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. Author manuscript; available in PMC: 2021 Feb 1.
Published in final edited form as: Train Educ Prof Psychol. 2020 Feb;14(1):34–41. doi: 10.1037/tep0000280

Practice and Dissemination of Motivational Interviewing: A Psychology Internship Curriculum

Julie A Schumacher 1, Scott F Coffey 2, Daniel C Williams 3, Michael B Madson 4, Nicholas W McAfee 5
PMCID: PMC7731985  NIHMSID: NIHMS1044440  PMID: 33312323

Abstract

Sufficient training in substance use issues has been identified as a common gap in professional psychology graduate training. Satisfactory training in evidence-based practices has also been identified as a common gap for providers who care for individuals with substance use problems. The “practice and dissemination” curriculum we developed seeks to address both of these gaps during the predoctoral internship training year by first training psychology interns to competently deliver motivational interviewing (MI) to individuals with substance use problems and then train community providers and volunteers to do so. From 2012–2013, a total of 55 community providers and volunteers from a homeless shelter, a substance use treatment facility, and a community mental health facility received training in MI through this curriculum by attending continuing education events delivered by 17 psychology interns. Evaluation of the dissemination portion of the curriculum as part of an exempt educational research project revealed that community providers were able to achieve significant increases in MI knowledge, readiness to implement MI, and MI skill as assessed with a video analogue measure by the end of the workshop. They also reported satisfaction with the workshop. These evaluation findings provide preliminary support for the curriculum as a novel and efficacious way to disseminate MI to community providers. Research is necessary to determine long-term outcomes of such training and to identify strategies to overcome potential barriers such as the substantial faculty effort necessary to implement the intensive curriculum.

Keywords: motivational interviewing, curriculum, dissemination, internship training, substance use disorders

Gaps in Training in Substance Use Disorder Treatment

Within the literature on behavioral health, a gap between research and practice is well-described and long-standing (e.g. Glasgow & Emmons, 2007; Glasgow, Lichtenstein, & Marcus, 2003; Rohrbach, Grana, Sussman, & Valente, 2006). Thus, it is perhaps not surprising that the research to practice gap has also been identified as a substantial concern in substance use disorder treatment (Morgenstern, 2000; Read, Kahler, & Stevenson, 2001). Many substance use disorder treatment providers continue to rely heavily on treatments supported only by providers’ personal experiences in recovery or anecdotal evidence (Carroll & Rounsaville, 2003; Miller, Sorensen, Selzer, & Brigham, 2006). Even within facilities that self-describe as adhering to a particular treatment model (e.g., twelve-step, cognitive behavioral), the types and fidelity of services provided may differ radically between facilities (Hanson & Gutheil, 2004). These differences may matter, because fidelity of intervention delivery often predicts client outcomes (Campbell, Guydish, Le, Wells, & McCarty, 2015; Guydish et al., 2014).

Unfortunately, recent research suggests that many psychologists complete their graduate training ill-equipped to address the research to practice gap in substance use disorder treatment. Dimoff, Sayette, and Norcross (2017) surveyed APA-accredited U.S. clinical psychology programs and found that less than one third offered any specialty training in addiction. Similar findings for counseling psychology were reported by Madson, Bethea, Daniel, & Necaise (2008). On a more promising note, Dimoff and colleagues found that 40% of programs surveyed had at least one faculty member who studied addictions. The practice and dissemination curriculum we developed provides training to psychology interns in evidence based substance use disorder treatment, while at the same time leveraging the addiction expertise within psychology training programs to facilitate implementation of evidence based substance use disorder treatments in the surrounding community.

