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Kathleen M. Carroll - One of the best experts on this subject based on the ideXlab platform.

  • Outcome expectations and associated treatment outcomes in Motivational Enhancement Therapy delivered in English and Spanish.
    The American journal on addictions, 2015
    Co-Authors: Kelly Serafini, Tami L. Frankforter, Luis M. Añez, Manuel Paris, Suzanne E. Decker, Brian D. Kiluk, Kathleen M. Carroll
    Abstract:

    Background and Objectives The relationship between patients’ baseline expectations regarding treatment outcome and actual outcomes has not been widely studied within the field of substance use disorders. We hypothesized that outcome expectations would be unrelated to outcomes in a study investigating Motivational Enhancement Therapy delivered in English (MET-E) consistent with our earlier work, and conducted exploratory analyses in a separate study that investigated the same treatment delivered in Spanish (MET-S). Methods These secondary analyses compared patient outcome expectations and substance use treatment outcomes in two large, multisite randomized controlled clinical trials that evaluated three sessions of MET-E or MET-S. The MET-E sample included 461 participants and the MET-S sample included 405 participants. Outcome expectations were measured by a single item regarding expectations about abstinence prior to initiating treatment. Results Outcome expectations were strongly associated with most substance use outcomes in the MET-S trial (but not in MET-E), even after controlling for severity of substance use at baseline. In MET-S, those who indicated that they were “unsure” that they would achieve abstinence during treatment submitted a greater percentage of drug-positive urine toxicology screens during the treatment period than those who were ‘sure’ they would achieve abstinence (F = 18.83, p 

  • outcome expectations and associated treatment outcomes in Motivational Enhancement Therapy delivered in english and spanish
    American Journal on Addictions, 2015
    Co-Authors: Kelly Serafini, Tami L. Frankforter, Luis M. Añez, Manuel Paris, Suzanne E. Decker, Brian D. Kiluk, Kathleen M. Carroll
    Abstract:

    Background and Objectives The relationship between patients’ baseline expectations regarding treatment outcome and actual outcomes has not been widely studied within the field of substance use disorders. We hypothesized that outcome expectations would be unrelated to outcomes in a study investigating Motivational Enhancement Therapy delivered in English (MET-E) consistent with our earlier work, and conducted exploratory analyses in a separate study that investigated the same treatment delivered in Spanish (MET-S). Methods These secondary analyses compared patient outcome expectations and substance use treatment outcomes in two large, multisite randomized controlled clinical trials that evaluated three sessions of MET-E or MET-S. The MET-E sample included 461 participants and the MET-S sample included 405 participants. Outcome expectations were measured by a single item regarding expectations about abstinence prior to initiating treatment. Results Outcome expectations were strongly associated with most substance use outcomes in the MET-S trial (but not in MET-E), even after controlling for severity of substance use at baseline. In MET-S, those who indicated that they were “unsure” that they would achieve abstinence during treatment submitted a greater percentage of drug-positive urine toxicology screens during the treatment period than those who were ‘sure’ they would achieve abstinence (F = 18.83, p < .001). Discussion and Conclusions Patients’ outcome expectations regarding the likelihood of abstinence may be an important predictor of drug use treatment outcomes among Spanish-speakers, but not necessarily for English-speakers. Scientific Significance Individual differences and cultural factors may play a role in the association between outcome expectations and treatment outcomes. (Am J Addict 2015;XX:1–8)

  • Motivational Enhancement Therapy coupled with cognitive behavioral Therapy versus brief advice: a randomized trial for treatment of hazardous substance use in pregnancy and after delivery
    General hospital psychiatry, 2012
    Co-Authors: Kimberly A. Yonkers, Ariadna Forray, Heather B. Howell, Nathan Gotman, Trace Kershaw, Bruce J. Rounsaville, Kathleen M. Carroll
    Abstract:

