Phase II Motivational Interviewing: An Experiential Online Training Tool
Condition: Substance Use Disorders; Chronic Mental Disorder; HIV/AIDS
MeSH terms: Substance-Related Disorders; Mental Disorders
Study type: Interventional

Summary: 
      Clinical social workers, doctors, outreach workers, and all other staff providing direct care
      to vulnerable populations face multiple challenges in obtaining and maintaining training and
      implementing evidence based practices in diverse community settings. Motivational
      Interviewing is a well-established evidence based practice that is challenging to implement
      across programs and agencies because it requires that skills gained from training be
      reinforced as a service provider employs the practice.

      This study builds on findings from a Phase I study. With funding from a Phase I Small
      Business Innovation Research grant from the National Institute of Health, the Center for
      Social Innovation developed the Motivational Interviewing Simulator: An Experiential Online
      Training Tool. The interactive, case-based, multiplayer web-based game allows service
      providers to deepen their skills in Motivational Interviewing (MI), a widely recognized
      evidence-based practice that supports people to make positive behavior changes related to
      health, wellness, mental illness, and addiction.

      The Phase II randomized controlled trial's primary aim is to assess the relative
      effectiveness of three interventions (MI Training Only; MI Training + eBook; MI Training +
      SIM) in increasing provider MI knowledge and skill retention over time.

      During Phase II of this study, we will recruit 180 providers from 18 community agencies
      serving individuals who live in supportive housing, many of whom have histories of mental
      illness, addiction, homelessness, and medical problems. After receiving a standardized
      two-day onsite MI training, participants will be randomized into one of three conditions: 1)
      MI Training Only; 2) MI Training + eBook (an online comparison with comparable information to
      the Simulator without the interactive elements); or 3) MI Training + Simulator. The
      longitudinal, mixed methods study will assess providers' acquisition and retention of MI
      knowledge and skills through surveys and coding of standardized client interviews; barriers
      and facilitators of MI implementation via focus groups; organizational-level data via key
      informant interviews and site visits; and client outcomes for 3,600 clients through surveys,
      administrative, data and focus groups.
    

Detailed description: 
      Between 2011 and 2012, the Center for Social Innovation, LLC (C4), developed and evaluated a
      prototype of the Motivational Interviewing Simulator: An Experiential Online Training Tool.
      The interactive, case-based, multiplayer web-based game allows service providers to deepen
      their skills in Motivational Interviewing (MI), a widely recognized evidence-based practice
      that supports people to make positive behavior changes related to health, wellness, mental
      illness, and addiction. Phase I study findings support the product's feasibility and the need
      for a large-scale randomized trial to determine the tool's effectiveness. During Phase I,
      participants in the Simulator group showed significant improvements in MI skills as measured
      by Motivational Interviewing Treatment Integrity (MITI) scores (34% improvement over
      baseline) and Helpful Responses Questionnaire (HRQ) scores (13% improvement over
      baseline)-both substantially higher than the rates of improvement for participants in the
      control groups.

      This project represents Phase II of the work to further develop the MI Simulator and to study
      its impact on provider behavior and client outcomes. Phase II will create multiple "play
      arenas"-Single Player, Two Player, and Advanced Free-play spaces-and multiple case-based
      scenarios related to mental health, homelessness, addiction, and primary care. The
      significantly expanded product will have wide appeal across a large workforce of providers
      serving vulnerable populations, and it will support National Institute of Mental Health's
      strategy of "closing the gap between the development of new, research-tested interventions
      and their widespread use by those most in need."

      The Phase II randomized controlled trial is guided by four specific aims. The first aim is to
      diversify the prototype Motivational Interviewing Simulator to meet the needs of a wider
      audience. Based on Phase I findings, we will build on the prototype by adding a Single Player
      Arena, expanding the existing Two-Player Arena, and creating an Advanced Free-play Arena
      where learners can go beyond basic MI skills. Additionally, the expanded product will include
      multiple scenarios, story-lines, and characters for each arena, and multiple levels of play
      for each scenario. The second aim is to evaluate the Simulator through a randomized
      controlled trial. The third aim is to disseminate findings. And the fourth aim is to prepare
      for commercialization.

      Phase II seeks to answer a number of Research Questions that concern service providers,
      clients, and organizations. Research questions pertaining to service providers are as
      follows: What are the relative impacts of these interventions on providers' confidence,
      knowledge and skills acquisition and retention? What supports are needed for providers to
      adhere to the MI model with fidelity over time? And Does the impact of the treatment
      condition vary by the amount of time the service provider spends engaged with the Sim or
      eBook tools? One key research questions pertaining to clients is as follows: Do clients
      served by providers receiving the Sim or eBook interventions show improved outcomes such as
      housing stability and receptiveness to mental health treatment, medication adherence, greater
      satisfaction with the provider, and greater confidence in individual treatment or recovery
      plans, relative to the Training Only group? Two key research questions focusing on
      organizations implementing MI are as follows: How does agency context influence provider
      adherence to the MI model? And, What are the organizational-level barriers and facilitators
      to successful MI implementation and fidelity?

