VA exploring the use of motivational phone calls to vets
The Department of Veterans Affairs has discovered that a brief therapeutic phone conversation called motivational interviewing is more effective than a simple “check-in” call in convincing Iraq and Afghanistan Veterans with mental health diagnoses to begin getting treatment.
The powerful results produced by motivational interviewing were revealed during a study led by Dr. Karen Seal, director of the Integrated Care Clinic at the San Francisco VA Medical Center. She is also an associate professor of medicine and psychiatry at the University of California, San Francisco.
“Study participants receiving telephone motivational interviewing also were significantly more likely to stay in therapy,” Seal observed. “They also reported a reduction in their use of marijuana, and a decreased sense of stigma associated with seeking mental health treatment.”
The study was published recently in General Hospital Psychiatry.
“Fifty-two percent of the approximately half-million Iraq and Afghanistan Veterans currently being seen by VA have one or more mental health diagnoses,” Seal reported. “These diagnoses include posttraumatic stress disorder, depression, and anxiety.
“We’ve gone to great lengths to provide these Veterans with state-of-the-art mental health treatment,” she continued. “The irony is that they are not necessarily engaging in this treatment. Our study was designed to try to connect our Veterans with the treatments that are available to them. A simple telephone conversation, if done correctly, seems to go a long way in getting these Veterans into treatment.”
Motivational interviewing is when counselors encourage their clients to explore and talk about discrepancies between their core values and how they actually behave. It’s a psychotherapeutic intervention that’s been used successfully in other settings, according to Seal.
“Explaining to a counselor how you want to change your behavior can motivate you to actually make some behavioral changes, such as going in for treatment,” Seal explained. “The counselor then supports and encourages your intention to make those changes.”
The study used 73 Veterans of Iraq and Afghanistan who screened positive for one or more mental health issues, but were not currently in treatment. These 73 were randomly assigned either to Group A or Group B. Members of Group A received four motivational interviewing sessions. Group B, the control group, received four neutral check-in sessions over a period of eight weeks. All of this was done over the phone.
“We thought that using the telephone to conduct this intervention would be a really good idea because these Veterans are young, they’re busy, they’re in school, they have families,” Seal explained. “And they all carry cell phones.”
By the end of the study, 62 percent of the motivational interviewing group had begun treatment, while only 26 percent of the control group had begun treatment.
“The counselors who helped us conduct this study were not licensed clinicians, but people with masters’ degrees who were trained for about eight hours,” Seal noted. “This means that the expense for personnel will not be huge if motivational interviewing becomes a routine procedure.”
Seal emphasized that the study, while encouraging, was simply an initial pilot trial designed to assess the potential effectiveness of motivational interviewing that occurs over the phone.
“We need more research to test the technique with larger groups of Veterans,” she said. “We’re planning a follow-up study involving Veterans at VA outpatient clinics in rural communities. I think we might be on to something really good here.”