Motivational Interviewing and the Family Check-Up: Predicting Emerging Adult Health Risk Behavior Outcomes

Abstract

Emerging adulthood is a unique developmental stage during which significant transitions in living environment, social networks, personal responsibilities, and identity development occur. Stress resulting from such transitions relates to increases in health risk behaviors. As such, emerging adults (EAs) have a high prevalence of substance use disorders and sexually transmitted infections. However, EAs are less likely to seek treatment. Therefore, brief methods of intervention, such as Motivational Interviewing (MI) and the Family Check-up (FCU), might be useful approaches for working with this unique population. MI and the FCU are linked with decreases in health risk behaviors. The FCU comprises three sessions: an initial interview, an ecological assessment, and a feedback session. MI techniques are used during the feedback session. Only a few studies have investigated treatment fidelity of the FCU and no studies have examined the use of MI techniques within the FCU. The current study aims to assess treatment fidelity of the FCU, specifically measuring the extent to which therapists adhere to principles of MI during FCU feedback sessions. The current study also aims to determine if a positive relationship exists between therapists’ MI-adherence and client change talk (CT), and to determine if MI-adherence and client CT predict post-intervention health risk behaviors among the 134 EAs who participated in the FCU. Measures of health risk behaviors were collected pre- and post-intervention. MI-adherence was measured with the Motivational Interviewing Treatment Integrity (MITI 4) and client change language was measured using the Client Language Easy Rating Scale (CLEAR) and the Motivational Interviewing Skills Code 2.1 (MISC 2.1) self-exploration code. Four therapists were assessed for treatment fidelity. Results indicate overall fair treatment fidelity. Significant differences between therapists were observed. MI-adherence was positively related to client CT, but not client self-exploration. Several indicators of MI-adherence predicted decreases in EA post-intervention health risk behaviors. Client CT predicted a decrease in EA post-intervention marijuana quantity and client self-exploration predicted increases in marijuana quantity and number of sexual partners. These results have important implications for FCU training and implementation, and indicate that MI-adherence might be a mechanism of change within the FCU intervention.