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Implementing Parent-Teen Motivational Interviewing + Behavior Therapy for ADHD in Community Mental Health

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Abstract

Despite the promise of psychosocial interventions for adolescent Attention Deficit Hyperactivity Disorder (ADHD), there are no studies that examine their implementation in community mental health contexts. In this study, we evaluate the implementation of community-based Supporting Teens’ Autonomy Daily (STAND), a parent-teen Motivational Interviewing + Behavior Therapy intervention for adolescents with ADHD. Adolescents with ADHD (N = 225), who were clients at four community mental health agencies, received treatment from 82 therapists. There was double randomization of adolescents and therapists to STAND or Usual Care (UC). Nearly all therapists randomized to STAND completed the training and regularly attended supervision, rating STAND as acceptable and lower burden than UC practices. In the STAND group, MI competence and implementation were lower than in university trials (benchmark range, 19.5% for reflection to question ratio to 83.1% for technical globals). MI integrity in the STAND group was significantly higher than UC across most MITI indices. Content fidelity was adequate in STAND’s engagement and skills phases (76.4–85.0%), but not its planning phase (24.4%). Therapists commonly neglected weekly review of goals and home practice and deviated from manualized pace and sequencing of therapy tasks. Learning MI was more challenging for bilingual therapists and therapists with more years of experience. STAND was delivered with higher integrity in earlier sessions and office-based sessions. Discussion identifies future directions for exporting adolescent ADHD interventions to community settings. Patient outcome data for this trial is presented elsewhere. Trial Registration: NCT02694939 www.clinicaltrials.gov.

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Funding

This study was funded by the National Institute of Mental Health (R01 MH106587; Sibley, PI).

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Authors and Affiliations

  1. Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

    Margaret H. Sibley

  2. Center for Child Health, Behavior, & Development, Seattle Children’s Research Institute, Seattle, WA, USA

    Margaret H. Sibley

  3. Center for Children and Families, Florida International University, Miami, FL, USA

    Margaret H. Sibley, Paulo A Graziano, Leonard Bickman, Stefany J. Coxe, Pablo Martin, Lourdes M. Rodriguez, Niloofar Fallah & Mercedes Ortiz

  4. Department of Psychiatry & Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

    Margaret H. Sibley

  5. Department of Psychology, Florida International University, Miami, FL, USA

    Paulo A Graziano & Stefany J. Coxe

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  1. Margaret H. Sibley
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  2. Paulo A Graziano
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Correspondence to Margaret H. Sibley.

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Conflict of Interest Disclosures

Dr. Sibley receives book royalties from Guilford Press for the treatment manual described herein. She receives royalties from Vimeo, Inc. for training videos for the treatment described herein. She has consulted with Takeda Pharmaceuticals. No other authors report conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Florida International University IRB; #103225) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sibley, M.H., Graziano, P.A., Bickman, L. et al. Implementing Parent-Teen Motivational Interviewing + Behavior Therapy for ADHD in Community Mental Health. Prev Sci 22, 701–711 (2021). https://doi.org/10.1007/s11121-020-01105-7

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