MOVING MOTIVATIONAL INTERVIEWING INTO PRACTICE

将动机访谈付诸实践

• 批准号: 6174542
• 负责人: WILLIAM R. MILLER
• 金额: $ 33.08万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-30 至 2003-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6174542
• 关键词: behavior therapy; behavioral /social science research tag; clinical research; clinical trials; drug abuse therapy; education evaluation /planning; health care personnel education; human subject; interview; motivation; patient care planning; training; workshop

Treatments with evidence of efficacy do not readily transfer into routine clinical practice. A particular challenge is changing established practice behaviors through continuing professional education. The average clinician practices for 30 years or more, during which time optimal practice is likely to undergo major changes. The usual continuing education format of a one-time workshop is unlikely to modify stable practice behavior substantially. The proposed study applies the basic design of a randomized clinical trial to test the efficacy of procedures for disseminating the clinical intervention style of motivational interviewing (MI). MI was selected because (1) there is strong evidence of its efficacy in addressing substance use disorders, (2) its procedures are well specified, (3) it is consonant with current trends in managed care, and (4) it has many of the attributes specified by Everett Rogers as promoting adoption of an innovation into established practice. A pilot study showed that a 2-day workshop alone was insufficient to change counselors' practice behavior enough to make a difference for clients. Two promising training enhancement procedures (individualized feedback to clinicians, and reinforced practice through individual consultations) will be evaluated via a design combining between-group and within-group effects with 140 substance abuse practitioners. Two well-developed systems for process coding of tapes will be used both to evaluate the efficacy of training, and to advance theory-relevant knowledge of active processes operating in motivational interviewing. A parallel substudy will implement and evaluate MI training of Spanish-speaking clinicians.

有疗效证据的治疗方法不容易转化为常规临床实践。 一个特殊的挑战是通过继续专业教育改变既定的实践行为。 临床医生平均执业时间为 30 年或更长时间，在此期间，最佳实践可能会发生重大变化。 通常的一次性研讨会的继续教育形式不太可能大幅改变稳定的实践行为。 拟议的研究应用随机临床试验的基本设计来测试传播动机访谈（MI）临床干预风格的程序的有效性。 选择 MI 是因为 (1) 有强有力的证据表明其在解决物质使用障碍方面的功效，(2) 其程序明确，(3) 它符合管理式医疗的当前趋势，(4) 它具有许多埃弗雷特·罗杰斯 (Everett Rogers) 指定的促进将创新纳入既定实践的属性。 一项试点研究表明，仅为期两天的研讨会不足以改变咨询师的实践行为，从而为客户带来改变。 两项有希望的培训强化程序（对临床医生的个性化反馈，以及通过个人咨询强化实践）将通过结合组间和组内效应的设计对 140 名药物滥用从业者进行评估。 两个成熟的磁带过程编码系统将用于评估培训的效果，并提高动机访谈中主动过程的理论相关知识。 一项平行的子研究将实施和评估西班牙语临床医生的 MI 培训。