Motivational Interviewing Implementation and Practitioner Skill Acquisition in An Agency Serving Sexual Minority Youth

Background and Purpose: How to translate high fidelity evidence-based (EB) interventions into real world practice settings is a critical yet understudied area of research (Moyers et al., 2008). Social workers' systems perspective is useful to this end. Motivational interviewing (MI) is a strengths-based, culturally sensitive, and EB approach for addressing health risk behaviors (Rollnick, Miller, & Butler, 2009). As such, it is well suited to working with adolescents (D'Amico et al., 2008) as well as vulnerable and marginalized groups (Hettema, Steele, & Miller, 2005) like sexual minority youth (SMY).

Introducing system level change while training individuals in an MI adherent manner (e.g., person-centered, autonomy supportive) is a major challenge (Miller et al., 2004). Despite the over 28 published studies on MI training (Madson, Loignon & Lane, 2008), only three have addressed challenges associated with implementing MI into agency contexts. MI training studies typically occur at off site workshops, provide little or no ongoing supervision and evaluate practitioner skills only at posttest if at all (Madson, Loignon, & Lane, 2008). This study addressed these limitations and tested a model for implementing MI in an agency serving ethnically diverse SMY, who exhibit sexual risk and/or substance abuse behaviors.

Methods: A qualitative-quantitative mixed method design study explored strategies for implementing MI. Qualitative data consisting of: a) Interviews with six trainees and agency supervisors, and b) session audio recordings with 12 clients, were analyzed for congruence with MI themes using content analysis and grounded theory. Quantitative data included: a) Training time on topics from Miller and Moyers' (2006) eight stages of learning MI, and b) trainee skill acquisition using the Motivational Interviewing Treatment Integrity (MITI) instrument, both of which were assessed repeatedly over a four month period, using nonparametric descriptive statistics.

Results: Qualitative analyses revealed that stakeholder commitment to implement MI allowed for individualized training and support. Also, listening to and receiving feedback on audio recordings with SMY clients was integral to trainee MI skill development. Content on all stages of learning MI was presented within the first six hours of training. Subsequent sessions revisited: Use of reflections, recognizing change talk, and rolling with resistance (stages 2, 3, and 5, respectively). After four months, practice evoking change talk (i.e., stage 4) continues. Trainees learned at their own pace and all exceeded beginning proficiency according to the MITI. They further met the higher competency standard on all six MITI measures except achieving a reflection to question ratio of 2:1. The minimal resources required to obtain this level of implementation are described.

Conclusions: This was one of the first studies demonstrating the implementation of MI in an agency setting, using ongoing supervision and individualized training of practitioners to reach specified skill standards. It is the only study involving training practitioners to use MI with SMY. Findings include that MI was implemented in a small agency with top-down support and minimal resources. Additional findings include empirical support for using readily available training resources and specific strategies for their effective use were delineated.