Motivational Interviewing Activity

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc.requires everyone who is in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest to the provider. The ACCME defines 'relevant' financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Any conflicts of interest are resolved prior to the delivery of the educational activity to the learner. CTI does not permit individuals with financial conflicts of interest to participate in any stage of activity development.
Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.
Disclosure: Has disclosed no relevant financial relationships.

Reviewers

Steve Applegate, MEd, MEd (President, Applegate Consulting, )Mr. Applegate has experience in substance use counseling, state initiatives impacting substance use, and professional training. His prior positions include director of higher education and instructional design at the North Carolina Governor's Institute on Alcohol and Substance Abuse, project director of the North Carolina Initiative of the Mid-Atlantic Addiction Technology Transfer Center, and program director of the Addiction Sciences Center (an outpatient substance abuse treatment center at the University of Virginia Health Sciences Center). Mr. Applegate works as an on-site consultant and travels to the Clinical Tools (CTI) office on a monthly basis from his office in Richmond, VA. Mr. Applegate helped design the CTI Instructional Manual and works to continue to revise it as we expand our Instructional Design methodology. Mr. Applegate has extensive experience with online education and training, especially in the area of substance abuse. He often pushes the envelope of technology and brainstorms with Clinical Tools how we can utilize new technology within our products. He helped guide development of the curriculum plan and assessments in Phase I of the current project.
Disclosure: Has disclosed no relevant financial relationships.

Audience and Accreditation

Audience:

Health care professionals

TypeEst. TimeReleasedExpires
FBRC1 hr(s)12/3/1512/3/17
FBN1 hr(s)11/20/1510/31/17
FBCSW1 hr(s)12/3/1512/3/17
FBD1 hr(s)10/31/1012/31/16
AMA PRA Category 1 Credit(s)™1hr(s)12/3/1512/3/18
FBM1 hr(s)12/3/1512/3/17
FAPA1 hr(s)12/3/1512/3/17
NYS OASAS1 hr(s)4/6/174/5/19
NBCC1 hr(s)3/16/162/18/18
NBCC1 hr(s)3/1/182/29/20

Accreditation Statement: Clinical Tools, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
AMA PRA Category 1 Credit™ Designation Statement: Clinical Tools, Inc. designates this enduring material for a maximum of AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
NYS OASAS Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 hour(s) of NYS OASAS credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.
NBCC Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 clock hour(s) of NBCC credit. Clinical Tools, Inc. has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6161. Activities that do not qualify for NBCC credit are clearly identified. Clinical Tools is solely responsible for all aspects of the activity.
A letter of completion for up to 1 hour(s) is available for non-physicians.
A score of 70% on the post-test is required to complete the activity.

Overview

Goal: To train health care providers and students in primary care and other clinical settings in the basic motivational interviewing techniques to motivate people having substance use and other health problems to change behaviors in order to improve health.

Professional Practice Gaps

Professional practice gaps exist when there is a disparity between educational needs and the ideal or desired level of knowledge, competence, and performance. Few primary care providers routinely provide substance use interventions with their patients or appropriate follow-up (Roche & Freeman, 2004; D'Amico et al., 2005). The structured counseling skills of motivational interviewing are an effective means of motivating patients to change addictive behavior (Miller & Rollnick, 2012). Motivational Interviewing has been used successfully in primary care as a brief intervention for addiction (Rahm et al., 2014) particularly for enhancing readiness to change, goal-oriented action, and treatment adherence (VanBuskirk & Wetherell, 2014). Training physicians in motivational interviewing skills will prepare them to provide effective substance use interventions for patients.

Providers vary a great deal with respect to their self-efficacy in counseling skills to address substance use problems (Midboe, et al., 2011). Providing instruction on the steps involved in motivational interviewing will adhere the foundation for building self-efficacy and fulfill the knowledge need. Also, primary care providers express uncertainty in their ability to perform brief counseling interventions (Saitz, 2013). Understanding how to apply the clinical steps will help address this competence need. Additionally, experience with interactive case scenarios will help providers transfer competency in motivational interviewing into practice to help address the performance need for greater self-efficacy with counseling skills for substance use problems.

References:
Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28(3): 7-30. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18077300 Accessed on: 2014-07-28.
Carroll KM, Ball SA, Nich C, Martino S, Frankforter TL, Farentinos C, Kunkel LE, Mikulich-Gilbertson SK, Morgenstern J, Obert JL, Polcin D, Snead N, Woody GE, National Institute on Drug Abuse Clinical Trials Network. Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend. 2006; 81(3): 301-12. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16169159 Accessed on: 2014-07-29.
Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. HHS Publication. 2015; SMA 15-4927, NSDUH Series H-50: . Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm
Clinical Tools Inc. Needs analysis evaluation for: Online Skills Training for Primary Care Physicians on Substance Abuse.. NIDA Contract No. HHSN271200800038C. 2009.
D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15725979 Accessed on: 2013-10-24.
Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites. Drug Alcohol Depend. 2009; 99: 280-295. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/ Accessed on: 2011-03-24.
Mersy DJ. Recognition of alcohol and substance abuse. American Family Physician. 2003; 67: 1529-1532. Available at: http://www.aafp.org/afp/2003/0401/p1529.html Accessed on: 2013-10-24.
Midboe AM, Cucciare MA, Trafton JA, et al.. Implementing motivational interviewing in primary care: the role of provider characteristics. J Behav Med. 2014; 37(4): 768-80. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717678/ Accessed on: 2018-02-22.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. The Guilford Press. 2013. Available at: http://www.amazon.com/Motivational-Interviewing-Third-Edition-Applications/dp/1609182278 Accessed on: 2014-10-10.
Rahm AK, Boggs JM , Martin C, et al.. Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings . Subst Abus. 2014. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25127073 Accessed on: 2015-05-27.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23(1): 11-18. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14965883 Accessed on: 2013-10-24.
Saitz R. Addressing Unhealthy Alcohol Use in Primary Care. Springer. 2013. Available at: https://www.amazon.com/Addressing-Unhealthy-Alcohol-Primary-Care/dp/146144778X Accessed on: 2017-07-26.
VanBuskirk KA, Wetherell JL. Motivational interviewing with primary care populations: a systematic review and meta-analysis.. J Behav Med. 2014; 37(4): 768-80. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4118674/ Accessed on: 2018-02-22.
This activity is designed to change: Competence, Performance.

