Motivational Interviewing for Gun Violence Prevention

(SHIFT Trial)

Overseen By Julia M Fleckman, PHD, MPH

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Tulane University

Disqualifiers: Under 16, Over 24, Psychosis, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 5

Duration: 6 months

350 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The trial aims to explore the effectiveness of Motivational Interviewing (MI) combined with firearm safety training in reducing gun violence among young people aged 16 to 24. Participants treated for a gunshot, stab wound, or similar injury in a New Orleans hospital will alternate between receiving this intervention and standard care. The researchers aim to determine if those receiving MI develop safer attitudes and behaviors related to firearms and have a reduced risk of future violence compared to those who do not. Suitable participants are those living in Louisiana, recently injured by gun-related violence, and able to voluntarily agree to partake in the study. As an unphased trial, this study offers participants a unique opportunity to contribute to innovative research that could lead to safer communities.

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 prior data suggests that this motivational interviewing intervention is safe for youth?

Research has shown that Motivational Interviewing (MI), particularly when combined with firearm safety training, is generally well-received. Studies have found that these methods help individuals express their reasons for wanting to change and make plans to enhance safety. No strong evidence indicates any major negative effects from these methods.

MI supports personal choice and aids participants in making decisions about change within a caring environment. The firearm safety training component provides useful safety tips and planning skills.

Overall, this approach is considered safe, with no reports of serious negative outcomes. Participants often find the process helpful and engaging, indicating it is a safe option for those seeking to reduce the risk of gun violence. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative ways to prevent gun violence through motivational interviewing (MI) combined with firearm safety training. Unlike traditional treatments that may focus on medical and psychological care after violence occurs, this approach aims to prevent incidents by empowering individuals to make proactive changes in their behavior. MI is unique in that it centers on the participant, helping them to identify their own reasons for change and build personalized plans for safer firearm handling. This participant-driven approach, combined with expert guidance from a licensed clinical social worker, offers a potentially new avenue for reducing gun violence and its impacts on communities.

What evidence suggests that Motivational Interviewing and Firearm Safety Training could be effective for gun violence prevention?

This trial will compare the effectiveness of combining Motivational Interviewing (MI) with firearm safety training against standard care. Research has shown that this combination can help reduce repeated incidents of gun violence. One study found that MI increased individuals' willingness to change risky behaviors by focusing on their personal reasons and plans for change. This approach respects individuals' decision-making abilities and promotes safe practices. Additionally, structured firearm safety counseling, such as the 5 A's method, has been shown to improve safety habits. These findings suggest that this intervention can lead to safer behaviors and attitudes towards firearms. ^{3 4 5 6 7}

Who Is on the Research Team?

Julia M Fleckman, PhD, MPH

Principal Investigator

Tulane University

Are You a Good Fit for This Trial?

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 do not agree to participate in the trial voluntarily.

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

Interventions

• Motivational Interviewing and Firearm Safety Training

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.

How Is the Trial Designed?

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+

Centers for Disease Control and Prevention

Collaborator

Trials

902

Recruited

25,020,000+

Published Research Related to This Trial

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 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]

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]

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]

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 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]

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]

The study developed a reliable and valid assessment tool called the Motivational Interviewing Skills for Health Care Encounters (MISHCE) to evaluate healthcare providers' competence in motivational interviewing, which is crucial for effective patient interactions.

MISHCE demonstrated good internal consistency (Cronbach's alpha of 0.75) and strong reliability metrics, ensuring it can effectively measure both the skills of providers and the quality of the therapeutic alliance in brief healthcare encounters.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motivational Interviewing Skills in Health Care Encounters (MISHCE): Development and psychometric testing of an assessment tool. Petrova, T., Kavookjian, J., Madson, MB., et al.[2015]

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]

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]

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