Measure of Empathy, the HRQ, May be Useful as Quick Assessment of MI Training Progress

• Motivational interviewing (MI) is an evidence-based practice shown to be effective when working with people in treatment for substance use disorders.

However, MI comprises a complex set of skills that are not easy to master, so training requires valid measurement of fidelity and skill.  The gold standard for MI fidelity assessment is an audiotaped interview scored by a rater with a detailed structured instrument such as the Motivational Interviewing Treatment Integrity 2.0 (MITI 20.0) Coding System.

Audiotaping interviews can be difficult in community practice settings where time constraints and limited staffing and access to technology can all be barriers. A simpler, yet still objective, means of assessing MI skill would be of significant benefit. To that end, this study evaluated the use of the Helpful Responses Questionnaire (HRQ), a pen-and-paper test of empathy (a foundational MI skill) that does not require an audiotaped session.

A randomized trial of 3 different regimens for training counselors in MI (live supervision using teleconferencing, tape-based supervision, and workshop only) offered the opportunity to evaluate the performance of the HRQ as a measure of MI ability, compared to the several MITI 2.0 global scores and subscales.

Participants were counselors (N=97) from 26 community-based substance use treatment programs affiliated with the Long Island and New York Nodes (now the Greater New York Node) of the NIDA Clinical Trials Network. Counselor MI proficiency was measured at 4 time points: baseline (before an initial 2-day MI workshop), post-workshop, 8 weeks post-workshop (i.e., post-supervision), and 20 weeks post-workshop with both MITI 2.0 and HRQ.

Findings included:

• HRQ total scores correlated significantly with the Reflection to Question Ratio from the MITI 2.0 at post-workshop, week 8, and week 20, and with the Spirit and Empathy global scores at week 20.
• Correlations of HRQ with other MITI 2.0 subscales and time points after workshop were small and not significant.
• As predicted, HRQ scores differed between training conditions, with counselors assigned to live supervision achieving better HRQ scores than those in Workshop only.

Conclusions: These findings suggest that the HRQ may not be useful as a screening tool to identify counselors with higher vs. lower baseline proficiency in MI, but may provide a shorthand measure of reflective listening skill during training. Thus, the HRQ can be used as a quick assessment of progress in MI training. More work is needed to both develop vignettes relevant to substance use for the HRQ, and to create a more comprehensive pen-and-paper measure of MI skill that will be easy to collect and less time intensive than coding MITI assessments.

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