Towards Efficient and Sustainable Motivational Interviewing Training: A Multisite Implementation Trial in the Wake of the American College of Surgeons’ Alcohol SBI Policy Mandate

Friday 1:00 – 2:15 Breakout B2

Presentor: Doyanne Darnell

Doyanne Darnell, University of Washington; Chris Dunn, University of Washington; Dave Atkins, University of Washington; Leah Ingraham, University of Washington; , Doug Zatzick; University of Washington


The American College of Surgeons mandates that Level I trauma centers have a mechanism to identify and intervene with problem drinkers. Brief interventions using Motivational Interviewing (MI) are efficacious in reducing alcohol use and re-injury among trauma inpatients. A crucial implementation issue in this setting is that trauma centers choose their brief interventionists without assessing provider ability to learn MI in advance. We present training data from a randomized implementation trial with usual care nurses and social workers at 20 U.S. trauma centers. The study deployed  a novel 27-month training/evaluation package using standardized patients to assess MI skills following a 6-month training period consisting of a workshop, emailed feedback, and telephone coaching. Training resulted in improved MI scores across multiple MI skill domains; however, provider ability to meet established proficiency cut-offs varied considerably. Baseline predictors of post-training MITI scores included years since receiving professional degree (negative relationship) and the MITI Percent MI-Adherent aptitude (positive relationship). Findings suggests that training usual care trauma providers to do brief interventions using MI is feasible, yet not all providers undergoing training can reach MI proficiency. Obtaining reliable estimates of pre-training skill may help direct training efforts. Funding: NIH R01/AA016102, K24/MH086814, and T32/MH082709.


Monitoring the fidelity of Motivational Interviewing counselors: Counting frogs in the jungle

Friday 1:00 – 2:15 Breakout B2

Presentor: Chris Dunn

Chris Dunn, University of Washington; Doyanne Darnell, University of Washington; Dave Atkins, University of Washington; Peter Roy-Byrne, University of Washington



Many studies have established the clinical impact of Motivational Interviewing (MI), but little is known about the long-term MI fidelity of trained counselors during the years after their MI training is over. In the study presented, we explored two aspects of counseling expertise: improvement in skill over time and consistency of MI performance within counselors. Using an established MI scoring system to rate as many as 56 MI sessions per counselor allowed us to quantify MI consistency within counselors. Our sample of counselors performed MI for drug abuse with challenging safety net primary care patients for up to three years after MI training. For most MI fidelity summary scores, there was little evidence of within-counselor improvement with practice. Furthermore, within-counselor variability significantly exceeded between-counselor variability, raising doubt about how much we should depend on these scores as a means of comparing counselors with each other. These data suggest that large scale MI fidelity monitoring would be impossible using human coders. Automated fidelity monitoring systems currently under development are more promising for providing efficient and sustainable quality control of counseling.

Matching Models of Implementation to System Needs and Capacities: Addressing The Human Factor

Friday 1:00 – 2:15 Breakout B2

Presentor: Helen Best

Helen Best, M.Ed, Treatment Implementation Collaborative, LLC; Susan Velasquez, Ph.D., Department of State Hospitals – California



While Dialectical Behavior Therapy has been widely disseminated, most of the large scale system initiatives have faced formidable obstacles which make the implementation extremely challenging.  In a large scale installation of DBT in the California State Hospital System, the authors of this presentation have defined five pillars of support that are interdependent and often incongruent across time.  The need for an overarching plan addressing the fit of the treatment, funding, administrative and clinical support, all supported by high quality training, consultation and supervision is well documented and in play within this implementation of DBT.  Yet the five levels of support required to move from planning to outcomes requires constant and ongoing tending.  These areas are: Central Office (DSH), Hospital Level Executive Administration, Discipline Silo’s, Units implementing DBT, Clinicians learning to provide DBT, and system flow (patient fit, beds, mandates, incidents, etc.).  This presentation will overlay the impact of Good, Cheap and Fast against the back drop of time, funding and scalability to discuss how these hierarchical layers play critical roles across day to day implementation of an EBP.  Installation can be achieved.  Sustainability is most impacted by the human factor as decisions roll across all levels and impact day to day treatment outcomes and endurance.  It is our goal to illustrate the need to address ongoing development of implementation champions and/or teams across all systemic levels and highlight learning from Napa State Hospital in particular.