Phase II Motivational Interviewing: An Experiential Online Training Tool - SBIR - Clinical Trial

Between 2011 and 2012, the Center for Social Innovation, LLC (C4), developed and evaluated a prototype of the Motivational Interviewing Simulator: An Experiential Online Training Tool. The interactive, case-based, multiplayer web-based game allows service providers to deepen their skills in Motivational Interviewing (MI), a widely recognized evidence-based practice that supports people to make positive behavior changes related to health, wellness, mental illness, and addiction. Phase I study findings support the product's feasibility and the need for a large-scale randomized trial to determine the tool's effectiveness. During Phase I, participants in the Simulator group showed significant improvements in MI skills as measured by Motivational Interviewing Treatment Integrity (MITI) scores (34% improvement over baseline) and Helpful Responses Questionnaire (HRQ) scores (13% improvement over baseline)-both substantially higher than the rates of improvement for participants in the control groups.

This project represents Phase II of the work to further develop the MI Simulator and to study its impact on provider behavior and client outcomes. Phase II will create multiple "play arenas"-Single Player, Two Player, and Advanced Free-play spaces-and multiple case-based scenarios related to mental health, homelessness, addiction, and primary care. The significantly expanded product will have wide appeal across a large workforce of providers serving vulnerable populations, and it will support National Institute of Mental Health's strategy of "closing the gap between the development of new, research-tested interventions and their widespread use by those most in need."

The Phase II randomized controlled trial is guided by four specific aims. The first aim is to diversify the prototype Motivational Interviewing Simulator to meet the needs of a wider audience. Based on Phase I findings, we will build on the prototype by adding a Single Player Arena, expanding the existing Two-Player Arena, and creating an Advanced Free-play Arena where learners can go beyond basic MI skills. Additionally, the expanded product will include multiple scenarios, story-lines, and characters for each arena, and multiple levels of play for each scenario. The second aim is to evaluate the Simulator through a randomized controlled trial. The third aim is to disseminate findings. And the fourth aim is to prepare for commercialization.

Phase II seeks to answer a number of Research Questions that concern service providers, clients, and organizations. Research questions pertaining to service providers are as follows: What are the relative impacts of these interventions on providers' confidence, knowledge and skills acquisition and retention? What supports are needed for providers to adhere to the MI model with fidelity over time? And Does the impact of the treatment condition vary by the amount of time the service provider spends engaged with the Sim or eBook tools? One key research questions pertaining to clients is as follows: Do clients served by providers receiving the Sim or eBook interventions show improved outcomes such as housing stability and receptiveness to mental health treatment, medication adherence, greater satisfaction with the provider, and greater confidence in individual treatment or recovery plans, relative to the Training Only group? Two key research questions focusing on organizations implementing MI are as follows: How does agency context influence provider adherence to the MI model? And, What are the organizational-level barriers and facilitators to successful MI implementation and fidelity?

Phase II will test four hypotheses (H1, H2, H3, H4). H1 predicts that providers in the Simulation condition will show the strongest knowledge and skill retention during the study period when compared to MI Training Only and MI Training + eBook conditions. H2 predicts that providers in the eBook condition will have stronger knowledge skill and retention over the study period when compared to the MI Training Only Condition. H3 predicts that clients served by providers in the Simulation condition will show greater improvements in housing stability and receptiveness to mental health treatment, medication adherence, greater satisfaction with the provider, and greater sense of confidence in individual treatment or recovery plans when compared to clients of MI Training + eBook and MI Training Only conditions. H4 predicts that clients served by providers in the Simulation condition will show improved communication with their provider and greater sense of confidence in individual treatment or recovery plans compared to those clients with providers in the MI training + eBook and MI Training Only.