, S. M. L., & Miller, W. R. (2005). Assessing competence in the use of motivational interviewing. Journal of Substance Abuse Treatment, 28, 19-26.

Rollnick, S., & Miller, W. R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-334.

Contact Information

Name: Melinda Hohman, PhD
Agency/Affiliation: San Diego State University
Department: School of Social Work
Website: www.motivationalinterview.org
Email:
Phone: (619) 594-5500
Fax: (619) 594-5991

Date Reviewed: June 2011 (originally reviewed in August 2006)