Motivational Interviewing for Gun Violence Prevention

(SHIFT Trial)

Overseen by Julia M Fleckman, PhD, MPH

Age: < 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Tulane University

Disqualifiers: Under 16, Over 24, Psychosis, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This study is a quasi-experimental design, specifically a non-randomized controlled trial (NCT) designed to test the effects of gun violence reduction intervention including MI for youth ages 16-24 years old who present to the Emergency Department or ICU Spirit of Charity Trauma Center (SCTC) at University Medical Centers or another area hospital in New Orleans, Louisiana following a gunshot injury or stab wound. The study will utilize an enrollment strategy that involves alternating, across recruitment days, the assigned study condition. Thus, Day 1 participants would be enrolled into TAU, Day 2 participants would be enrolled in MI-case management condition, Day 3 participants would be enrolled in TAU, etc. This proposed design will minimize any confounds associated with self-selection while possibly increasing enrollment rate. Research questions include: 1. Will youth allocated to the MI prevention condition have safer firearm related behaviors and beliefs compared to the TAU control condition at 6 months post- enrollment? 2. Will youth allocated to the MI prevention condition have reduced gun violence recidivism compared to the TAU control condition at 18 months post-enrollment. 3. How do youth's social and normative environments influence their gun behaviors and attitudes? Researchers will compare intervention and TAU arms to see if there are any differences in outcome measures. Participants will: 1. complete study eligibility assessment, be assigned to one of two conditions depending on the date of assessment, consent, and enroll in the Emergency Department (ED) or inpatient unit of hospital by a study team member, 2. participate in one of two conditions: MI administered by a licensed clinical social worker, or treatment as usual control group (TAU) administered by a study team member (n=170 per condition) 3. complete three surveys (baseline, 3-month, and 6-month) conducted by a study team member 4. 18-month post examination of participant hospital records 5. have the option to complete a 1-1.5 hour interview, 1-3 months after the 6-month survey is completed (n=50)

Do I have to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the study team or your healthcare provider.

What data supports the effectiveness of the treatment Motivational Interviewing and Firearm Safety Training for gun violence prevention?

Motivational Interviewing (MI) has been shown to be effective in helping people change behaviors, such as reducing drug and alcohol use, by encouraging them to talk about their own reasons for change. This approach has been successfully used in various settings, including health-related behavior changes and psychiatric disorders, suggesting it could be beneficial for gun violence prevention by addressing ambivalence and promoting safer behaviors. ^{1 2 3 4 5}

Is Motivational Interviewing generally safe for humans?

The research articles reviewed do not provide specific safety data for Motivational Interviewing, but they focus on training and skill acquisition, suggesting that the method is generally considered safe for use in various settings. ^{2 6 7 8 9}

How is the treatment Motivational Interviewing and Firearm Safety Training different from other treatments for gun violence prevention?

Motivational Interviewing (MI) is unique because it focuses on helping individuals explore and resolve their mixed feelings about changing behaviors, which can lead to more effective prevention of gun violence. Unlike other treatments, MI involves a collaborative conversation style that encourages individuals to talk themselves into making positive changes, making it particularly effective for behavior change. ^{3 4 7 10 11}

Research Team

Julia M Fleckman, PhD, MPH

Principal Investigator

Tulane University

Eligibility Criteria

This trial is for youth aged 14-24 who have been admitted to the Emergency Department or ICU at SCTC in New Orleans, Louisiana after a gunshot injury or stab wound. Participants must be willing to undergo motivational interviewing and firearm safety training with case management, complete surveys, and allow hospital record review.

Inclusion Criteria

Reside in the state of Louisiana

I can give my consent to participate.

Gunshot wound, stab wound, or assault related blunt force trauma injury treated at University Medical Center

Exclusion Criteria

English is not my first language.

I am unable to understand and give consent for the trial.

