Assessing Motivational Interviewing Integrity for Group Interventions with Adolescents

The group format is commonly used to treat adolescents who use alcohol and other drugs (AOD) (Kaminer, 2005; Vaughn & Howard, 2004) even though little is known about the distinguishing factors of effective and ineffective group interventions (Engle, Macgowan, Wagner, & Amrhein, 2010). Recent work with at-risk adolescents indicates that motivational interviewing (MI) interventions (Miller & Rollnick, 2002; Rollnick, Miller, & Butler, 2008) can be successful as MI offers a collaborative, non-judgmental, and non-confrontational approach (Naar-King & Suarez, 2010). Although studies of youth receiving individual MI have shown effectiveness (Baer, Garrett, Beadnell, Wells, & Peterson, 2007; D’Amico, Miles, Stern, & Meredith, 2008; Monti, et al., 2007; Spirito, et al., 2004), there are only four published group MI studies (Bailey, Baker, Webster, & Lewin, 2004; D’Amico, Osilla, & Hunter, 2010; Engle, et al., 2010; Schmiege, Broaddus, Levin, & Bryan, 2009). Furthermore, MI treatment integrity has been mainly conducted with individual interventions (Baer, et al., 2004; Martino, Ball, Nich, Frankforter, & Carroll, 2008; Moyers, Martin, Manuel, Hendrickson, & Miller, 2005; Vader, Walters, Prabhu, Houck, & Field, 2010). Only one study to date has evaluated MI integrity with adolescent group sessions (Engle, et al., 2010) using measures of MI competence and adherence, such as the Motivational Interviewing Treatment Integrity scale (Moyers, Martin, Manuel, Miller, & Ernst, 2010). Treatment integrity is important to ensure that a therapy is delivered as intended by the treatment developers (Beidas & Kendall, 2010; Godley, Garner, Smith, Meyers, & Godley, 2011; Rakovshik & McManus, 2010). The Motivational Interviewing Treatment Integrity (MITI) scale (Moyers, et al., 2010) is a widely used measure of MI competence and adherence. Engle et al. (2010) used the MITI to examine the group process and found that group facilitator empathy was associated with more positive commitment language (e.g., “I’m quitting for the summer”), which was then associated with reduced AOD use (Engle, et al., 2010). Although this study was pioneering, further studies are needed as only 19 sessions were coded, only one of the MITI global ratings (empathy) was assessed, and there was no comparison group. Thus, to move the field forward, more detailed treatment integrity analyses (i.e., more group sessions and a comparison group) are needed so that we can assess how MI groups differ from other adolescent groups. . Finally, in order for treatment integrity to be successfully measured, alternative measurements to intra-class correlation (ICC) are needed to assess inter-rater agreement (e.g., Shrout & Fleiss, 1979). Calculating the ICC is not always feasible as there may be different sets of raters for each session or there may be missing data (e.g., one session might be coded by all raters, but another session may not). Thus, other approaches that compensate for these limitations must be utilized in order for studies to quantify inter-rater agreement. The current study addresses these gaps by using the global and behavioral counts on the MITI to 1) assess agreement between raters, 2) calculate inter-rater agreement using two alternative methods to the ICC, and 3) evaluate the use of MI between a group led by facilitators trained and supervised in MI as compared to a group with a self-help and Alcoholics Anonymous focus. This is an important first step in understanding whether the MITI is feasible for use in group settings and determining MI integrity in this setting. We hypothesized that coders would reliably assess MI behaviors and that trained and supervised MI facilitators would deliver more MI consistent behavior than the facilitator in the usual care (non-MI) group sessions.