Promises and Challenges of Motivational Interviewing to Address Gaps

Motivational Interviewing (MI; Miller & Rollnick, 2013) is a relatively brief and flexible intervention that has been shown in several controlled trials to produce significant change in multiple substance-related outcomes (Hogue, Henderson, Becker, & Knight, 2018; Kohler & Hoffman, 2015; Lenz, Rosenbaum, & Sheperis, 2016; Lundahl, Tollefson, Kunz, Brownell, & Burke, 2010). A drawback of MI, as Miller and Rollnick (2009; 2013) have noted, is that although MI is conceptually simple, proficient implementation of this communication style rests on a complex skill set that is not easy to learn. Thus, although researchers have demonstrated that community providers can be trained to use MI proficiently (Carroll et al., 2006; Miller, Yahne, Moyers, Martinez, & Pirritano, 2004) substantial training may be required. In two recent meta-analyses, de Roten, Zimmerman, Ortega, and Despland (2013) identified 12–16 hours as an adequate dose of MI workshop training and noted that coaching and feedback further enhances skill, while Schwalbe, Oh, and Zweben (2014) showed that MI training effects were best maintained through a minimum of five hours of coaching from an expert MI trainer over a six-month period. Reviews of the MI training literature reveal that although workshop training alone used to be common (Madson, Loignon, & Lane 2009; Söderlund, Madson, Rubak, & Nilsen, 2011), the vast majority of recent MI training studies include at least some post-workshop coaching (Madson, Villarosa-Hurlocker, Schumacher, Williams, & Guathier, 2018). Although a survey of MI trainers suggests that this intensive training may reflect years of practices and attitudes that community providers must unlearn in order to learn MI (Schumacher, Madson, & Nilsen, 2014), our experience training psychology interns in MI, suggests substantial variability in dose of training necessary to achieve competence in MI even within that group (Schumacher et al., 2018).

Practice and Dissemination Curriculum

To address the gap in psychology training in the area of substance use disorders, while also facilitating implementation of evidence based practice in community based substance use disorder treatment settings, we developed a practice and dissemination curriculum for MI. This four-part curriculum implemented in a psychology internship program includes: classroom training and supervised practice delivering MI to substance use disorder clients followed by classroom training and supervised practice delivering MI training to a group of community providers. We have pilot tested a similar four-part curriculum focused on providing training in evidence-based treatment for posttraumatic stress disorder (Chin et al., 2019). Previous work on the first two components of the curriculum have been published earlier, in which we documented that interns were able to achieve competence in MI through supervised practicum, and that the dose of feedback-based supervision required to achieve this a priori benchmark was highly variable (Schumacher et al., 2018). In the current paper, we describe the second two components of the curriculum which focuses on the outcomes of training that interns provided to community providers. The training was evaluated with a simple pre-post design and we hypothesized that community providers would evidence significant changes in knowledge and skill as a result of the training.

Method

Participants

From 2012–2013, a total of 55 community providers and volunteers representing three community programs that focused on helping individuals make changes in harmful substance use behaviors participated in the MI training and evaluation through the curriculum. The community programs included a community-based substance use disorder treatment program (n = 8), a homeless day shelter (n = 13), and a community-based program for individuals with serious mental illness and dual disorders (n = 34). Training participants were predominantly female (n = 41; 74.5%) and identified racially as White (n =25; 45.5%), Black/African American (n = 27, 49.1%), or more than one race (n = 3; 5.5%). Participants varied in age with 12.7% (n = 7) indicating they were 18–30, 30.9% indicating they were 31–45 (n = 17), 52.7% indicating they were 46–64 (n = 29), and the remaining 3.6% (n =2) indicating they were over the age of 64. Participants had reported various levels of highest educational attainment with 10.9% (n = 6) indicating high school diploma or GED, 7.3% (n = 4) indicating professional certificate, 010.9% (n = 6) indicating associates degrees, 25.5% (n = 14) indicating bachelor’s degree, 27.3% (n = 15) indicating master’s degree, 9.1% (n = 5) indicating doctoral degree, and 9.1% (n = 5) not reporting.

Evaluation Instruments

Participants completed all evaluation instruments, with the exception of the instrument assessing background characteristics and prior training and training satisfaction, immediately prior to and immediately following the workshop in MI. The former was sent as part of the registration packet and the latter was collected only at post-workshop.

Background characteristics and prior training

A brief instrument was utilized to collect potentially relevant background information such as sex, age, race, and education.

Knowledge of motivational interviewing

To assess baseline knowledge of Motivational Interviewing and change in knowledge as a result of training, a measure developed for a large MI dissemination project in New York State was adapted (Walitzer, Dermen, Barrick, & Shyhalla, 2009). The adaptations focused on making sure all items captured the terminology and concepts presented during our specific training. The instrument comprised 15 true/false items to assess participant knowledge of Motivational Interviewing techniques and spirit. Sample items include: “Breaking through clients’ denial about their alcoholism or addiction is a central part of motivational interviewing [false]” and “The use of summaries is a basic method of motivational interviewing [true].” Participants also had the option to endorse “don’t know,” which was scored as incorrect when the total percentage of correct responses was calculated.

