Motivational Interviewing

CACTI was developed for Project ELICIT, a randomized study of two training methods for motivational interviewing with 190 front-line substance-abuse treatment providers [29] . The software was designed for use with the Motivational Interviewing Skill Code (MISC 2.5) [30] , a sequential-coding system for psychotherapy sessions that was derived from the Sequential Code for Observing Process Exchanges (SCOPE) [31] . The SCOPE uses concurrent transcripts and audio recordings to divide and rate client and clinician speech; it was employed in Project PREMIR [6] (link), a psychotherapy process study of 118 recordings of 13 Motivational Enhancement Therapy clinicians. The MISC 2.5 serves three purposes: parsing (unitizing) speech into codeable utterances (speech units), sequential coding of client and clinician utterances, and assignment of global ratings for clients and clinicians. Multiple versions of the program were tested and refined by trained MISC 2.5 coders before CACTI was employed in Project ELICIT.

The ASAP study was a randomized clinical trial of the effectiveness of a brief motivational intervention [14 ] on alcohol consumption among a group of hospitalized patients at Boston Medical Center. Details of the recruitment procedures, inclusion criteria, description of sample and results of the RCT have been published [15 (link)]. The Institutional Review Board of Boston University Medical Center approved this study, and the Institutional Review Board of Smith College approved the secondary analyses. After consenting to enroll, all subjects received an interviewer-administered baseline assessment prior to randomization into the control or intervention group. Subjects were randomly assigned to control or intervention group using a blocked randomization procedure. Intervention subjects participated in a brief motivational interview with a counselor (less than half an hour). Control subjects received usual care.
Follow-up was planned at 3-month and 12-month timepoints. Because the subjects came from a transient and hard-to-reach population, the researchers employed exhaustive techniques to track subjects over the follow-up period. The two primary alcohol-related outcomes were measures of alcohol consumption and linkage to appropriate alcohol treatment; for these secondary analyses we focus solely on treatment differences in alcohol consumption. The outcome of interest was the average number of standard drinks consumed per day in the past thirty days as reported using the Timeline Followback method [1 ] at the 3 and 12-month interviews. For the purpose of this secondary analysis we consider the 3 month time point; similar results were seen utilizing 12 month data (not reported here).
Eight models were fit comparing treatment to control for the ASAP study:
Poisson standard Poisson model,
Over-dispersed Poisson Poisson model with empirical ("robust") variance estimator,
NB negative binomial,
ZIP zero-inflated Poisson, shared inflation parameter estimated for both randomized groups (p₁ = p₂),
ZINB zero-inflated negative binomial, shared inflation parameter estimated for both randomized groups (p₁ = p₂),
TTEST two-sample unequal variance t-test,
WILCOXON Wilcoxon-Mann-Whitney, a non-parametric two-sample comparison procedure suitable for ordinal data, and
PERMUTE two-sample permutation test.

CO-FIDEL's development process (Supplementary Material S2) included two approaches: (1) An opinion-seeking technique from experts in the field of coaching and childhood disability; and (2) A rapid literature review of the intervention studies related to coaching for their coaches' fidelity ascertainment procedures. Four (n = 4) experts in the field of family coaching and/or childhood disability research and clinical practice participated to CO-FIDEL development: a Social Worker & Psychotherapist (AB); Researchers (Occupational Therapist (AM); Developmental Pediatrician (MO)); and a Postdoctoral fellow—Occupational Therapist (TO).
In the scope of BRIGHT Coaching, our team conducted and published a systematic review and analysis on existing coaching interventions that are provided to parents of children with or with suspected developmental disabilities (3 (link)). This systematic review included 28 intervention studies. All of them were part of the rapid review process, extracting information on coaches training and fidelity ascertainment, where present. Findings were then presented to the team, generating discussion on the features of an optimal coaching fidelity evaluation tool: content, nature, administration method, frequency of administration, and scoring. In relation to BRIGHT Coaching and the childhood disability coaching principles, the following elements, reflecting intervention fidelity, were considered in the CO-FIDEL's design:
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Types of behaviors to be measured: behaviors that are program-specific, essential, and also behaviors that need to be avoided (12 (link)).

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Coaching competence: the level of engagement with participant (13 (link)), and the sensitivity with which the treatment protocol was applied (14 (link)).

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Measures: Frequency counts of particular behaviors (12 (link)) and use of a rating scale to better reflect rater's true evaluation (15 (link)).

