Motivational Interviewing Proficiency within the Context of a Home-Based Intervention for Parents of Children with Disruptive Behavior Disorders

Background and Purpose: Disruptive behavior disorders not only result in persistent impairment but are also often associated with comorbid disorders such as attention deficit hyperactivity disorder, depression, and anxiety disorders. Motivational interviewing (MI) is being used increasingly in the context of educational practice and research to improve engagement and implementation fidelity through coaching and is considered a requisite skill set for some interventions. One such intervention is homeBase, which is a recently developed parent management training for parents of children with disruptive behavior. Few studies to date have examined skill acquisition among personnel implementing MI interventions in school contexts. This presentation includes an analysis of MI fidelity data with the context of a large randomized trial involving the homeBase intervention to determine the extent to which interventionists were able to meet MI proficiency thresholds. Methods: The recordings were coded using the Motivational Interviewing Treatment Integrity Tool (MITI 4.0). Specifically, we examined descriptive statistics and the percent of recordings that met Moyers et al.’s (2014) proficiency threshold across for four summary scores. The technical global indicator measures interventionists; ability to amplify change talk and soften sustain talk on a 1 to 5 likert scale with scores exceeding 3.0 exceeding the minimum proficiency threshold. The relational global indicator measures interventionists’ partnership and empathy on the same scale and with the same proficiency standard. The percent complex reflection indicator is ratio of complex reflections to simple plus complex reflections with .40 exceeding the minimum proficiency threshold. The fourth indicator, reflections-to-questions, is the ratio of reflections to questions, with 1.0 representing the minimum proficiency threshold. Ninety-nine audio samples were distributed equally across the three coders, and one of these coders was identified as the reliability anchor and conducted reliability coding for 20% of the recordings. We assessed inter-rater reliability via 2-way mixed effects, absolute agreement, average-measures intraclass correlations (ICCs). Results: Global technical and relational scores on the MITI averaged 3.82 (SD = .46) and 3.76 (SD = .75), respectively. Ninety six percent of the recordings exceeded the minimum proficiency threshold for the technical global indicator, and 60% exceeded the minimum proficiency threshold for the relational global indicator. The mean percent complex reflection indicator was .62 with 87% of the recordings exceeding one of the two proficiency thresholds. The mean question-to-reflection ratio was 2.03 (SD = 2.20) with 59% of the recordings exceeding the proficiency threshold. Reliability was excellent for two global indicators (Technical and Relational), good for Percent Complex Reflections, and fair Reflection-to-Question summaries. Conclusions and implications: This study is the first in which Moyer’s thresholds have been applied within the context of school-based intervention. We conclude the training and supervision provided is promising, and requires modification to ensure a larger percentage of recordings meet proficiency the proficiency thresholds. Implications for training school-based practitioners and social work education, as well as future research, are discussed.