Project AFTER

Does feedback and consultation improve and sustain learning of Motivational Interviewing Skills in Air Force providers? This study was a randomized, controlled trial of 129 behavioral health providers in the United States Air Force. We recruited clinicians from a variety of disciplines, and they all received a two-day workshop in motivational interviewing. After the workshop, clinicians were randomized to receive either 1) no further training enrichments or 2) feedback and consultation over a six week period. The feedback consisted of objective coding of an actual work sample of the provider using MI after the training. The consultations were phone calls with an MI expert using a standardized protocol to identify and overcome barriers to practicing MI. After completing their training (plus any enrichments) clinicians recorded samples of themselves conducting MI at 4, 8 and 12 after their initial workshop. These tapes of actual treatment session were reviewed with the Motivational Interviewing Treatment Integrity Code and scores for the clinician's proficiency in MI were calculated. These scores were compared to the same scores from an identical baseline work sample. Results indicated that clinician's scores were highest immediately after training, deteriorating nearly to baseline at 12 months. There were no differences in the two groups in overall skill acquisition, but this may be because only those clinicians doing well turned in follow up tapes. Overall, the clinicians in this study had poor basic counseling skills compared to other similar studies. The clinicians who did the best at learning MI in our study were those who had the best basic therapy skills prior to our study. We conclude that the usual enrichment strategies may not be sufficient for groups who do not have adequate basic counseling skills.