Readiness to learn and implement MI

Community providers completed two copies of the Change Questionnaire Version 1.2 (Miller, Moyers & Amrhein, 2005). This 12-item instrument is designed to assess motivation to change a particular behavior along several dimensions. Respondents are asked to rate on an 11-point scale, ranging from “0 = definitely not” to “10 = definitely” the degree to which they agree with each of 12 statements about the change under consideration. Sample items include: “I want to make this change” and “It is important for me to make this change.” Although the instrument typically allows respondents to supply the change being considered, for the curriculum evaluation, respondents were asked about two specific changes: 1) to learn Motivational Interviewing; and 2) to integrate Motivational Interviewing into my daily clinical practice. Average item response was used in analyses.

The Video Assessment of Simulated Encounters - Revised (VASE-R; Rosengren et al., 2005)

The VASE-R is a video-based method for assessing clinicians’ skill in MI and consists of video presentation of three vignettes in which actors portray individuals who have had experienced various levels of problems related to substance use. In the VASE-R, clinicians are prompted to identify or generate written responses consistent with particular MI principles. The VASE-R includes 18 items (6 per vignette) that produce a total score and five subscale scores (i.e., Reflective Listening, Responding to Resistance, Summarizing, Eliciting Change Talk, & Developing Discrepancy). In a validation sample VASE-R total and subscale scores had small to moderate correlations with several other indices of Motivational Interviewing proficiency, including the Helpful Responses Questionnaire (HRQ) and certain Motivational Interviewing Skills Code (MISC) summary codes (Rosengren Rosengren, Hartzler, Baer, Wells, & Dunn, 2008). Madson, Schumacher, Noble and Bonnell (2013) provided additional evidence of reliability and the sensitivity of the VASE-R to detect changes in MI behavior. VASE-R total scores range from 0 to 36, and subscale scores have varying ranges: reflective listening (0–8), responding to resistance (0–10), summarizing (0–6), change talk (0–6), and developing discrepancy (0–6), with higher scores indicate greater MI skill. Rosengren and colleagues (2008) identified VASE-R score benchmarks for qualifying trainees as (a) untrained (total score = 18), (b) beginning proficiency (total score = 26), and (c) expert proficiency (total score = 31).

Participant satisfaction

Participant satisfaction with the training they received was assessed using a measure developed for the current project. The measure assesses satisfaction in 5 specific areas: (a) classroom facility (e.g. “The facility [room, A/V equipment, lighting, etc.] was conducive to learning.”); (b) design of the course (e.g., “The order in which the course material was presented was conducive to learning.”); (c) instructors’ presentation skills (e.g., The instructors explained things clearly.”); (d) instructors’ knowledge (e.g., “The instructors clearly know a lot about this topic.”); and (e) usefulness of the course content and materials (e.g., “The things I learned in this training will help me improve my clinical practice.”). It also includes two items assessing global satisfaction (e.g., “I would recommend this training to a colleague.”) Respondents are instructed to indicate how much they agree with each statement using an 11 point scale ranging from 0 to 10 with 0 anchored as “Not at All”, 5 anchored as “A medium Amount” and 10 anchored as “Very Much.” Four items were reverse scored (e.g., “The material was presented to slowly.”) A total of 19 items were averaged to generate the average satisfaction rating. To enhance honest responding, respondents provided this information anonymously.

Procedures

Evaluation of the curriculum was designated as exempt educational research by the University of Mississippi Medical Center Institutional Review Board. MI training was provided by 17 advanced graduate students in clinical psychology (7 men, 10 women) who were completing their one-year internship, the final degree requirement in professional psychology at a scientist practitioner model program that emphasizes evidence-based practice. Prior to delivering the training, the interns received the didactic and practicum training in MI as well as training in how to provide training in MI for substance use disorders to community providers. The MI didactic and practicum training, described more fully in an earlier publication (Schumacher et al., 2018), comprised a 15-hour introductory workshop organized to reflect the sequence of learning MI outlined by Miller and Moyers (2006) and included didactic presentations, video and live demonstrations, experiential exercises, and an audio-recorded role-played MI session about which feedback was provided. The primary MI practicum placements were in the adult substance use disorder treatment programs affiliated with the internship, and continued at least until the intern completed two consecutive MI sessions coded at or above the competence benchmark on the Motivational Interviewing Treatment Integrity Code (MITI 3.1.1; Moyers, Martin, Manuel, Miller, & Ernst, 2010). This required 10 (SD = 4.0) MI sessions on average. To provide sufficient feedback and guidance to foster intern mastery, an entire hour of supervision was devoted to a single hour of client contact (the hour during which the MI session was provided) during this practicum. Prior to the MI training received in this curriculum, 8 interns (47.1%) reported no prior training in MI and 4 (23.5%) reported having had only 1–2 hours of prior training.

