title: Targeting consumers in the early stages of substance use treatment: a pilot study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Thresholds Evaluation and Research Center.
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Davis
authors.affiliation: Thresholds.
authors.forename: Tim
authors.initials: T
authors.lastname: Devitt
authors.affiliation: Thresholds.
authors.forename: Sheila
authors.initials: S
authors.lastname: O'Neill
authors.affiliation: Department of Preventative Medicine, Northwestern University.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kaiser
authors.affiliation: The Center for Psychiatric Rehabilitation,, Boston University.
authors.forename: Kim T
authors.initials: KT
authors.lastname: Mueser
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D003258:Consumer Behavior / Q000706:statistics & numerical data; D003479:Curriculum; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006040:Goals; D006801:Humans; D007318:Inservice Training; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D062405:Motivational Interviewing / Q000379:methods* / Q000592:standards; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010865:Pilot Projects; D036301:Qualitative Research; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome