Teaching, monitoring and evaluating motivational interviewing practice

The demand for professional training in Motivational Interviewing (MI) has been growing rapidly since the first edition of the MI textbook (Miller and Rollnick 1991) and the publication of its manualised version, Motivational Enhancement Therapy for Project MATCH (Miller et al. 1992). To address the demand for professional MI training and to promote real MI proficiency among community practitioners, systematic preparation of hundreds of trainers has occurred through the Motivational Interviewing Network of Trainers (MINT), developed and managed under the auspices of the Center on Alcoholism, Substance Abuse and Addictions at the University of New Mexico. These 'MINTed' trainers have been providing widespread MI training on an international basis (Miller and Rollnick 2002) and the number of training events provided overall has been escalating in the past several years (Miller 2003). Additional efforts to disseminate proficient MI practice and to examine its effectiveness in non-university affiliated community treatment programmes (CTP) have been occurring within the United States through the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN). The CTN's purpose is to conduct psychosocial, pharmacological, and combined treatment trials in community settings and to test their effectiveness under these real-world conditions. Twelve protocols evaluating psychosocial treatments have been implemented. Our centre at the CTN New England Node has been leading three protocols evaluating the effectiveness of MI or Motivational Enhancement Therapy (MET) in enhancing retention and substance use outcomes. Our group supplied a fourth MET protocol for pregnant women (CTN 013: Motivational Enhancement Therapy to Improve Treatment Utilization and Outcome in Pregnant Substance Users) the training and supervision approach described in this chapter. In each of these CTN protocols, we have implemented training plans that develop the clinicians' fidelity to MI treatment. The plans have involved MINT modelled 2-day skill-building workshops delivered by MI expert trainers on-site at the participating agencies (Carroll et al. 2002). We have also used a post-workshop clinician adherence and competence audiotape rating system implemented by agency supervisors to monitor the clinicians' actual MI performance within client sessions and to provide them with feedback and instruction for how to improve their MI skills, reach the protocols' MI certification criteria, and maintain ongoing proficiency standards (Carroll et al. 2002). We have used these training plans with a demographically, educationally, and professionally diverse group of clinicians drawn from community-based treatment programmes across the United States (Ball et al. 2002a). Through our experiences in implementing these CTN protocols, fine-tuning our training plans and clinician tape rating system, and building on the emerging MI training literature, we have gained extensive knowledge and experience in teaching, monitoring, and evaluating MI practice among real-world clinicians attempting to use it in addiction treatment programmes. In this chapter, we outline what we have learned in each of these training domains and provide the reader with recommendations of how to maximise training impact for clinicians trying to learn MI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)