After the competency benchmark was achieved, interns received classroom training in how to deliver MI training to community providers. Content for the classroom training included basic principles of technology transfer (Addiction Technology Transfer Center, 2004) as well as a review of the entire 15-hour workshop they had received earlier in the training year. Classroom training was didactic and experiential with faculty providing tips and suggestions for various aspects of the workshop and interns taking turns leading workshop exercises, serving as audience members, and providing feedback to their peers.

During the MI dissemination practicum, the outcomes of which are the primary focus of this paper, teams of interns would go to the community placement with the first author, an experienced MI trainer and member of the Motivational Interviewing Network of Trainers, to deliver training. The interns delivered the full training, but the faculty member was on site to provide supervision and support as interns delivered training, and would also work with participants during small group exercises. The faculty member also identified facilities desiring training each year, completed paperwork to ensure continuing education credit could be provided, and compiled evaluation feedback to provide feedback to the interns on the training they delivered. Each intern participated in only one training: a team of 4 interns provided training at the community-based substance use disorder treatment program, a team of 5 interns provided training to the homeless day shelter, and a team of 8 interns provided training to the community-based program for individuals with serious mental illness and dual disorders. Consistent with MI training best-practices (de Roten et al., 2013), the MI training delivered to community providers was a 2-day workshop offered as 2 full days or 4 half days of training. This training included established MI training exercises most frequently identified by experienced MI trainers during a curriculum development survey as being appropriate for an introductory training in MI for substance use (Schumacher et al., 2012). Given documented problems with provider participation in post-workshop coaching (Moyers et al., 2008; Schumacher, Madson, & Norquist, 2011), feedback-based coaching was incorporated into the workshop as well as being offered after the workshop. Specifically, trainers would break participants into pairs or small groups and provide individualized coaching and performance-based feedback during role plays and other practice exercises. The team training approaching created trainer/faculty to participant ratios that allowed each participant to receive individualized feedback and coaching throughout the training (largest ratio = 3.78:1). Community providers were able to receive continuing education credit for participation in the workshop training.

Statistical Analysis

Given the simple pre-post design of the workshop evaluation, paired samples t-tests were used to determine whether changes from pre-training to post-training in knowledge, attitudes, or skills were statistically reliable. Cohen’s d was calculated as a measure of effect size. We created a cross-tabulation of participants pre- and post- VASE-R total score benchmark category, and used a chi-square analysis to examine whether participants moved into higher benchmark categories as a result of training. Given that satisfaction ratings were only collected at post-training, the item mean and standard deviation were calculated and qualitatively compared to scale anchors to gauge participant overall level of satisfaction.

Results

Missing Data

On the VASE-R, 6 participants had missing data at pre- and post, 5 had missing data at post only, and 1 had missing data at pre-only. On the knowledge measure, 4 participants had missing data at pre- and post, 7 had missing data at post only, and 1 had missing data at pre-only. On the readiness to learn MI measure, 5 participants had missing data at pre- and post, 4 had missing data at post only, and 1 had missing data at pre-only. On the readiness to implement MI measure, 4 participants had missing data at pre- and post, 6 had missing data at post only, and 2 had missing data at pre-only. Independent samples t-test comparisons of participants who provided data at pre- but not post to participants with complete data revealed no significant differences at pre-evaluation on any measure. Analyses include only participants who provided data at baseline and follow-up (n = 43–45).

Knowledge

As shown in Table 1, participants demonstrated a significant increase in knowledge of MI as a result of training, t (42) = 6.65, p < .001. Whereas the average score on the pre-training evaluation was 54.2% items correct, the average score on the post-training evaluation was 84.7%. Cohen’s d was 1.01, indicating a large effect.

Table 1.

