Davis Kristin E, Devitt Tim, O'Neill Sheila, Kaiser Susan M, Mueser Kim T
Thresholds Evaluation and Research Center.
Thresholds.
Psychiatr Rehabil J. 2014 Mar;37(1):37-42. doi: 10.1037/prj0000047.
Engaging persons with co-occurring disorders in substance use treatment presents a significant challenge for public mental health service providers. Standardized, user-friendly guidelines may have great benefit for community mental health outreach staff working with individuals with co-occurring disorders. The purpose of this study is to describe the impact of a brief, structured goal development curriculum ("Fresh Start") on clinicians' motivational interviewing skills and to assess clinician and consumer satisfaction with the curriculum.
Four clinicians, each working with 3-4 consumer participants, were assessed with the Yale Adherence and Competency Scale prior to and during use of Fresh Start to determine improvements in motivational interviewing and goal setting. Consumer participants were assessed in brief qualitative interviews to assess satisfaction. Chart-review of routinely collected substance use data was used to assess reductions in use.
Clinicians demonstrated high ratings in relational motivational interviewing skills at baseline which were maintained at study conclusion. Clinicians had lower technical motivational interviewing skills at baseline and made modest improvements in motivational interviewing techniques targeting increasing change talk. Fresh Start participants completed an average of 10 sessions (SD = 2.35). Among the 16 consumers who volunteered to participate in using the Fresh Start curriculum, 12 finished the program and 9 decided to reduce use and composed a sobriety plan.
High rates of completion indicate acceptability of the curriculum and feasibility for implementing the program in a community setting. Short, goal-setting interventions are needed and under proper conditions may be teachable in vivo.
让同时患有多种疾病的人参与物质使用治疗，对公共心理健康服务提供者来说是一项重大挑战。标准化、用户友好的指南可能会极大地造福于与同时患有多种疾病的个体打交道的社区心理健康外展工作人员。本研究的目的是描述一个简短的、结构化的目标制定课程（“重新开始”）对临床医生动机访谈技能的影响，并评估临床医生和消费者对该课程的满意度。
四名临床医生，每人与3 - 4名消费者参与者合作，在使用“重新开始”之前和期间，用耶鲁依从性和能力量表进行评估，以确定动机访谈和目标设定方面的改进。对消费者参与者进行简短的定性访谈以评估满意度。使用常规收集的物质使用数据进行图表审查，以评估使用量的减少情况。
临床医生在基线时的关系性动机访谈技能评分较高，在研究结束时保持不变。临床医生在基线时的技术动机访谈技能较低，在针对增加改变谈话的动机访谈技巧方面有适度改进。“重新开始”的参与者平均完成了10次课程（标准差 = 2.35）。在自愿参加“重新开始”课程的16名消费者中，12人完成了该计划，9人决定减少使用并制定了戒酒计划。
高完成率表明该课程具有可接受性，并且在社区环境中实施该计划具有可行性。需要简短的目标设定干预措施，并且在适当条件下可能可以在实际环境中教授。
