Adoption of Motivational Adoption of Motivational Interviewing/Motivational Interviewing/Motivational

Enhancement TherapyEnhancement Therapy

Joseph Guydish PhDJoseph Guydish PhD, , Sarah Turcotte Manser MA, Sarah Turcotte Manser MA, Martha A. Jessup RN PhD,Martha A. Jessup RN PhD, Barbara Tajima EdM Barbara Tajima EdM

Institute for Health Policy Studies, University of Institute for Health Policy Studies, University of California,California,

San FranciscoSan Francisco

This work was supported by National Institute on Drug Abuse (R01 DA-14470), 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 by the California-Arizona research node of the NIDA Clinical Trials Network

(U10 DA-105815), and by the NIDA San Francisco Treatment Research Center (U10 DA-105815), and by the NIDA San Francisco Treatment Research Center (P50 DA-09253) (P50 DA-09253)

American Psychological Association

August 18, 2007

MI/MET CTN TrialsMI/MET CTN Trials

NIDA Clinical Trials Network (CTN)NIDA Clinical Trials Network (CTN) Randomized Clinical Trial of Randomized Clinical Trial of

Motivational Interviewing (MI) and Motivational Interviewing (MI) and Motivational Enhancement Therapy Motivational Enhancement Therapy (MET) (MET)

11 sites (MI=5, MET=6)11 sites (MI=5, MET=6) 884 participants (MI=423, MET=461)884 participants (MI=423, MET=461) Data points: baseline, 28 day, 84 dayData points: baseline, 28 day, 84 day

MAP Study Methods

Studied adoption of MI/MET in Studied adoption of MI/MET in clinics clinics where it was testedwhere it was tested

5 sites: MI=3, MET=25 sites: MI=3, MET=2

29 Key informant interviews29 Key informant interviews

Interviews on average 4.25 Interviews on average 4.25 months after the months after the treatment phase treatment phase of the trialsof the trials

Organizational ChangeOrganizational Change

Organizational Organizational Structure and CultureStructure and Culture

De Smet (1998)De Smet (1998)

Burke & Litwin Burke & Litwin (1992)(1992)

Organizational Organizational Readiness for ChangeReadiness for Change

Backer (1995)Backer (1995)

Attitudes Towards Attitudes Towards ResearchResearch

Lamb et al. (1998)Lamb et al. (1998)

Perception of Perception of InterventionIntervention

Backer (1991)Backer (1991)

Rogers (1995a)Rogers (1995a)

ResourcesResources Rogers (1995b)Rogers (1995b)

Dissemination of Study Dissemination of Study ResultsResults

Sorensen et al (1998)Sorensen et al (1998)

Brown (1998)Brown (1998)

Level Number (n=29)

Intervention Developer 1

Funder 1

Lead Investigator 3

Regional Investigator 7*

Clinic or Program Director 5†

Clinical Supervisor 2

Clinician 10

Multi Levels of Assessment

* 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.

Interviews were completed 4 -13 months after treatment phase completion

Data AnalysisData Analysis

Organizational functioning Organizational functioning Theoretical framework informed key Theoretical framework informed key

domains domains Closed coding developed using Closed coding developed using

analytic categoriesanalytic categories Concurrent data collection and Concurrent data collection and

analysisanalysis Analytic memos, team discussion, and Analytic memos, team discussion, and

on-going comparison of the dataon-going comparison of the data

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

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...

Clinic Director

A Champion

... 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 administrators…they needed to pull everyone together.

Clinic Research Supervisor

Difficulty Implementing the Trial

How is Adoption Measured ?

You never really know how people practice, when they’re 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

A Range of Adoption OutcomesA Range of Adoption Outcomes

No No AdoptionAdoption

IntentionIntentionTo To

AdoptAdopt

Tool box Tool box AdoptionAdoption

Partial Partial AdoptionAdoption

AdoptionAdoption Re-invention, Re-invention, AdaptationAdaptation

NA *NA * No AdoptionNo Adoption IntentionIntentionTo To AdoptAdopt

Tool box Tool box AdoptionAdoption

Partial Partial AdoptionAdoption

AdoptionAdoption Re-invention, Re-invention, AdaptationAdaptation

MI/MET Site 1

Site 2

Site 3

Site 4

Site 5

Adoption of MI/MET at Clinic Sites (n=5)Adoption of MI/MET at Clinic Sites (n=5)

* No opportunity to adopt

Adoption in Prior Adoption in Prior StudiesStudies

Fals-Stewart study of Brief Couples Fals-Stewart study of Brief Couples Therapy (BCT) in 5 sitesTherapy (BCT) in 5 sites

1 site adopted1 site adopted

Study of Matrix adoption in 6 sitesStudy of Matrix adoption in 6 sites

1 site adopted1 site adopted

Study of MI/MET in 5 sitesStudy of MI/MET in 5 sites

2 sites adopted2 sites adopted

Rate of Adoption: 25%Rate of Adoption: 25%

Conclusions

Post clinical trials rate of adoption is lowPost clinical trials rate of adoption is low

Need infrastructure to support adoptionNeed infrastructure to support adoption

Determine what kind of implementation is Determine what kind of implementation is wanted (toolbox, partial, full, adaptation)wanted (toolbox, partial, full, adaptation)

Determine method to measure adoptionDetermine method to measure adoption