    Abstract Objective The objective was to compare the efficacy of Motivational Enhancement Therapy coupled with cognitive behavioral Therapy (MET-CBT) to brief advice for treatment of substance use in pregnancy. Method This was a randomized, parallel, controlled trial that was yoked to prenatal care and delivered at hospital outpatient clinics. We enrolled 168 substance-using women who had not yet completed an estimated 28 weeks of pregnancy. Obstetrical clinicians provided brief advice, and study nurses administered manualized MET-CBT. The primary outcome was percentage of days in the prior 28 days in which alcohol and/or drugs were used immediately before and 3 months postdelivery. Results There were no significant differences across groups in terms of self-reported percentage of days in which drugs or alcohol were used prior to and 3 months postdelivery. Biological measures showed similar results. There was a trend ( P =.08) for lower risk of preterm birth among those who received MET-CBT. Conclusions The tested interventions had similar therapeutic effects. Hence, both treatments may be suitable for pregnant substance users, depending on the population, setting and provider availability. Interventions that are intensified after delivery may decrease postpartum "rebound" effects in substance misuse.

  • Mutual influence in therapist competence and adherence to Motivational Enhancement Therapy
    Drug and alcohol dependence, 2011
    Co-Authors: Zac E. Imel, Samuel A. Ball, Steve Martino, John S. Baer, Kathleen M. Carroll
    Abstract:

    Although psychoTherapy involves the interaction of client and therapist, mutual influence is not typically considered as a source of variability in therapist adherence and competence in providing treatments assessed in clinical trials. We examined variability in therapist adherence and competence in Motivational Enhancement Therapy (MET) both within and between caseloads in a large multi-site clinical trial. Three-level multilevel models (repeated measures, nested within clients, nested with therapists) indicated significant variability both within and between therapists. There was as much and sometimes more variability in MET adherence and competence within therapist caseloads than between therapists. Variability in MET adherence and competence within caseloads was not consistently associated with client severity of addiction at baseline. However, client motivation at the beginning of the session and days of use during treatment were consistent predictors of therapist adherence and competence. Results raise questions about the nature of therapist adherence and competence in treatment protocols. Accordingly, future analysis of clinical trials should consider the role of mutual influence in measures of therapist performance.

  • Evaluating Motivational Enhancement Therapy adherence and competence among Spanish-speaking therapists.
    Drug and alcohol dependence, 2009
    Co-Authors: Elizabeth J Santa Ana, Kathleen M. Carroll, Samuel A. Ball, Charla Nich, Tami L. Frankforter, Manuel Paris, Lourdes Suarez-morales, José Szapocznik, Luis Añez, Steve Martino
    Abstract:

    Despite the fact that the number of Hispanic individuals in need of treatment for substance use problems is increasing internationally, no studies have investigated the extent to which therapists can provide empirically supported treatments to Spanish-speaking clients with adequate fidelity. Twenty-three bilingual Hispanic therapists from five community outpatient treatment programs in the United States were randomly assigned to deliver either three sessions of Motivational Enhancement Therapy (MET) or an equivalent number of drug counseling-as-usual (CAU) sessions in Spanish to 405 Spanish-speaking clients randomly assigned to these conditions. Independent ratings of 325 sessions indicated the adherence/competence rating system had good to excellent interrater reliability and indicated strong support for an a priori defined fundamental MET skill factor. Support for an advanced MET skill factor was relatively weaker. The rating scale indicated significant differences in therapists' MET adherence and competence across conditions. These findings indicate that the rating system has promise for assessing the performance of therapists who deliver MET in Spanish and suggest that bilingual Spanish-speaking therapists from the community can be trained to implement MET with adequate fidelity and skill using an intensive multisite training and supervision model.

Khalida Ismail - One of the best experts on this subject based on the ideXlab platform.

