Lessons learned from measuring fidelity with the Motivational Interviewing Treatment Integrity code (MITI 4)

Area of Science:

• Psychology
• Clinical Psychology
• Addiction Treatment

Background:

• The Motivational Interviewing Treatment Integrity (MITI) code assesses adherence and quality in Motivational Interviewing (MI).
• The MITI is applicable to MI used alone or in combination with other therapeutic modalities.
• This study evaluated the MITI 4.2.1 for fidelity measurement in Motivational Enhancement Therapy (MET) and the combined Community Reinforcement Approach-Senior (CRAS).

Purpose of the Study:

• To assess the reliability of the MITI 4.2.1 for measuring treatment fidelity in elderly individuals with alcohol use disorders.
• To evaluate the MITI 4.2.1's performance in both standard Motivational Enhancement Therapy (MET) and the integrated Community Reinforcement Approach-Senior (CRAS).

Main Methods:

• The MITI 4.2.1 was employed to evaluate treatment sessions from the Elderly Study, a multinational randomized trial.
• Training for raters was conducted internationally and at a Danish site.
• Interrater reliability was quantified using the Intraclass Correlation Coefficient (ICC) on 52 rated sessions.

Main Results:

• The overall mean ICC for the MITI 4.2.1 was 0.78, indicating good to excellent reliability across most measures.
• Specific measures like 'confront', 'emphasize autonomy', and 'softening sustain talk' demonstrated fair reliability.
• The MITI 4.2.1 exhibited similar reliability in CRAS sessions compared to MET sessions, with the exception of the 'persuade with permission' measure.

Conclusions:

• The MITI 4.2.1 is a reliable tool for assessing Motivational Interviewing fidelity, even within the CRAS.
• Achieving high interrater reliability for 'softening sustain talk', specific 'rare measures', and 'persuade with permission' presents challenges.