Do therapist behaviors differ with Hispanic youth? A brief look at within-session therapist behaviors and youth treatment response.

Abstract

Brief addiction treatments, including motivational interviewing (MI), have shown promise with youth. One under-examined factor in this equation is the role of therapist behaviors. We therefore sought to assess whether and how therapist behaviors differ for Hispanic versus non-Hispanic youth and how that may be related to treatment outcome. With 80 substance-using adolescents (M age = 16 years; 65% male; 59% Hispanic; 41% non-Hispanic) we examined the relationship between youth ethnicity and therapist behaviors across two brief treatments (MI and Alcohol/Marijuana Education; AME). We then explored relationships to youth three-month treatment response across four target outcomes: binge drinking days, alcohol-related problems, marijuana use days, and marijuana-related problems. In this study, therapists showed significantly more MI skills within the MI condition and more didactic skills in the AME condition. With respect to youth ethnicity, across both conditions (MI and AME), therapists used less MI skills with Hispanic youth. Contrary to expectations, therapists’ use of MI skills was not connected to poorer outcomes for Hispanic youth across the board (e.g., for binge drinking days, marijuana use days, or marijuana-related problems). Rather, for Hispanic youth, therapists’ use of lower MI skills was only related to poorer treatment outcomes in the context of alcohol-related problems. The observed relationships highlight the importance of investigating salient treatment interactions between therapist factors and youth ethnicity to guide improvements in youth treatment response.

Ambivalence: Prerequisite for success in motivational interviewing with adolescents?

“…Critically, the metric for this therapeutic active ingredient is reflective listening, which can, and has been measured . In line with recent neurocognitive work with adolescents , this therapeutic active ingredient may be critical in producing adolescents' MI treatment response .…”

“…There are fewer studies evaluating the relationship between MI technical skills and behavior change among adolescents. In one study, Feldstein Ewing, Gaume, and colleagues used process coding (via the Motivational Interviewing Treatment Integrity coding system; MITI) to compare therapists' technical skills with Hispanic versus non‐ Hispanic adolescents. The authors found that therapists employed significantly fewer MI skills with Hispanic youth (MI spirit; support of autonomy; complex reflections; evocation).…”

Working memory capacity and addiction treatment outcomes in adolescents

“…Group equivalence and retention were assessed using t -tests and Fisher's exact test. Our prior analysis in this sample indicated no significant outcome differences between treatment conditions at 3 months (29). We focused the study analyses on alcohol and cannabis-related problems scores (i.e., RAPI and MJP) measured at the three-month follow-up (3-mo); each analysis covaried for the baseline measure of the dependent variable.…”

“…This study was part of a larger clinical trial evaluating health disparities (28). Results for the parent trial, including study flow and overall 3-month treatment outcomes can be found elsewhere (29). In the present study, all analyses are focused on the sample for which a working memory index was available, from the Wechsler Intelligence Scale for Children (WISC: 30) for youth ≤16 years of age, or the Wechsler Adult Intelligence Scale (WAIS: 31)for youth >16 years.…”

Structure of Problem Recognition Questionnaire with Hispanic/Latino Adolescents

“…It is argued that MI is fitting for Hispanic/Latino individuals (and other racial/ethnic minorities) due to client-centered elements that facilitate the ability for therapists to understand diverse worldviews (Feldstein Ewing, Wray, Mead, & Adams, 2012; Miller et al, 2007). However, it was found that therapists deliver MI less competently with Hispanic/Latino adolescents than with non-Hispanic/Latino adolescents and that the poorer delivery was associated with less responsiveness to treatment (Feldstein Ewing, Gaume, Ernst, Rivera, & Houck, 2015). Another motivational intervention had stronger effects among Hispanic/Latino adolescents that identified more strongly with their Hispanic/Latino heritage (Gil, Wagner, & Tubman, 2004) and this would not be expected if the motivational strategies are incongruent with their culture.…”