  • Do the effects of psychological treatments on improving glycemic control in type 1 diabetes persist over time? A long-term follow-up of a randomized controlled trial.
    Psychosomatic medicine, 2012
    Co-Authors: Katie Ridge, Stephen Thomas, Jonathan W. Bartlett, Yee Seun Cheah, Geoffrey Lawrence-smith, Kirsty Winkley, Khalida Ismail
    Abstract:

    ObjectivesIn a randomized controlled trial, adults with Type 1 diabetes and suboptimal glycemic control who received Motivational Enhancement Therapy (MET) plus cognitive behavioral Therapy (CBT) had a greater reduction in their 12-month hemoglobin A1c (HbA1c) than those who received usual care (UC)

  • Motivational Enhancement Therapy with and without cognitive behaviour Therapy for Type 1 diabetes: economic evaluation from a randomized controlled trial
    Diabetic medicine : a journal of the British Diabetic Association, 2011
    Co-Authors: Anita Patel, Stephen Thomas, Esther Maissi, Trudie Chalder, Ulrike Schmidt, Janet Treasure, H-c Chang, Ian A Rodrigues, M Smith, Khalida Ismail
    Abstract:

    Diabet. Med. 28, 470–479 (2011) Abstract Aims  To assess the cost-effectiveness of Motivational Enhancement Therapy and cognitive behaviour Therapy for poorly controlled Type 1 diabetes. Methods  Within-trial prospective economic evaluation from (i) health and social care and (ii) societal perspectives. Three hundred and forty-four adults with Type 1 diabetes for at least 2 years and persistent, suboptimal glycaemic control were recruited to a three-arm multi-centre randomized controlled trial in London and Manchester, UK. They were randomized to (i) usual care plus four sessions of Motivational Enhancement Therapy (ii) usual care plus four sessions of Motivational Enhancement Therapy and eight sessions of cognitive behaviour Therapy or (iii) usual care alone. Outcomes were (i) costs, (ii) Quality-Adjusted Life Year gains measured by the EuroQol 5-dimensional health state index and the 36-item Short Form and (iii) diabetes control measured by change in HbA1c level at 1 year. Results  Both intervention groups had significantly higher mean health and social care costs (+ £535 for Motivational Enhancement Therapy and + £790 for combined Motivational Enhancement and cognitive behavioural Therapy ), but not societal costs compared with the usual-care group. There were no differences in Quality Adjusted Life Years. There was a significantly greater HbA1c improvement in the combined Motivational Enhancement and cognitive behavioural Therapy group (+ 0.45%; incremental cost-effectiveness ratio = £1756), but the not in the Motivational Enhancement Therapy group. Cost-effectiveness acceptability curves suggested that both interventions had low probabilities of cost-effectiveness based on Quality Adjusted Life Years (but high based on HbA1c improvements). Imputing missing costs and outcomes confirmed these findings. Conclusions  Neither Therapy was undisputedly cost-effective compared with usual care alone, but conclusions vary depending on the relative importance of clinical and quality-of-life outcomes.

  • Motivational Enhancement Therapy with and without cognitive behavior Therapy to treat type 1 diabetes: a randomized trial.
    Annals of internal medicine, 2008
    Co-Authors: Khalida Ismail, Stephen Thomas, Esther Maissi, Trudie Chalder, Ulrike Schmidt, Jonathan W. Bartlett, Anita Patel, Chris Dickens, Francis Creed, Janet Treasure
    Abstract:

    BACKGROUND: Although psychological issues can interfere with diabetes care, the effectiveness of psychological treatments in improving diabetes outcomes is uncertain. OBJECTIVE: To determine whether Motivational Enhancement Therapy with or without cognitive behavior Therapy improves glycemic control in type 1 diabetes compared with usual care. DESIGN: Randomized, controlled trial. SETTING: 8 diabetes centers in London and Manchester, United Kingdom. PATIENTS: 344 adults with type 1 diabetes for longer than 2 years, with hemoglobin A(1c) levels of 8.2% to 15%, and without complications or severe comorbid disease. INTERVENTION: Nurse-delivered Motivational Enhancement Therapy (4 sessions over 2 months), Motivational Enhancement Therapy plus cognitive behavior Therapy (12 sessions over 6 months), or usual care. MEASUREMENTS: 12-month change in hemoglobin A(1c) levels (primary outcome), hypoglycemic events, depression, quality of life, fear of hypoglycemia, diabetes self-care activities, and body mass index (secondary outcomes). RESULTS: In an analysis including all randomly assigned patients, the 12-month change in hemoglobin A(1c) levels compared with usual care was -0.46% (95% CI, -0.81% to -0.11%) in the Motivational Enhancement Therapy plus cognitive behavior Therapy group and -0.19% (CI, -0.53% to 0.16%) in the Motivational Enhancement Therapy group alone. There was no evidence of treatment effects on secondary outcomes. LIMITATIONS: Of 1659 screened patients, only 507 were eligible and 344 participated. Data on the primary outcome were unavailable for 11.3% of the participants. Study design did not permit distinction of the additive effect of cognitive behavior Therapy plus Motivational Enhancement Therapy from the effect of greater intensity and duration of the combined intervention compared with the Motivational Enhancement Therapy alone. CONCLUSION: Nurse-delivered Motivational Enhancement Therapy and cognitive behavior Therapy is feasible for adults with poorly controlled type 1 diabetes. Combined Therapy results in modest 12-month improvement in hemoglobin A(1c) levels compared with usual care, but Motivational Enhancement Therapy alone does not.

Andrew R. Morral - One of the best experts on this subject based on the ideXlab platform.

  • using a cross study design to assess the efficacy of Motivational Enhancement Therapy cognitive behavioral Therapy 5 met cbt5 in treating adolescents with cannabis related disorders
    Journal of Studies on Alcohol and Drugs, 2011
    Co-Authors: Rajeev Ramchand, Beth Ann Griffin, Marika J. Suttorp, Katherine M. Harris, Andrew R. Morral
    Abstract:

    Objective:To evaluate how adolescents with marijuana problems who received a research-based treatment (five sessions of Motivational Enhancement Therapy plus cognitive behavioral Therapy [MET/CBT5]) in an experimental setting would have fared had they received exemplary community-based outpatient treatment.Method:Twelve-month outcomes representing six domains (substance use problems, substance use frequency, emotional problems, illegal activities, recovery, and institutionalization) were assessed for youth who received MET/CBT5 in the Cannabis Youth Treatment study and youth who received outpatient treatment from one of three community-based programs selected for evidence of efficacy. Groups were matched on pretreatment characteristics using a propensity score weighting strategy.Results:Youth who received MET/CBT5 exhibited greater reductions in substance use frequency, substance use problems, and illegal behaviors 12 months after treatment entry than had they entered the community-based outpatient progra...

  • Using a Cross-Study Design to Assess the Efficacy of Motivational Enhancement Therapy―Cognitive Behavioral Therapy 5 (MET/CBT5) in Treating Adolescents with Cannabis-Related Disorders
    Journal of studies on alcohol and drugs, 2011
    Co-Authors: Rajeev Ramchand, Beth Ann Griffin, Marika J. Suttorp, Katherine M. Harris, Andrew R. Morral
    Abstract:

    Objective:To evaluate how adolescents with marijuana problems who received a research-based treatment (five sessions of Motivational Enhancement Therapy plus cognitive behavioral Therapy [MET/CBT5]) in an experimental setting would have fared had they received exemplary community-based outpatient treatment.Method:Twelve-month outcomes representing six domains (substance use problems, substance use frequency, emotional problems, illegal activities, recovery, and institutionalization) were assessed for youth who received MET/CBT5 in the Cannabis Youth Treatment study and youth who received outpatient treatment from one of three community-based programs selected for evidence of efficacy. Groups were matched on pretreatment characteristics using a propensity score weighting strategy.Results:Youth who received MET/CBT5 exhibited greater reductions in substance use frequency, substance use problems, and illegal behaviors 12 months after treatment entry than had they entered the community-based outpatient progra...

Janet Treasure - One of the best experts on this subject based on the ideXlab platform.

