Motivational Interviewing (MI)

Scientific Rating:
1
Well-Supported by 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. Motivational Interviewing (MI) has been rated by the CEBC in the areas of: Motivation and Engagement Programs and Substance Abuse Treatment (Adult).

Target Population: Caregivers of children referred to the child welfare system, has been used with adolescents

Brief Description

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 can be used by itself, as well as in combination with other treatments. It has been utilized in pretreatment work to engage and motivate clients for other treatment modalities.

Program Goals:

The goals of Motivational Interviewing (MI) are:

  • Enhance internal motivation to change
  • Reinforce this motivation
  • Develop a plan to achieve change

Essential Components

The essential components of Motivational Interviewing (MI) include:

  • Emphasis of two essential dimensions related to an individual's ambivalence to change:
    • the importance of the change
    • the confidence that the change can be accomplished
  • Inclusion 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 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?
  • Utilization of reflecting listening statements that focus on the client’s language around change. The goal is to evoke from clients their own reasons, needs, desire, and abilities to change.

Adult Services

Motivational Interviewing (MI) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

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

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

There are no minimal educational requirements to be trained in MI.

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 http://www.motivationalinterviewing.org/ contains a list of trainers by state along with current training offerings.

Number of days/hours:

Please see http://www.motivationalinterviewing.org/motivational-interviewing-training for more information.

Implementation Information

Since Motivational Interviewing (MI) 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 Motivational Interviewing (MI).

Formal Support for Implementation

There is formal support available for implementation of Motivational Interviewing (MI) as listed below:

Melinda Hohman, see contact information at end of entry, has a list of trainers who provide formal support and coaching.

Fidelity Measures

There are fidelity measures for Motivational Interviewing (MI) as listed below:

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. Coding resources to measure fidelity can be found at http://casaa.unm.edu/codinginst.html.

Implementation Guides or Manuals

There are implementation guides or manuals for Motivational Interviewing (MI) as listed below:

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://www.motivationalinterviewing.org/sites/default/files/mia-step.pdf.

Research on How to Implement the Program

Research has not been conducted on how to implement Motivational Interviewing (MI).

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 program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Safety

Show relevant research...

Several meta-analyses have been conducted on the effects of MI:

  • Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843-861. 
  • Hettema, J., Steele, J., & Miller, W. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91-111.
  • Vasilaki, E., Hosier, S., & Cox, W. (2006). The efficacy of motivational interviewing as a brief intervention for excessive drinking: A meta-analytic review. Alcohol and Alcoholism, 41, 328-335.
  • Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D. & Burke, B. L. (2010). A meta-analysis of Motivational Interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20, 137-160.

*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 — Mean=21.2 years
  • Race/Ethnicity — 91% White, 4.5% Asian, less than 1% Black, Latin American, or Native American
  • Gender — 52% Female
  • Status — Participants were student volunteers recruited through the media.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of Motivational Interviewing (MI) on alcohol risk reduction programming for young adults. 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 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 the classroom and MI 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. Limitations include lack of an assessment-only control group and generalizability due to ethnicity.

Length of postintervention 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 — Younger than 19 years
  • Race/Ethnicity — 84% White and 16% Other
  • Gender — 55% Female
  • Status — Participants were students recruited through a mailed questionnaire.

Location/Institution: University of Washington

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of Motivational Interviewing (MI) on alcohol risk reduction programming for young adults. 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 MI condition received individualized feedback sessions and written information comparing their drinking patterns and consequences with their peers. Groups did not differ in drinking frequency, but the MI group showed significant reductions in drinking quantity and negative consequences from drinking over the follow-up period. Limitations include reliability on self-report measures and study included participants from only one large university.

Length of postintervention 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 — Mean=34 years
  • Race/Ethnicity — Standard: 86.2% Caucasian, 10.3% Hispanic, and 3.4% African American. Intervention: 80.6% Caucasian, 9.7% Hispanic, 6.5% African American, and 3.2% Other.
  • Gender — Standard: 62.1% Female, Intervention: 80.6% Female
  • Status — Participants were individuals referred by child welfare caseworkers for a substance abuse evaluation.

Location/Institution: Connecticut

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of Motivational Interviewing (MI) as an enhanced treatment initiation with substance abusers. Participants were randomly assigned to receive either standard treatment or standard treatment with MI. Measures utilized include the rates of participants who attended one or three subsequent drug abuse treatment sessions after the evaluation as well as basic demographic data and substance abuse history was also collected. 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. Limitations include small sample size, lack of follow up, and generalizability of findings due to ethnicity.

Length of postintervention 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 — Mean=27.1 years
  • Race/Ethnicity — 47.9% Caucasian, 32.4% African American, 12.7% Native American, and 7.0% Hispanic
  • Gender — 200% Female
  • Status — Participants were 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)
This study examined the efficacy of Motivational Interviewing (MI) on substance abuse treatment retention for women. Participants were randomly assigned to MI or to an education control condition. All participants also attended weekly psychoeducational 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. Limitations include lack of use of standardize measurements, small participant size, and lack of follow-up.

Length of postintervention 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 — 18-64 years
  • Race/Ethnicity — Not specified
  • Gender — 94% Male and 6% Female
  • Status — Participants were hospital patients with alcohol problems based on a positive screening result.

Location/Institution: Germany

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of Motivational Interviewing (MI) on alcohol intervention for general hospital inpatients. Participants were randomly assigned to a control group, or to one of two MI groups: liaison service group or a physician-based group. Measures utilized include the Readiness to Change Questionnaire (RCQ), Treatment Readiness Tool (TReaT), Health Behaviour Questionnaire, and the Mental Health Inventory (MHI-5). Results indicated 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. Limitations include generalizability due to gender and missing data.

Length of postintervention follow-up: Approximately 11 months.

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 — 18-44 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. Limitations included the relatively small sample size and a higher attrition in the intervention group than the comparison group.

Length of postintervention follow-up: 4-6 weeks.

References

Hohman, M. (2012). Motivational Interviewing in social work practice. New York: Guilford Press.

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). New York: Guilford Press.

N'zi, A. M., Lucash, R. E., Clionsky, L. N., & Eyber, S. M. (2016). Enhancing Parent-Child Interaction Therapy with Motivational Interviewing Techniques. Cognitive and Behavioral Practice. doi 10.1016/j.cbpra.2016.03.002

Contact Information

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

Date Research Evidence Last Reviewed by CEBC: February 2015

Date Program Content Last Reviewed by Program Staff: November 2016

Date Program Originally Loaded onto CEBC: August 2006