title: Correspondence of motivational interviewing adherence and competence ratings in real and role-played client sessions.
abstract: Treatment integrity ratings (adherence and competence) are frequently used as outcome measures in clinician training studies, drawn from recorded real client or role-played client sessions. However, it is unknown whether clinician adherence and competence are similar in real client and role-played sessions or whether real and role-play clients provide similar opportunities for skill demonstration. In this study, we examined the correspondence of treatment adherence and competence ratings obtained in real client and role-played sessions for 91 clinicians trained in motivational interviewing (MI), using data from a multisite trial examining 3 methods of clinician training (Martino et al., 2011). Results indicated overall poor integrity rating correspondence across the 2 session types, as indicated by weak correlations (rs=.05-.27). Clinicians were rated significantly more MI adherent overall and specifically used more advanced MI strategies in role-played than real client sessions at several assessment time points (ds=0.36, 0.42). Real clients, in comparison to the role-play actor, demonstrated greater motivation at the beginning of the session (d=1.09), discussion of unrelated topics (d=0.70), and alliance with the clinician (d=0.72). These findings suggest that MI integrity rating data obtained from real client and role-played sessions may not be interchangeable. More research is needed to improve the procedures and psychometric strength of treatment integrity assessment based on role-played sessions.
authors.affiliation: New England Mental Illness Research Education and Clinical Centers/VA Connecticut Healthcare System, West Haven, CT 06516, USA. suzanne.decker@yale.edu
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Decker
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
authors.forename: Charla
authors.initials: C
authors.lastname: Nich
authors.forename: Monica
authors.initials: M
authors.lastname: Canning-Ball
authors.forename: Steve
authors.initials: S
authors.lastname: Martino
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D002986:Clinical Trials as Topic; D006801:Humans; D062405:Motivational Interviewing / Q000592:standards*; D015337:Multicenter Studies as Topic; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D010349:Patient Compliance / Q000523:psychology*; D011369:Professional-Patient Relations; D012381:Role Playing