Only six out of the 28 included studies in our systematic review (3 (link)) referred to the ascertainment of coaches' fidelity in delivering their health coaching program to parents of children with developmental disabilities (16 (link)–21 (link)). Table S1 (Supplementary Material S3) outlines the extracted data. Overall, the fidelity assessment procedures in terms of content and methods were not described in enough detail. The method of assessment was either a review of an audiotaped or a videotaped session or supervision of active cases by the principal investigator or an accredited practitioner. Evaluation frequency ranged from weekly to bi-monthly. Only one study specified that coaches needed to attain a fidelity score of >90% to begin the provision of the intervention to study participants (17 (link)).
Following the review of these findings and a team discussion among experts in the fields of coaching and childhood disability, we decided to incorporate principles of the Motivational Interview Skills Code (MISC) (22 , 23 (link)) and the Solution-Focused Interview Skills (SFIS) (24 , 25 (link)) to the rating tool. MISC refers to demonstrating skills related to acceptance, empathy, and spirt, including collaboration, evocation, and autonomy support. Consistent MISC responses included the following: advise with permission, affirm, emphasize control, question openly, reflect, reframe, and support. Inconsistent responses included: advise without permission, confront, direct, raise concern without permission and warn (22 , 23 (link)). SFIS refers to using open-ended questions, summaries, tolerating and using silences, complimenting participants' strengths and past/current successes, and affirming client's perceptions (24 , 25 (link)). Given that our coaches were trained on employing those two techniques within their BRIGHT Coaching sessions, it was deemed appropriate to evaluate their performance based on these concepts. In addition, we incorporated a section on the overall ability of the coach to deliver the content and their attitude during the session. Following the initial development of CO-FIDEL in close collaboration between the four experts, a draft version of the tool was presented to the participating coaches for their feedback and adjusted accordingly prior to implementation.
As a result, Version 1.0 of the CO-FIDEL contains 4 ratable sections. The cover page includes descriptors of the evaluated session and dedicated space for general comments (Supplementary Materials S4 and S5). Sections 2, 3, and 4 of the tool were designed to match the types of behaviors to be measured that are program-specific, essential, and behaviors that need to be avoided (12 (link)). In addition, as recommended by previous research, we considered including frequency counts of particular behaviors (12 (link)) (i.e., Section 3) and use of a rating scale to better reflect rater's true evaluation (15 (link)) (i.e., Sections 1, 2 and 4).

We performed a needs assessment by conducting 193 interviews and surveys with clinicians, patients, tobacco treatment specialists, nurses, and administrators, in order to determine the barriers to tobacco control delivery. New tobacco control program services were implemented [7 (link)].
After the identification of a patient with current tobacco use, physicians were prompted to refer the patient to tobacco cessation. A multilingual tobacco treatment specialist (TTS) conducted a culturally sensitive motivational interview, gave educational materials, and referred the consenting patient for a tobacco cessation consultation. Patients with a qualifying tobacco use history were referred by the physicians themselves or with TTS prompting to LDCT screening. The use of multilingual support overcame a significant barrier to LCS in patients from racial and ethnic minority groups. Physicians considered patient life expectancy and willingness to have screening and potentially curative therapy before referral to LDCT screening.
We reviewed the tobacco use assessments and engagement with the tobacco control program by race and ethnicity across the City of Hope southern California treatment sites in 2021 (1 academic center and 40 community centers). We analyzed LCS rates and tobacco cessation referral rates, and cessation effectiveness after program implementation.
The COH tobacco control program consisted of quality improvement projects. This was submitted to the COH investigational review board, which concluded the program was deemed non-human-subject research. Therefore, no patient informed consent was required (IRB number 19201).
These new services were implemented in 2019 and continued until the present. Observational evaluations began in 2019 pre- and post-implementation.

The treatment module of Echo-APP can provide patients with a variety of treatment options, aiming to help patients enhance their motivation to stop drug use, reduce drug cravings, strengthen self-control to avoid relapse, strengthen emotional management skills, and enhance individual and social functions (Multimedia Appendix 2).
The whole module includes the following 10 treatment units: (1) strengthening the motivation of drug withdrawal, (2) recognition of drug cravings and incentives, (3) high-risk situations identification and coping skill, (4) dealing with negative cognition, (5) understanding of emotions, (6) stress management, (7) understanding of family conflicts, (8) preventing relapse, (9) mindfulness, and (10) awareness of positive attitude and well-being (Multimedia Appendix 3). Based on the patient's assessment results, the treatment unit that meets the needs of the patient’s condition will be selected to provide to the patient.
Each treatment unit follows a structured setting for CBT. At the beginning of each treatment unit, there will be a brief introduction to the treatment goals and themes of the unit. After that, it will enter the formal treatment session, in which various common tools of CBT [29 (link),30 (link)] (eg, thinking record sheet, analysis sheet of drug use pros and cons, risk level evaluation sheet for external factor, alternative behavior selection sheet), mindfulness-based relapse prevention technique [31 (link)] (integrated into treatment unit 6, 8, and 9), motivational enhancement therapy [32 (link)] (integrated into treatment unit 1), and related knowledge popularization (eg, the damage of different drugs and the antecedent, behavior, and consequence theory of emotion) will be applied.