  • Motivational Enhancement Therapy with and without cognitive behaviour Therapy for Type 1 diabetes: economic evaluation from a randomized controlled trial
    Diabetic medicine : a journal of the British Diabetic Association, 2011
    Co-Authors: Anita Patel, Stephen Thomas, Esther Maissi, Trudie Chalder, Ulrike Schmidt, Janet Treasure, H-c Chang, Ian A Rodrigues, M Smith, Khalida Ismail
    Abstract:

    Diabet. Med. 28, 470–479 (2011) Abstract Aims  To assess the cost-effectiveness of Motivational Enhancement Therapy and cognitive behaviour Therapy for poorly controlled Type 1 diabetes. Methods  Within-trial prospective economic evaluation from (i) health and social care and (ii) societal perspectives. Three hundred and forty-four adults with Type 1 diabetes for at least 2 years and persistent, suboptimal glycaemic control were recruited to a three-arm multi-centre randomized controlled trial in London and Manchester, UK. They were randomized to (i) usual care plus four sessions of Motivational Enhancement Therapy (ii) usual care plus four sessions of Motivational Enhancement Therapy and eight sessions of cognitive behaviour Therapy or (iii) usual care alone. Outcomes were (i) costs, (ii) Quality-Adjusted Life Year gains measured by the EuroQol 5-dimensional health state index and the 36-item Short Form and (iii) diabetes control measured by change in HbA1c level at 1 year. Results  Both intervention groups had significantly higher mean health and social care costs (+ £535 for Motivational Enhancement Therapy and + £790 for combined Motivational Enhancement and cognitive behavioural Therapy ), but not societal costs compared with the usual-care group. There were no differences in Quality Adjusted Life Years. There was a significantly greater HbA1c improvement in the combined Motivational Enhancement and cognitive behavioural Therapy group (+ 0.45%; incremental cost-effectiveness ratio = £1756), but the not in the Motivational Enhancement Therapy group. Cost-effectiveness acceptability curves suggested that both interventions had low probabilities of cost-effectiveness based on Quality Adjusted Life Years (but high based on HbA1c improvements). Imputing missing costs and outcomes confirmed these findings. Conclusions  Neither Therapy was undisputedly cost-effective compared with usual care alone, but conclusions vary depending on the relative importance of clinical and quality-of-life outcomes.

  • Motivational Enhancement Therapy with and without cognitive behavior Therapy to treat type 1 diabetes: a randomized trial.
    Annals of internal medicine, 2008
    Co-Authors: Khalida Ismail, Stephen Thomas, Esther Maissi, Trudie Chalder, Ulrike Schmidt, Jonathan W. Bartlett, Anita Patel, Chris Dickens, Francis Creed, Janet Treasure
    Abstract:

    BACKGROUND: Although psychological issues can interfere with diabetes care, the effectiveness of psychological treatments in improving diabetes outcomes is uncertain. OBJECTIVE: To determine whether Motivational Enhancement Therapy with or without cognitive behavior Therapy improves glycemic control in type 1 diabetes compared with usual care. DESIGN: Randomized, controlled trial. SETTING: 8 diabetes centers in London and Manchester, United Kingdom. PATIENTS: 344 adults with type 1 diabetes for longer than 2 years, with hemoglobin A(1c) levels of 8.2% to 15%, and without complications or severe comorbid disease. INTERVENTION: Nurse-delivered Motivational Enhancement Therapy (4 sessions over 2 months), Motivational Enhancement Therapy plus cognitive behavior Therapy (12 sessions over 6 months), or usual care. MEASUREMENTS: 12-month change in hemoglobin A(1c) levels (primary outcome), hypoglycemic events, depression, quality of life, fear of hypoglycemia, diabetes self-care activities, and body mass index (secondary outcomes). RESULTS: In an analysis including all randomly assigned patients, the 12-month change in hemoglobin A(1c) levels compared with usual care was -0.46% (95% CI, -0.81% to -0.11%) in the Motivational Enhancement Therapy plus cognitive behavior Therapy group and -0.19% (CI, -0.53% to 0.16%) in the Motivational Enhancement Therapy group alone. There was no evidence of treatment effects on secondary outcomes. LIMITATIONS: Of 1659 screened patients, only 507 were eligible and 344 participated. Data on the primary outcome were unavailable for 11.3% of the participants. Study design did not permit distinction of the additive effect of cognitive behavior Therapy plus Motivational Enhancement Therapy from the effect of greater intensity and duration of the combined intervention compared with the Motivational Enhancement Therapy alone. CONCLUSION: Nurse-delivered Motivational Enhancement Therapy and cognitive behavior Therapy is feasible for adults with poorly controlled type 1 diabetes. Combined Therapy results in modest 12-month improvement in hemoglobin A(1c) levels compared with usual care, but Motivational Enhancement Therapy alone does not.