I am either younger than 14 or older than 24.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Enrollment and Initial Assessment

Participants complete study eligibility assessment, are assigned to one of two conditions, consent, and enroll in the Emergency Department or inpatient unit of the hospital

1 day

1 visit (in-person)

Treatment

Participants receive either Motivational Interviewing with case management and firearm safety training or Treatment as Usual

6 months

Multiple visits (in-person and virtual)

Follow-up

Participants complete surveys and are monitored for changes in firearm-related behaviors and beliefs

18 months

3 visits (in-person or virtual) for surveys, plus hospital record examination

Qualitative Interview (Optional)

Participants have the option to complete a 1-1.5 hour interview to gain in-depth understanding of social and normative environments

1-3 months after 6-month survey

Treatment Details

Interventions

• Motivational Interviewing and Firearm Safety Training (Behavioral Intervention)

Trial Overview The study tests if motivational interviewing (MI) combined with case management reduces gun violence behaviors and recidivism among injured youths compared to treatment as usual (TAU). It alternates enrollment into MI-case management or TAU based on the day of assessment.

Participant Groups

Group I: Intervention Condition Experimental Treatment 1 Intervention

The experimental arm condition consists of motivational interviewing with case management and firearm safety training with a licensed clinical social worker (LCSW). Motivational Interviewing (MI) is a participant-centered yet directive method for enhancing readiness to change. The purpose of MI is to help an individual articulate their own reasons and develop their own plans for making behavioral change. MI respects these values of self-determination and self-efficacy, and emphasizes the participant's right to make decisions about change. The firearm safety training (FST) will be led by the team's LCSW and include a brief demonstration, identification of reasons why the participant may or may not practice safe storage, and develop a plan moving forward. The FST will integrate MI techniques throughout the session.

Group II: Treatment as Usual Active Control 1 Intervention

Patients assigned to the TAU condition will receive standard care for victims of violence at the Trauma Center. All TAU-assigned patients will be screened by psychiatry consult/liaison staff for posttraumatic symptoms, depression, and substance use. Patients with significant symptoms will be offered pharmacotherapy and/or supportive psychotherapy. Patients will also be provided with a list of community resources available for victims of violence, including mental health and social services. Patients in TAU will receive the same information sheet (e.g., job training) provided to patients in the MI condition.

Who Is Running the Clinical Trial?

Tulane University

Lead Sponsor

Trials

129

Recruited

259,000+

James Zanewicz

Tulane University

Chief Medical Officer

MD from Tulane University

Elaine Hamm

Tulane University

Chief Executive Officer since 2022

PhD in Microbiology from the University of Oklahoma

Centers for Disease Control and Prevention

Collaborator

Trials

902

Recruited

25,020,000+

Dr. Debra Houry

Centers for Disease Control and Prevention

Chief Medical Officer

MD, MPH

Dr. Susan Monarez

Centers for Disease Control and Prevention

Chief Executive Officer

PhD

Findings from Research

Training in Motivational Interviewing (MI) significantly improved the skills of two health practitioners, allowing them to engage more effectively with patients in managing diabetes.

The enhanced practitioner skills led to positive changes in patient behavior during sessions, indicating that MI training can be beneficial in clinical settings for improving health-related behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motivational interviewing training: a pilot study of the effects on practitioner and patient behaviour. Britt, E., Blampied, NM.[2010]

A 2-day virtual training program in motivational interviewing (MI) for 30 clinicians from Veterans Affairs medical centers was effective, with participants reporting high satisfaction and confidence in applying new skills to their practice.

The virtual format of the training removed barriers such as travel and cost, making it particularly beneficial for clinicians in rural areas, and participants indicated they were actively using MI techniques three months after the training.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual Synchronous Motivational Interviewing Training for Geographically Dispersed Interprofessional Learners. Bryan, JL., Saxon, LC., Mesidor, MM., et al.[2023]

Motivational interviewing (MI) is an effective communication technique that helps patients engage in discussions about changing their health behaviors by addressing their ambivalence.

MI practitioners use specific skills and strategies to create a gap between a patient's current behaviors and their personal goals, facilitating a more productive conversation about health changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motivating Behavioral Change. Tooley, EM., Kolahi, A.[2022]

Staff in Swedish prisons who received ongoing training in motivational interviewing (MI) showed significantly greater competency in MI skills compared to those conducting usual prison planning interviews, indicating that continuous training is beneficial.

