Motivational Interviewing at Intake vs Intake as Usual on Client Engagement in Addiction Treatment

Study Overview
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Brief Summary
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This K23 study is an effectiveness-implementation hybrid type I design to determine the effectiveness of Motivational Interviewing at Intake (MII), relative to intake-as-usual on client engagement and mechanisms of engagement among adults seeking outpatient addiction treatment. We also will obtain personnel feedback on the feasibility of implementing MII into standard practice by having personnel from the addiction treatment study sites complete implementation climate measures before Motivational Interviewing (MI) training and post-clinical trial, as well as an individual interview on implementation feasibility post-trial.

Official Title
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Adapting Intake Procedures to Improve Treatment Delivery in Addiction Treatment

Conditions
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Substance-Related Disorders, Treatment Adherence

Intervention / Treatment
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* Behavioral: Motivational Interviewing at Intake (MII)
* Behavioral: Intake as Usual (IAU)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria (client participants): English-speaking adults seeking treatment for alcohol or other drug use at one of two outpatient addiction treatment programs Provision of signed and dated informed consent form Stated willingness to comply with all study procedures Physically withdrawn from alcohol or other drugs Inclusion Criteria (personnel participants): English-speaking adults currently employed at one of the two outpatient addiction treatment programs Provision of electronic informed consent Exclusion Criteria (client participants): Experiencing severe withdrawal symptoms Actively psychotic, manic, and/or suicidal Exclusion Criteria (personnel participants): current position: facility owner or clinical director

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Effectiveness-Implementation Hybrid Type 1 Design
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Motivational Interviewing at Intake (MII)<br>Clients allocated to the MII condition will receive a 90-minute pure Motivational Interviewing (MI) session. | Behavioral: Motivational Interviewing at Intake (MII)<br>* The MII will involve a goal-oriented and collaborative conversation about why the client wants treatment now, and how treatment might fit with his/her most important values. The provider will use open questions, reflective listening and autonomy support in a flexible, non-authoritative manner. Rather than asking specific questions in different life domains, the provider will explore with the client their desires, abilities, reasons, and needs for treatment, how treatment fits with their values, and what successful treatment looks like to them. The client's language about change will be strategically reinforced to increase its frequency and strength across the session.<br>|
| Active Comparator: Intake as Usual (IAU)<br>Clients allocated to the IAU condition will receive the 90-minute standard assessment that is delivered to all clients entering intensive outpatient program (IOP)/outpatient program (OP). | Behavioral: Intake as Usual (IAU)<br>* In line with the American Society of Addiction Medicine (ASAM) guidelines, the IAU condition involves a semi-structured interview of the client's psychosocial history and clients answer a series of questions in the following domains: support system, living situation, educational, occupational, family, and medical history.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants who attended the first outpatient treatment program session based on electronic medical record review | Treatment entry is determined by review of electronic medical record of whether clients attended their first scheduled treatment session | up to 36 weeks | 
| Number of treatment sessions attended during the three-month outpatient treatment program based on electronic medical record review | Number of treatment sessions that clients attend is determined by review of electronic medical record and calculating number of treatment sessions attended. | up to 36 weeks | 
| Number of participants who completed the three-month outpatient treatment program based on electronic medical record review | Completion of the three-month outpatient treatment program is determined by review of electronic medical record | up to 36 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in client readiness to enter treatment on the University of Rhode Island Change Assessment Scale (URICA) at 1 hour post-intake | The URICA is a validated, self-report measure of client readiness for treatment engagement. Possible scores range from 32 to 160 with higher scores indicative greater readiness to enter treatment. Change = (Hour 1 score - Baseline Score). | baseline and 1 hour post-intake | 
| Score on therapeutic alliance on the Working Alliance Inventory (WAI) at 1-hour post-intake | The WAI is a validated, self-report measure of client perceptions of the therapeutic process by assessing three sub scales: Goals, Bond, and Tasks. Possible scores on sub scales range from 12 to 84 with higher scores indicative of better therapeutic alliance. | 1 hour post-intake |