Pre and Post-Training Scores on MI Knowledge, Attitude and Skills and Skill Measures

Pre Post
Variable (Beginning/Expert VASE-R Benchmark) Mean (SD) Mean (SD) df t Cohen’s d
1. MI Knowledge (% correct) 54.26 (33.48) 84.65 (10.23) 42 6.65*** 1.01
2. CQ - Motivation to Learn MI 8.41 (1.00) 8.31 (1.97) 44 0.35 .05
3. CQ - Motivation to Implement MI 8.45 (1.16) 8.83 (1.00) 43 2.06* .31
4. VASE-R Total Score (26/31) 13.30 (9.05) 21.60 (7.55) 42 7.73*** 1.18
5. VASE-R Reflective Listening (6/7) 3.93 (2.84) 5.60 (2.63) a 42 4.42*** .64
6. VASE-R Respond. to Resistance (8/9) 3.40 (2.78) 7.06 (2.50) a 42 8.82*** 1.34
7. VASE-R Summarizing (3/5) 1.02 (1.63) 2.14 (1.34) a 42 4.43*** .67
8. VASE-R Elicit. Change Talk (4/5) 2.28 (1.86) 3.60 (1.76) a 42 3.99*** .61
9. VASE-R Dev. Discrepancy (4/5) 2.67 (2.03) 3.19 (1.91) a 42 1.65 .25
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Note. CQ = Change Questionnaire Version 1.2. Mean item score for the CQ is presented. VASE-R = Video Assessment of Simulated Encounters Revised. Item summary scores for the VASE-R are presented.

a

Mean score is within one point of VASE-R beginning proficiency benchmark.

*

p < .05

**

p < .01

***

p < .001

Readiness to Learn and Implement MI

Participants reported generally high readiness to learn and implement MI both before and after the training they received (see Table 1). The average ratings on both versions of The Change Questionnaire were above 8 out of 10 on both the pre- and post-training evaluations. There was no significant increase in readiness to learn MI from pre- to post-training, however there was a significant increase in readiness to implement MI from pre- to post-training, t (42) = 2.05, p = .046. Cohen’s d was .31, indicating a small effect.

VASE-R

Participants showed significant improvements from the beginning to the end of training on all VASE-R subscale scores with effect sizes ranging from medium to large (Cohen’s d = .61 to 1.34), with the exception of “developing discrepancy,” which did not change significantly (see Table 1). Examination of the mean scores indicated that whereas no pre-training scores fell within 1-point of the beginning proficiency benchmark on the VASE-R, all scores, with the exception of total score were within 1-point of this benchmark at the completion of training. A chi-square analysis of a cross-tabulation of total VASE-R score benchmark category at pre- and post-training indicated significant movement across categories as a result of training, X2 df 9 n = 43 32.30 p < .001. Specifically, 29 (67.4%) of the participants fell below the untrained benchmark on the VASE-R prior to training but only 10 (23.3%) fell below this benchmark at the end of training. In addition, whereas only 5 participants (11.6%) met or exceeded the beginning proficiency benchmark at the outset of training 12 participants (28%) met or exceeded these standards at the completion of training. Overall, 62.8% (n = 27) of participants ended training with scores in a higher benchmark category than they began it.

Satisfaction

Overall, participants in the intern-delivered workshop were satisfied with the training they received. The average item score for the measure ranged from 6.84 to 10.00 with participants overall endorsing a mean of 8.81 (SD = 0.88). This indicates that overall they agreed a medium amount to very much with statements about the quality and utility of various aspects of the training as well as their satisfaction with the training overall.

Discussion

This educational research project examined a curriculum in which psychology interns, who have received intensive training and supervision in MI (Schumacher et al., 2018), then receive training in how to disseminate this approach to community providers. The dissemination practicum experience that culminates this dissemination training, involves teams of interns going into the community with a faculty supervisor to provide workshop training in MI to providers from a variety of backgrounds, working in a variety of settings, to assist individuals experiencing problems related to harmful substance use. Evaluation of this dissemination practicum revealed that psychology interns were able to help community providers achieve significant increases in knowledge of motivational interviewing, intention to implement motivational interviewing, and ability to demonstrate MI-consistent responses. VASE-R outcomes appear comparable to what has been reported in the literature. Rosengren and colleagues (2008) reported a mean change in VASE-R total score of 5.92 points from pre- to post-training and in this project a mean change of 8.3 points was found. Of note, however, participants in the current study had average baseline scores that were almost 5 points lower than those reported by Rosengren and colleagues. Moreover, examination of mean scores at pre- and post- in the context of established benchmarks on the VASE-R suggest that the changes achieved, by at least some providers were meaningful. Although changes in the developing discrepancy subscale on the VASE-R were not achieved, this scale was least sensitive to training effects in prior research (Rosengren et al., 2008).

