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Do organization-level interventions affect motivational interviewing reports by counselors?

Do organization-level interventions affect motivational interviewing reports by counselors? Stevens Manser , S, Travis, D, Borah, E, and Spence, R University of Texas, Center for Social Work Research, Addiction Research Institute. Introduction. Methods.

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Do organization-level interventions affect motivational interviewing reports by counselors?

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  1. Do organization-level interventions affect motivational interviewing reports by counselors? Stevens Manser, S, Travis, D, Borah, E, and Spence, R University of Texas, Center for Social Work Research, Addiction Research Institute Introduction Methods One-Way ANOVA was performed to determine significance of differences on MI factors among groups. Fisher’s least significant difference was employed for post hoc comparisons. At pre-test, study group differences approached significance for “MI Usefulness” [F(2, 59) = 2.97, p = .059]. Post hoc comparisons revealed that while all group means improved, Group 1 reported significantly more MI Usefulness at pre-test (t = -0.345, p =.02). Although pre-test “MI Skepticism” was not significantly different [F(2, 59) = 2.11, p = .13] post hoc comparisons approached significance, with Group 2 reporting less skepticism than Group 3 (t = -0.441, p = .051). At post-test measurement, there were no significant differences on any MI subscales. Science-to-services has been the focus of continuing interest and concern in the field of alcoholism and drug abuse. Institute of Medicine reports (2001; 2005) have detailed this issue and related issues concerning quality of care improvement. Research findings demonstrate that client treatment engagement (Carroll, 2006) and post-treatment outcomes (Hettema, 2005) can be improved with the use of Motivational Interviewing (MI) and that client outcomes are higher in programs with more positive organizational functioning ratings (Greener et al. 2007). There is clearly a need for quality improvement strategies which involve the collection and use of clinically useful information that enhance organizational functioning for implementing innovations, such as Motivational Interviewing, to will improve service quality. The Texas Process and Practice Improvement Study was conducted to test the effects of two organization-level interventions on the use of evidence-based practice (i.e. Motivational Interviewing). Interventions included: 1) communicating simplified information about the current quality of services through graphic feedback on during treatment client outcomes; and 2) providing a change workshop to encourage employment of strategies that would improve organizational functioning to allow evidence-based practice use. This study was conducted to determine if differences existed from pre- to post-study on various aspects of MI. Differences were examined between and within study groups. Additional analysis was conducted to determine if reports on MI varied by sex and ethnicity/race of counselors in study groups. Counselor surveys were administered online at the beginning and end of the study. In addition to collecting demographic information, the survey included subscales to assess various factors related to Motivational Interviewing including: Knowledge, Skepticism, Usefulness, Research Awareness, Support, Training, Use, and Readiness. Six subscales were scored using a 1 to 5 Likert scale (1 = strongly disagree; 5 = strongly agree). Items comprising each subscale were summed and divided by the total number of items to yield a final subscale score. Three items used other response categories (see table below). Independent t-tests were used to assess for significant differences on MI subscales from pre- to post-study for each study group. ANOVA was used to test for differences between the study groups on MI subscales pre- and post-intervention. ANOVA was also used to test for differences in MI subscale scores based on sex, race/ethnicity and age. One-Way ANOVA was performed to determine if significant differences existed by sex on MI factors. At pre-test, significant differences existed on “MI Discussion” [F(1, 60) = 4.28, p = .043] and “MI Seeking/Support” [F(1, 60) = 4.28, p = .043] with male counselors reporting that they engage in discussion about MI and seek information about MI significantly more than female counselors. No other significant differences on MI subscales between males and females existed at pre-test. At post-test, significant differences existed on “MI Usefulness” [F(1, 55) = 7.08, p = .01] with male counselors reporting more agreement with MI usefulness than female counselors. No other significant differences on MI subscales existed at post-test. Additionally, no significant differences were found on MI subscales when examined by race/ethnicity and age of counselor. Design/Sample Study design included a sample of counselors (n = 148) in thirty-two outpatient substance abuse treatment clinics that were randomized to four study groups. Group 1 received a graphic feedback intervention; Group 2 received a graphic feedback + change workshop intervention; Groups 3 and 4 received no intervention. All clinics were invited to participate in a voluntary one-day Motivational Interviewing booster training at the beginning of the study. Participation in training and interventions varied within and across study groups. Results All groups reported using MI with a smaller percentage of clients from pre- to post-study. Independent t-tests revealed significant differences from pre- to post-test on one MI subscale by counselors in Groups 2 and approaching significance by counselors in Group 3. Counselors in the Graphic Feedback + Change Workshop (Group 2) reported lower use of MI with clients from pre- to post-test (M = 4.00, SD = .97 and M = 3.5, SD = 1.30, t(28) = 2.06, p = .049). Counselors in the No Intervention Group (Group 3) reported lower use of MI from pre- to post-test (M = 4.06, SD = 1.24 and M = 2.89, SD = 1.62, t(23) = 2.04, p = .053). No other MI subscales demonstrated significant change from pre- to post-study. The chart below shows changes in reported MI use with clients and readiness to use MI from pre- to post-study. Overall, counselors in the study were 68.49% female. Whites comprised 47.26% of all counselor participants, Hispanics 33.56%, and African-Americans 15.07%. The mean age of counselors was 48.79 years, with wide variability demonstrated (SD = 11.01). The overall study numbers and numbers for each study group are presented in the table below. Discussion & Recommendations Initial data analysis reveals that interventions positively influence factors related to MI, but not always to a significant degree. MI skepticism was lowered in study groups receiving interventions and reports of MI usefulness improved. In general, clinics in interventions groups reported more agreement on MI subscales than clinics in the control study groups. Interventions also appeared to improve male counselor perceptions of MI more than those of female counselors. Process data collected throughout the study and results of focus groups with clinics revealed wide variability in readiness and rates of activity and participation in study intervention activities. Additionally, staff retention appears to be a factor that may contribute to participation levels . Analysis of individual clinic level data using these factors as mediators may reveal differences among clinics. This study was supported by DHHS Grant No. 1R21DA019759-01 through a contract with the Texas Department of State Health Services. This poster was presented at the College on Problems of Drug Dependence in Reno, NV: June 2009 Contact information: stacey.manser@mail.utexas.edu

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