Educational Objectives:

After completing this activity participants will be able to:
  • Use a patient-centered, non-authoritarian, collaborative approach to establish a therapeutic alliance with a patient who needs to make a health behavior change.

  • Use communication skills from motivational interviewing to work collaboratively with patients to identify a specific health behavior change goal as the focus during the counseling session.

  • Identify a patient's current readiness to change a health behavior problem and select the appropriate steps and skills of motivational interviewing to use based on that level of readiness.

  • Evoke participation by patients in exploring their motivations, ambivalence, or resistance to making a health behavior change.

  • Apply motivational interviewing techniques in collaborative planning with patients to address substance use or other health problems.

  • Adapt motivational interviewing skills to medical settings.

Modules in this Training Activity

  • Motivational Interviewing for Primary Care

Practice Gap References:

Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28(3): 7-30. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18077300 Accessed on: 2014-07-28.
Carroll KM, Ball SA, Nich C, Martino S, Frankforter TL, Farentinos C, Kunkel LE, Mikulich-Gilbertson SK, Morgenstern J, Obert JL, Polcin D, Snead N, Woody GE, National Institute on Drug Abuse Clinical Trials Network. Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend. 2006; 81(3): 301-12. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16169159 Accessed on: 2014-07-29.
Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. HHS Publication. 2015; SMA 15-4927, NSDUH Series H-50: . Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm
Clinical Tools Inc. Needs analysis evaluation for: Online Skills Training for Primary Care Physicians on Substance Abuse.. NIDA Contract No. HHSN271200800038C. 2009.
D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15725979 Accessed on: 2013-10-24.
Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites. Drug Alcohol Depend. 2009; 99: 280-295. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/ Accessed on: 2011-03-24.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. The Guilford Press. 2013. Available at: http://www.amazon.com/Motivational-Interviewing-Third-Edition-Applications/dp/1609182278 Accessed on: 2014-10-10.
Rahm AK, Boggs JM , Martin C, et al.. Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings . Subst Abus. 2014. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25127073 Accessed on: 2015-05-27.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23(1): 11-18. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14965883 Accessed on: 2013-10-24.

Most Recent Reviews

CTI Content Review: Tue, 11/3/2015
CTI Editorial Review: Tue, 11/24/2015

Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

Technical Requirement: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.

FundingInitial development of this activity was supported by a grant from the National Heart, Lung, and Blood Institute (#R44HL65885).
Training Activity References:
BoiseCoE. Motivational Interviewing -- OARS Skills. BoiseCoE. 2012. Available at: https://youtu.be/_KNIPGV7Xyg Accessed on: 2015-10-06.
Butler C, Rollnick S, Cohen D, Russell I, Stott N. Motivational counseling versus brief advice for smokers in general practice: a randomized trial. BR J Gen Pract. 1999; 49: 611-616. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1316198/ Accessed on: 2013-10-25.
Carey KB. Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach. Community Mental Health Journal. 1996; 32: 291-306. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8790970 Accessed on: 2013-10-28.
Clinical Tools, Inc.. Motivational Interviewing. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Clinical Tools, Inc.. Motivational Interviewing: Managing Challenging Patient Behavior. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Community Care of North Carolina. CCNC Motivational Interviewing Resource Guide. . 2013. Available at: https://www.communitycarenc.org/media/files/mi-guide.pdf Accessed on: 2015-06-11.
Copeland L, McNamara R, Kelson M, et al. Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: A systematic review. Patient Educ Couns. 2015; 98(4): 401-11. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25535015 Accessed on: 2015-09-29.
DiLillo V , West DS. Motivational interviewing for weight loss . Psychiatric Clinics of North America . 2011; 34: 861-869. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22098809 Accessed on: 2015-05-27.
Emmons K, Rollnick S. Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11137778 Accessed on: 2013-10-24.
Engle B. Motivational Interview with "Resistant" Heavy Drinker. . 2012. Available at: https://youtu.be/eNfy-FVvnRs Accessed on: 2015-10-06.
Glynn LH, Moyers TB. Chasing change talk: the clinician's role in evoking client language about change. Journal of Substance Abuse Treatment. 2010; 39(1): 65-70. Available at: http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(10)00073-5/abstract Accessed on: 2015-10-06.
Ingersoll KS, Wagner CC, Gharib S. Motivational groups for community substance abuse problems. Mid-Atlantic Addiction Technology Transfer Center, Center for Substance Abuse Treatment. 2000. Available at: http://people.uncw.edu/ogler/MI%20Groups%20for%20Com%20SA%20Prog.pdf Accessed on: 2013-10-24.
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Lyme A. Motivational Interviewing - Good Example. TheIRETAchannel. 2013. Available at: https://youtu.be/67I6g1I7Zao Accessed on: 2015-10-06.
Marlatt GA. Harm Reduction: come as you are. Addict Behav. 1996; 21: 779-88. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8904943 Accessed on: 2013-10-25.
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Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. Applications of Motivational Interviewing Series. New York: Guilford Press.. 2012; 3rd edition: . Available at: https://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781609182274 Accessed on: 2014-07-08.
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