The findings of this project provide unique value given the gap between research and practice in substance use disorder treatment (Carroll & Rounsaville, 2003; Miller et al., 2006; Morgenstern, 2000; Read et al., 2001). Advanced graduate students in clinical psychology achieved seemingly meaningful outcomes for their trainings. This is important because use of these relatively inexperienced trainers greatly increases the pool of potential trainers able to provide evidence-based trainings to substance use disorder treatment providers. Equipping these early career psychologists with tools to train their community in an evidence-based intervention may promote future dissemination efforts from these individuals, efforts focused on motivational interviewing or other evidence-based interventions (e.g., Chin et al., 2019). The results from this project may embolden faculty in psychology graduate training programs to incorporate community training experiences within dissemination educational efforts. By doing so, students will gain experience disseminating evidence-based interventions and practices, and community treatment providers may achieve skills similar to those acquired from trainings provided by more experienced trainers.

Limitations

Because this project was a curriculum evaluation and not a controlled research study, several limitations exist. For example, no information was collected from trainers or trainees that was not directly relevant to evaluation and development of the curriculum. Moreover, information collected from patients or clients as part of the curriculum (e.g., audio-taped sessions collected to provide supervision and feedback to trainers or trainees) was not analyzed for curriculum evaluation purposes or retained any longer than necessary for supervision purposes, because we followed the standard educational practices for handling such information. As a result, training outcomes were restricted to change in knowledge about MI and coded responses to video vignettes. Ideally, actual work samples from participants would be collected as evidence that they were proficient or not proficient following the training. This would also provide an indication of whether the training actually impacted outcomes for the clients served by providers. This has been identified as an important omission from much of the MI training literature (Madson et al., 2018), but is likely unrealistic for curriculum evaluation.

In addition to outcomes evaluated, design issues such as lack of a wait list or no training condition, lack of random assignment of trainers to trainees, and varied training audiences limit the conclusions that can be drawn from this work. Certainly, the pre-training versus post-training comparison captures some of the most interesting and important findings in this project, but a comparison to a control condition could address more possible threats to internal validity. Longer-term follow-up would enable examination of whether training gains persist or degrade over time (Schwalbe et al., 2014). Substantial missing data also necessitates cautious interpretation of findings, particularly in light of the fact that many participants were missing data ay pre- and post- because of late arrival and early departure from the training. This is likely because the training took place at participants’ work sites, so some participants would try to make phone calls or take care of other business before and after the workshop.

A limitation not of this evaluation, but of the curriculum itself, was the time intensity of the curriculum. MI is not easy to learn (Miller & Rollnick, 2009) and MI skill acquisition through supervised practice is often variable (Miller, Yahne, Moyers, Martinez, & Pirritano, 2004; Smith et al., 2012). As presented in our earlier work on the practice component of this curriculum (Schumacher et al., 2018), faculty supervisors had to code and provide feedback on segments of up to twenty intern work samples for an intern to master MI to the point that faculty felt comfortable sending them out into the community to train others and also had to attend community workshops and complete a variety of administrative tasks related to the curriculum. Although we strongly believe the skills and experiences obtained through a curriculum such as this were well worth the effort, they require a significant institutional commitment.

Future directions

Although interns were able to achieve what we feel are acceptable outcomes for their training, participants who attended their workshop with integrated coaching did not achieve the outcomes of the training we had hoped. Whereas their knowledge of MI and motivation to learn MI were arguably very good at the end of training, their ability to implement MI as measured with the VASE-R was, in many cases, still limited at post-training. It is common in MI training studies for some or even many clinicians not to achieve proficiency benchmarks in MI (Miller et al., 2004; Moyers et al., 2008; Smith et al., 2012). Although it is clear that more MI-consistent therapist behaviors and fewer therapist MI-inconsistent behaviors predict client outcomes, it is unclear exactly how proficient one must be at MI to improve client outcomes (Madson, Schumacher, Baer, & Martino, 2016). Until more information is available to guide decisions about when someone is trained enough, we continue to focus on proficiency benchmarks to determine whether our training has achieved desired outcomes (Moyers, Manuel, Martin, Henrickson, & Miller, 2005). However, it will be important for research to clarify when a trainee has mastered MI sufficiently to have the desired impact on client outcomes. Similarly, it is unclear how proficient in MI a trainer must be in order to achieve desired training outcomes. In this curriculum, we required that interns demonstrate a high level of proficiency before training community providers. However, it is possible that the same community provider outcomes could have been achieved with less MI practicum experience for the interns. It is also possible that providing training to community providers further enhanced interns’ own skills in MI. Future research will have to address these important questions

