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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3088 — A Randomized Controlled Trial of Motivational Interviewing to Improve Mental Health Treatment Engagement and Outcomes in OEF/OIF Veterans

Seal KH (San Francisco VA Medical Center, University of California San Francisco), McCamish N (San Francisco VA Medical Center), Abadjian L (San Francisco VA Medical Center), Tarasovsky G (San Francisco VA Medical Center), Daley A (San Francisco VA Medical Center), Ren L (San Francisco VA Medical Center)

Objectives:
Motivational interviewing (MI) is a client-centered, non-confrontational therapy with a strong evidence base for improving mental health treatment engagement and positive mental health outcomes. OEF/OIF veterans have high rates of mental health problems, yet fail to engage in adequate mental health treatment. We tested the efficacy of telephone-administered MI to enhance mental health treatment engagement and secondarily to improve clinical outcomes in OEF/OIF veterans.

Methods:
A pilot randomized controlled trial (RCT) has been conducted in three phases to develop a telephone-based MI intervention for OEF/OIF veterans. After telephone assessment for PTSD, depression, high-risk drinking, and substance misuse, veterans who screened positive for >= 1 mental health problem(s) and who were not in mental health treatment were randomized to receive either 3 telephone MI sessions or 3 neutral check-in calls (Attention Control) at 2, 4, and 8 weeks. Audiotaped sessions were monitored for adherence to MI. Blinded outcomes assessments were conducted at 8 and 16 weeks. Intent to treat analyses compared the proportions in each arm who initiated mental health treatment (at least one mental health visit) and effect sizes were calculated using Cohen’s h. Mixed model repeated measures analyses compared mental health symptoms and readiness for treatment.

Results:
To date, 76 OEF/OIF veterans with one or more mental health problems have enrolled in the pilot RCT; 38 in each of the MI and Control arms. The mean age is 33 (SD +/- 9), 26% women, 45% ethnic minorities. In the third phase of the study (n = 41), 61% (MI) versus 26% (Control) have initiated mental health treatment (p = 0.02, Cohen’s h = 0.72), but there have been no group differences in treatment retention. Compared to Controls, veterans receiving telephone MI had significantly lower hazardous drinking scores at 8-weeks, but this improvement was not sustained at 16-weeks. At 16-weeks, compared to Controls, the MI group had significantly higher scores on readiness and confidence regarding treatment engagement.

Implications:
Preliminary results suggest that telephone-based MI improves mental health treatment initiation, readiness, and high-risk drinking. An intensified intervention may enhance treatment retention and sustained outcomes.

Impacts:
Telephone MI is a promising intervention for difficult-to-engage OEF/OIF veterans.


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