  • A Practical Guide to the Use of Motivational Interviewing in Anorexia Nervosa
    European Eating Disorders Review, 1997
    Co-Authors: Janet Treasure, Anne Ward
    Abstract:

    The aim of this clinical report is to introduce the concept of Motivational interviewing and the psychology of change into the context of anorexia nervosa. We outline the transtheoretical model of change and consider its relevance to anorexia nervosa. We chart the development of brief interventions using concepts from this model and from psychoTherapy practice. Finally we illustrate the use of Motivational Enhancement Therapy for anorexia nervosa. © 1997 John Wiley & Sons, Ltd and Eating Disorders Association.

Tami L. Frankforter - One of the best experts on this subject based on the ideXlab platform.

  • Outcome expectations and associated treatment outcomes in Motivational Enhancement Therapy delivered in English and Spanish.
    The American journal on addictions, 2015
    Co-Authors: Kelly Serafini, Tami L. Frankforter, Luis M. Añez, Manuel Paris, Suzanne E. Decker, Brian D. Kiluk, Kathleen M. Carroll
    Abstract:

    Background and Objectives The relationship between patients’ baseline expectations regarding treatment outcome and actual outcomes has not been widely studied within the field of substance use disorders. We hypothesized that outcome expectations would be unrelated to outcomes in a study investigating Motivational Enhancement Therapy delivered in English (MET-E) consistent with our earlier work, and conducted exploratory analyses in a separate study that investigated the same treatment delivered in Spanish (MET-S). Methods These secondary analyses compared patient outcome expectations and substance use treatment outcomes in two large, multisite randomized controlled clinical trials that evaluated three sessions of MET-E or MET-S. The MET-E sample included 461 participants and the MET-S sample included 405 participants. Outcome expectations were measured by a single item regarding expectations about abstinence prior to initiating treatment. Results Outcome expectations were strongly associated with most substance use outcomes in the MET-S trial (but not in MET-E), even after controlling for severity of substance use at baseline. In MET-S, those who indicated that they were “unsure” that they would achieve abstinence during treatment submitted a greater percentage of drug-positive urine toxicology screens during the treatment period than those who were ‘sure’ they would achieve abstinence (F = 18.83, p 

  • outcome expectations and associated treatment outcomes in Motivational Enhancement Therapy delivered in english and spanish
    American Journal on Addictions, 2015
    Co-Authors: Kelly Serafini, Tami L. Frankforter, Luis M. Añez, Manuel Paris, Suzanne E. Decker, Brian D. Kiluk, Kathleen M. Carroll
    Abstract:

    Background and Objectives The relationship between patients’ baseline expectations regarding treatment outcome and actual outcomes has not been widely studied within the field of substance use disorders. We hypothesized that outcome expectations would be unrelated to outcomes in a study investigating Motivational Enhancement Therapy delivered in English (MET-E) consistent with our earlier work, and conducted exploratory analyses in a separate study that investigated the same treatment delivered in Spanish (MET-S). Methods These secondary analyses compared patient outcome expectations and substance use treatment outcomes in two large, multisite randomized controlled clinical trials that evaluated three sessions of MET-E or MET-S. The MET-E sample included 461 participants and the MET-S sample included 405 participants. Outcome expectations were measured by a single item regarding expectations about abstinence prior to initiating treatment. Results Outcome expectations were strongly associated with most substance use outcomes in the MET-S trial (but not in MET-E), even after controlling for severity of substance use at baseline. In MET-S, those who indicated that they were “unsure” that they would achieve abstinence during treatment submitted a greater percentage of drug-positive urine toxicology screens during the treatment period than those who were ‘sure’ they would achieve abstinence (F = 18.83, p < .001). Discussion and Conclusions Patients’ outcome expectations regarding the likelihood of abstinence may be an important predictor of drug use treatment outcomes among Spanish-speakers, but not necessarily for English-speakers. Scientific Significance Individual differences and cultural factors may play a role in the association between outcome expectations and treatment outcomes. (Am J Addict 2015;XX:1–8)