In early phases of curriculum development, we ran into the same barriers others have with providers reluctant to provide work samples and participate in coaching. To address this problem, we adapted by integrating coaching into the workshop training. However, this remains an issue that will be important to address in future work. As suggested by Miller & Moyers (2017), finding ways for providers, in a variety of fields to which MI is relevant, to receive the types of intensive training necessary to master MI while they are still in school (and performance feedback is a compulsory part of their training) is an important goal. Additional authors have commented on the importance of studying MI training as part of graduate training programs (Arkowitz & Miller, 2008; Madson et al., 2016; Madson, Speed, Bullock Yowell, & Nicholson, 2011). The curriculum evaluated in this project might be one way to achieve that aim while also fostering implementation of evidence based practice outside of training placements. However, future research is necessary to quantify the costs of curricular initiatives such as the one presented in this paper. Another avenue for further study might be to examine the effectiveness of a MI training curriculum as part of a doctoral training program that spans over multiple years and where a stepped implementation of this model could be integrated. These models might also incorporate features like vertical supervision to reduce the amount of faculty time and program costs necessary to achieve outcomes.

Table 2.

Number of Individuals in VASE-R Total Score Benchmark Categories at Pre and Post

Pre-Training Post-Training Benchmark Category
Below untrained Untrained to beginning Beginning to expert Expert or higher
Below untrained (n = 29) 10 17 2 0
Untrained to beginning (n = 9) 0 4 3 2
Beginning to expert (n = 4) 0 0 1 3
Expert or higher (n = 1) 0 0 0 1
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Acknowledgments

This work was supported by a grant from the National Institute on Drug Abuse (R25DA026637, PI: Schumacher). Preliminary findings from this work were presented at the 26th Annual Association for Psychological Science Convention, San Francisco, CA.

Biography

JULIE A. SCHUMACHER, PhD, is professor and vice chair for education in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center. She received her doctorate from Stony Brook University and completed an internship at Napa State Hospital. Her research and professional interests include motivational interviewing, prevention and treatment of substance use and dual disorder, and violence and trauma.

SCOTT F. COFFEY, PHD, passed away during the revision of this manuscript. Prior to his death he was a professor emeritus in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center. He received his doctorate from the University of Mississippi and completed his internship at the Medical University of South Carolina. He was best known for his work on negative emotion, trauma, and substance use disorders.

DANIEL C. WILLIAMS, PhD, is an associate professor and director of the division of psychology in the department of psychiatry and human behavior at the university of Mississippi Medical Center. He also serves as the vice-director of the psychology pre-doctoral internship program and the associate director of the office of well-being. He received his doctoral degree from the University of Memphis and completed his clinical internship at the VA North Texas Health Care System. His professional interests are in dissemination and implementation of evidence-based treatment for addiction and co-occurring disorders.

MICHAEL B. MADSON, PH.D., is a professor in the School of Psychology at the University of Southern Mississippi where he directs the Eagle Check-Up a brief motivational intervention for college student alcohol and marijuana use. He earned his PhD in counseling psychology from Marquette University. His research interests include motivational interviewing intervention, training and evaluation; harm reduction for substance use among college students

NICHOLAS W. MCAFEE, M.A., is currently a psychology intern at the University of Mississippi Medical Center where he serves as chief resident. He is completing his doctoral program in counseling psychology at the University of Missouri. His professional and research interests include brief treatment for problematic alcohol use, substance use, and gambling behavior and training healthcare providers how to assess for and treat substance and alcohol use disorders.

Contributor Information

Julie A. Schumacher, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center

Scott F. Coffey, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center

Daniel C. Williams, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center

Michael B. Madson, School of Psychology, University of Southern Mississippi

Nicholas W. McAfee, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center.

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