Motivational enhancement therapy: A case study of a community-wide implementation process
Description
Empirically supported substance abuse treatments are often the least used, while the least supported approaches (e.g. confrontation, drug education) are most used (Miller, 1995). Additionally, key components of an evidence-based practice are often not delivered with sufficient intensity (Sloboda & Schildhaus, 2002). The purpose of this case study was to explore the barriers and facilitators influencing adoption and implementation of motivational enhancement therapy (MET) and the consequences of the community-wide effort to disseminate MET by a researcher-provider collaborative. The identified case for this study was the substance abuse treatment community in metropolitan New Orleans, Louisiana. Twenty individuals representing the metropolitan area were interviewed; ten practitioners and ten administrators. The twenty participants included individuals who primarily treated substance-involved adolescents or post-incarcerated substance-involved offenders, and those who were trained in MET as well as those who were not trained in MET. Seven themes emerged: spreading the word, MET and fit, flexibility, reminders, counselor enhancement, client engagement and retention, and changing old school Results support many known barriers and facilitators to implementing evidence-based practices, including the importance of the innovation's fit with the clinician's counseling orientation and the need for ongoing supervision and training. Several themes provided new insights into the implementation of MET. First, while the impact of counselor orientation on adoption is well documented; the current study finds that the counselor's style (confrontational or client-centered) influenced one's perception of MET rather than the clinician's belief in the disease-concept. This finding questions previous research indicating that counselors who adhere to the disease-concept of addiction are less likely to use MET-like techniques. Second, MET was not only used in group and family therapy sessions, but was frequently used as a mode of communication in the therapeutic milieu for paraprofessional staff. Lastly, participants revealed that the treatment community decreased reliance on 'old school' (confrontational) techniques through the dissemination of MET. Thus, the findings support the use of a community-wide approach to diffusion of evidence-based practices