      Phase II will test four hypotheses (H1, H2, H3, H4). H1 predicts that providers in the
      Simulation condition will show the strongest knowledge and skill retention during the study
      period when compared to MI Training Only and MI Training + eBook conditions. H2 predicts that
      providers in the eBook condition will have stronger knowledge skill and retention over the
      study period when compared to the MI Training Only Condition. H3 predicts that clients served
      by providers in the Simulation condition will show greater improvements in housing stability
      and receptiveness to mental health treatment, medication adherence, greater satisfaction with
      the provider, and greater sense of confidence in individual treatment or recovery plans when
      compared to clients of MI Training + eBook and MI Training Only conditions. H4 predicts that
      clients served by providers in the Simulation condition will show improved communication with
      their provider and greater sense of confidence in individual treatment or recovery plans
      compared to those clients with providers in the MI training + eBook and MI Training Only.

      The Motivational Interviewing Simulator: An Experiential Online Training Tool (the Sim) has
      the potential to make a significant contribution to the fields of behavioral health, primary
      care, adult learning, dissemination science, and beyond. Phase I of the project demonstrated
      the feasibility of the product development effort and research approach. Phase II support
      will allow the Center for Social Innovation (C4) to expand the depth and sophistication of
      the product, evaluate its efficacy, and lay the groundwork for Phase III commercial roll-out.
      Specifically, Phase II will add multiple arenas and levels to the prototype simulator,
      allowing users to advance more deeply into Motivational Interviewing (MI) practice. The Phase
      II product expansion will also create multiple story-lines, a variety of characters, and
      expanded opportunities for feedback, features that will expand the product's marketability in
      Phase III. As described below, the Sim has strong commercial potential and fits well into
      C4's existing commercial training platform, the t3 (think. teach. transform.) learning
      initiative.

      The project is valuable in various ways. Firstly, the SIM has the potential for improving the
      lives of vulnerable people. The ultimate goal of this product is to improve the lives of
      people who have experienced mental illness, addiction, homelessness, violence, and other
      traumatic events. MI has been proven to have positive impact on clinical outcomes for these
      marginalized groups. We believe that effective training of the workforce to use MI will
      result in better care for people who would otherwise slip through the cracks of our systems.

      Secondly, the SIM has the potential to add value to the workforce. As C4 has expanded its
      reach to thousands of direct service providers across the United States and internationally,
      we have documented a lack of high-quality training opportunities for the behavioral health
      workforce and a hunger for training on the part of agencies and individual
      providers-particularly for MI. Much existing training is limited to onsite workshops,
      conferences, and other face-to-face training. The online products that do exist do not
      provide opportunities for peer-to-peer learning and have specific focuses (diabetes and
      substance use) that do not include mental health. This product will provide an engaging,
      highly interactive opportunity to learn a set of skills that many providers want to acquire.

      Thirdly, the SIM has the potential to have an impact on dissemination science. If the Sim
      proves to be a successful mode of learning, primarily as a "booster shot" following
      face-to-face training, the implications for dissemination of evidence-based practices are
      significant. We envision a family of learning simulation products built upon the architecture
      developed for this project, covering a wide range of practices and skills-helping to close
      the research- practice gap and move effective practices into the field more quickly.

      The expected outcomes of this study include findings that document the product's
      effectiveness. Expected research outcomes include improvements in provider knowledge and
      skill, documentation of organizational strategies that support the uptake of best practices,
      and improved outcomes for clients, including increased housing stability and greater
      engagement in mental health services.

      The Sim brings together a well-documented best practice, the need for ongoing provider
      training, and cutting-edge simulation technology. Through widespread dissemination following
      Phase II, the Sim has the potential to have tremendous impact, improving the skills of
      service providers and the lives of the people they serve.
    

Intervention name(s): Motivational Interviewing Simulator (SIM); Motivational Interviewing eBook (eBook); Motivational Interviewing Training (MI Training)
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The interactive, case-based, multiplayer web-based game allows service providers to deepen their skills in Motivational Interviewing (MI), a widely recognized evidence-based practice that supports people to make positive behavior changes related to health, wellness, mental illness, and addiction.The SIM will have three arenas for play, so that users can practice more advanced MI skills and include: Single Player, Two Player, and Advanced Free play. The SIM is equipped with multiple story-lines and characters to keep learners engaged over time and to provide practice on diverse case scenarios, making the Sim relevant to a wide audience. Lastly the SIM will provide an opportunity for feedback from peers and MI experts.; The Phase I research team developed a 69-page eBook as a "credible online comparator" that presents information comparable to that included in the Sim, but without the interactive, role-playing, peer learning functionalities embodied in the Sim. Developed in Hyperlink Markup Language, the eBook presented MI skills, followed by transcripts of effective and not-effective samples of MI from the Sim itself. The e-Book includes the story-lines along with sample dialogue and expert feedback on MI skills.; The training intervention consists of a free two-day standardized Motivational Interviewing (MI) training provided by experienced MI trainers.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Motivational Interviewing; Evidence Based Practice; Online Simulation; Workforce development; Training