However, overall competency levels among staff were low, suggesting that even with training, more extensive and ongoing support is necessary to achieve proficiency in MI techniques for effectively helping substance-misusing prisoners.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Learning motivational interviewing in a real-life setting: a randomised controlled trial in the Swedish Prison Service. Forsberg, L., Ernst, D., Farbring, CÅ.[2022]

Motivational Interviewing (MI) has proven effective in helping patients with substance use and psychiatric disorders, particularly when their ambivalence hinders progress in therapy.

The success of MI relies heavily on the caregiver's communication skills, especially in fostering 'change talk' from patients, suggesting that training in MI techniques should be included in psychiatric education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Motivational interviewing in psychiatry]. Mechtcheriakov, S., Rettenbacher, M.[2021]

A survey of 36 motivational interviewing (MI) trainers identified key preferences for the format, duration, and content of beginner-level MI training aimed at addiction treatment, highlighting the need for effective training methods.

The survey also revealed common challenges faced by novice trainers in delivering MI training and provided recommended strategies to overcome these barriers, which is crucial for improving the implementation of evidence-based practices in community treatment settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guidance for New Motivational Interviewing Trainers When Training Addiction Professionals: Findings from a Survey of Experienced Trainers. Schumacher, JA., Coffey, SF., Walitzer, KS., et al.[2021]

Motivational interviewing is a recognized treatment for drug and alcohol issues, but training practitioners in this method is challenging, as shown in a pilot trial with adolescent drug treatment practitioners.

The study found that while immediate training and supervision did not significantly improve overall skill levels, ongoing supervision is crucial for developing high-level skills in motivational interviewing, indicating that more intensive support may be necessary for effective learning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized trial of training and supervision in motivational interviewing with adolescent drug treatment practitioners. Mitcheson, L., Bhavsar, K., McCambridge, J.[2009]

Motivational interviewing (MI) is a recognized and effective counseling approach, leading to increased demand for training among healthcare professionals.

This systematic review consolidates research on MI training, detailing the populations trained, methods used, and outcomes, while also identifying which stages of the MI learning process were addressed in various studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training in motivational interviewing: a systematic review. Madson, MB., Loignon, AC., Lane, C.[2022]

In a study involving 164 participants, motivational interviewing (MI) was shown to be effective in reducing heavy drinking days, particularly when clients exhibited increasing levels of change talk about alcohol.

Therapist skills in MI were linked to better sexual risk outcomes, specifically reducing the likelihood of condomless sex among clients with low levels of change talk about sexual risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of therapist MI skill and client change talk class membership predicting dual alcohol and sex risk outcomes. Janssen, T., Magill, M., Mastroleo, NR., et al.[2020]

Motivational interviewing (MI) has been shown to be effective in influencing health behaviors, with 'MI spirit' and motivation identified as key mechanisms that may drive positive outcomes, based on a review of 37 studies.

Despite the focus on self-efficacy in many studies, it was not found to be a mechanism of MI, indicating a need for more high-quality research to explore other potential mechanisms and improve understanding of how MI works.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: a systematic review. Copeland, L., McNamara, R., Kelson, M., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Motivational interviewing training: a pilot study of the effects on practitioner and patient behaviour. [2010]

2. United States pubmed.ncbi.nlm.nih.gov

Virtual Synchronous Motivational Interviewing Training for Geographically Dispersed Interprofessional Learners. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Motivating Behavioral Change. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Learning motivational interviewing in a real-life setting: a randomised controlled trial in the Swedish Prison Service. [2022]

5. Germany pubmed.ncbi.nlm.nih.gov

[Motivational interviewing in psychiatry]. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Guidance for New Motivational Interviewing Trainers When Training Addiction Professionals: Findings from a Survey of Experienced Trainers. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Randomized trial of training and supervision in motivational interviewing with adolescent drug treatment practitioners. [2009]

8. United States pubmed.ncbi.nlm.nih.gov

Training in motivational interviewing: a systematic review. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

The role of therapist MI skill and client change talk class membership predicting dual alcohol and sex risk outcomes. [2020]

10. Ireland pubmed.ncbi.nlm.nih.gov

Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: a systematic review. [2021]

11. United States pubmed.ncbi.nlm.nih.gov

Motivational Interviewing Skills in Health Care Encounters (MISHCE): Development and psychometric testing of an assessment tool. [2015]