Improving Teen Health Through Motivational Interviewing: A SSWN Research Brief

School social workers are busy people.

Finding good research takes time.

We want to help.

Starting this month, we will post  Research Briefs (RBs) regularly. These RBs were completed by school social workers like you, taking research they’ve found and applying it to their school contexts.  These RBs will describe research articles and what the particular study could contribute to your school social work practice, starting as soon as tomorrow. They will cover the kinds of things you see every day in your practice and (hopefully) be written in a way that you can use the information immediately. You can also find some initial RBs completed by SSWN co-editor (and SSW and doctoral student extraordinaire) Michele Patak-Piatrafesa  here, here, & here.

We hope you like these RBs, that you find them useful, and that you consider going to our sister site SSWNetwork (join here; it’s free and no spam e-mails, ever) and tell us what you’re doing with the RB information so we can better promote Research That Matters to school social workers here in the U.S. and all over the world.–Professor Michael Kelly PhD, MSW co-editor, SSWN

Cushing, C., Jensen, C., Miller, M., Leffingwell, T., & Nezu, Arthur M. (2014). Meta-analysis of motivational interviewing for adolescent health behavior: Efficacy beyond substance use. Journal of Consulting and Clinical Psychology, 82(6), 1212-1218.

An Effective Intervention

Cushing, Jensen, Miller, and Leffingwell (2014) provide a brief report detailing their analysis of motivational interviewing (MI) for adolescent health behavior. Their study is striking because it examined the efficacy of MI beyond substance use. For example, it considered diet and physical activity, both of which may play a significant role in helping students improve their physical well-being, build self-esteem and self-advocacy skills, and lead to overall greater well-being.

What Is This Study About?

Cushing et al. (2014) systematically reviewed and meta-analyzed literature comparing MI with a control condition for change in health behaviors in adolescents, drawing upon what they describe as “robust” evidence for the efficacy of MI in adults (p. 1212). However, because Jensen et al. (2011) conducted a meta-analysis that suggested MI has a significant and lasting effect for adolescent substance use behavior, Cushing et al. looked only at studies involving health behaviors other than substance abuse. In particular, they defined health behavior as “an action performed by an adolescent that is known to meaningfully increase or decrease health risk (e.g. medication adherence, diet, physical activity) and did not involve tobacco or other substance use (2014, p. 1213). The researchers looked at the aggregate effect size of the studies they included as well as the sustained effects demonstrated in those that provided follow-up data.  

How Did the Researchers Conduct the Study?

The researchers analyzed 15 studies that used a between-groups design comparing the efficacy of at least one MI intervention session to a control that included adolescents. The studies, which took place in school and community settings, included data from a total of 1,610 participants between the ages of 12 and 21, and represented males and females of varied ethnicities. Interventionists included mental health professionals with at least master’s-level training as well as paraprofessionals, nurses, physicians, and dietitians, though most of the studies did not indicate the level of MI training the clinicians underwent. Eight studies reported the maintenance of treatment gains through data based on assessments ranging from 4 weeks to 2 years post-treatment. As part of the meta-analysis, two independent observers extracted the data; they examined research reports together in the case of disagreement until they reached agreement (Cushing et al., 2014).

What Did This Meta-Analysis Show?

Through this meta-analysis, MI interventions in adolescents were shown to have “small but significant effect sizes across numerous health behavior outcomes” (Cushing et al., 2014, p. 1214). The findings that emerged from this meta-analysis are consistent with those of previous studies showing that MI interventions are effective in targeting adult health behaviors. The effect size for the subset of studies reporting post-treatment data also was small but significant. Furthermore, factoring in all of the studies, the average number of intervention sessions was 5.6.

Why Are the Findings Important?

The findings of this meta-analysis indicate that MI is effective in promoting sustainable health behavior change in adolescents facing challenges that include medication adherence, diet, and physical activity, for example. The intervention is useful in a variety of settings, including schools, and may be employed by a range of professionals and paraprofessionals. Moreover, this study shows that “…a small number of meetings can produce meaningful change” (Cushing et al, 2014, p. 1214), leaving the door open for successful brief treatment opportunities and attesting to the feasibility of the intervention in terms of time and cost. The findings encourage further research with regard to the types of health behaviors that may be addressed through MI as well as the extent to which clinicians must be trained in MI to yield the most significant positive results.

What Does This Mean for School Social Workers?

School social workers may consider using MI interventions with a variety of adolescent student populations facing a growing array of problematic health behaviors. The MI strategy may prove effective in as few as five or six sessions, and may show sustained effectiveness for several weeks, months, or even years following treatment. Therefore, high school students, for example, may benefit from MI in a relatively short amount of time, and may continue to do so through the remainder of the school year, throughout the summer, and well into the remainder of their high school careers. In addition, school social workers who pursue training specifically in MI may find increased success in their ability to employ the intervention with students.

Editor’s Note:  for some great additional training and information in motivational interviewing in schools, check out SSW research Dr. Andy Frey’s work in MI here, and also including his co-authored book:

Herman, K. C., Reinke, W. M., Frey, A., & Shepard, S. (2013). Motivational interviewing in schools: Strategies for engaging parents, teachers, and students. Springer Publishing Company.