  • Evaluating Motivational Enhancement Therapy adherence and competence among Spanish-speaking therapists.
    Drug and alcohol dependence, 2009
    Co-Authors: Elizabeth J Santa Ana, Kathleen M. Carroll, Samuel A. Ball, Charla Nich, Tami L. Frankforter, Manuel Paris, Lourdes Suarez-morales, José Szapocznik, Luis Añez, Steve Martino
    Abstract:

    Despite the fact that the number of Hispanic individuals in need of treatment for substance use problems is increasing internationally, no studies have investigated the extent to which therapists can provide empirically supported treatments to Spanish-speaking clients with adequate fidelity. Twenty-three bilingual Hispanic therapists from five community outpatient treatment programs in the United States were randomly assigned to deliver either three sessions of Motivational Enhancement Therapy (MET) or an equivalent number of drug counseling-as-usual (CAU) sessions in Spanish to 405 Spanish-speaking clients randomly assigned to these conditions. Independent ratings of 325 sessions indicated the adherence/competence rating system had good to excellent interrater reliability and indicated strong support for an a priori defined fundamental MET skill factor. Support for an advanced MET skill factor was relatively weaker. The rating scale indicated significant differences in therapists' MET adherence and competence across conditions. These findings indicate that the rating system has promise for assessing the performance of therapists who deliver MET in Spanish and suggest that bilingual Spanish-speaking therapists from the community can be trained to implement MET with adequate fidelity and skill using an intensive multisite training and supervision model.

  • A multisite randomized effectiveness trial of Motivational Enhancement Therapy for Spanish-speaking substance users.
    Journal of consulting and clinical psychology, 2009
    Co-Authors: Kathleen M. Carroll, Steve Martino, Samuel A. Ball, Charla Nich, Tami L. Frankforter, Luis M. Añez, Manuel Paris, Lourdes Suarez-morales, José Szapocznik, William R. Miller
    Abstract:

    Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of Motivational Enhancement Therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week Therapy phase, there were no significant Treatment Condition x Time interactions nor Site x Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of Motivational Enhancement Therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude.

  • Community program therapist adherence and competence in Motivational Enhancement Therapy.
    Drug and alcohol dependence, 2008
    Co-Authors: Steve Martino, Samuel A. Ball, Charla Nich, Tami L. Frankforter, Kathleen M. Carroll
    Abstract:

    The extent to which clinicians in addiction treatment programs can implement empirically validated therapies with adequate fidelity that can be discriminated from standard counseling has rarely been evaluated. We evaluated the treatment adherence and competence of 35 therapists from five outpatient community programs who delivered either a three-session adaptation of Motivational Enhancement Therapy (MET) or an equivalent number of drug counseling-as-usual sessions to 461 clients within a National Institute on Drug Abuse Clinical Trial Network multi-site effectiveness protocol. MET therapists were carefully prepared to implement MET using a combination of expert-led intensive workshop training followed by program-based clinical supervision. Independent rating of sessions demonstrated that the adherence and competence items were very reliable (mean interclass correlation coefficients for adherence=.89 and competence=.81) and converged to form two a priori defined skill factors conceptually related to Motivational interviewing. Moreover, the factors discriminated between MET therapists and those who delivered drug counseling-as-usual sessions in predicted ways, and were significantly related to in-session change in client motivation and some client treatment outcomes (percent negative drug urine screens). These findings demonstrate the reliability and validity of evaluating Motivational interviewing fidelity and suggest that the combination of expert-led workshops followed by program-based clinical supervision may be an effective method for disseminating Motivational interviewing in community treatment programs.