Leveraging Machine Learning to Assess Coaches’ Use of Motivational Interviewing Consistent Language: Implications for Training and Practice

Motivational Interviewing (MI) is a conversational technique that empowers change. MI has been increasingly applied in schools. Teacher coaching embedding MI is an implementation strategy for shifting teacher practices and student outcomes; importantly, many school consultation models incorporate communication skills emphasized by MI. Though MI principles and assumptions are simple to convey, skilled use takes time and is best supported by specific, ongoing feedback about one’s practice. The capacity for such training and supervising educators to engage in MI is limited. This paper explores the extent to which machine learning (ML) can accurately code MI data; such automated MI coding could ultimately be used for training and supervision. We utilized 74 archival Double Check coaching session transcriptions from a randomized efficacy trial; the transcriptions were previously coded manually using an adapted version of the MI-SCOPE. After segmenting each conversation into individual utterances, we conducted a text classification analysis using three ML methods to assess the performance of ML for such coding. Results demonstrate the potential of ML when utterances were pre-defined and for language codes that occurred frequently (i.e. “other” language); unfortunately, those of greatest interest in MI (i.e. MI-consistent and inconsistent language; teacher change and sustain talk) occurred with relatively low frequency and thus were coded with poor accuracy. These results replicate and extend the prior limited research using ML to code MI within a therapeutic context. We identify future directions and lessons learned in leveraging ML to process such data.

Exploring Fidelity Elements of a Motivational Interviewing-Based Implementation Strategy to Improve Adoption of Evidence-Based Practices in Schools

Highly prevalent mental health needs among youth necessitate the use of evidence-based practices (EBPs). However, EBPs are inconsistently implemented in their primary service delivery setting, schools. Educators’ and School-based clinicians’ motivation and beliefs often hinder their EBP adoption. Beliefs and Attitudes for Successful Intervention in Schools (BASIS) is a theory-informed, group-based, pre-implementation strategy that blends Motivational Interviewing (MI), Strategic Education, and Social Influence techniques shown to improve individual behavior change mechanisms and evidence-based practice (EBP) adoption. MI techniques (e.g. elicit change talk, build an action plan) are integrated throughout BASIS sessions ( n= 2; group 3–10), including facilitator-mediated technical aspects (e.g. elicit change talk with open-ended questions, reflect on participant experiences); and individually oriented and small group workbook activities (e.g. setting an intention, problem-solving, planning). As part of a large-scale cluster-randomized control trial simultaneously examining the effectiveness of BASIS and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), BASIS was delivered via the web by a community-based facilitator to 47 school-based mental healthcare (SBMH) practitioners serving 47 schools in six states. In this paper, we describe the BASIS fidelity elements of content adherence (Aim 1); comprehensiveness, facilitation supports, facilitator competence, and participant responsiveness (Aim 2); and explore the variability and associations between fidelity elements (Aim 3). Overall fidelity elements were high, and closer analysis revealed that adherence and responsiveness were associated. These exploratory findings point to a need for future research to describe and analyze fidelity elements of BASIS other group-based MI-embedded supports, particularly for complex or comprehensive web-based MI-delivery.

“Especially Being Homeless, They Just Think You’re Infected with COVID or Something”: A Qualitative Exploration of the COVID-19 Pandemic’s Impact on People Experiencing Homelessness With a History of Injection Drug Use in Baltimore, Maryland

People experiencing homelessness with a substance use disorder are a highly structurally vulnerable population, facing a unique burden of compounding stigma, discrimination, and adverse health outcomes. Evidence remains mixed on best practices for housing interventions designed to meet the needs of this population. Ten people with a history of injection drug use experiencing homelessness during the COVID-19 pandemic were interviewed between July 2021 and February 2022 in Baltimore, Maryland. Thematic analysis was used to characterize the pandemic’s impact on their resource access, housing, and substance use. Participants highlighted substantial challenges resulting from structural changes during the pandemic, including limits on income-generating opportunities and resource access, and increases in experiences of stigma and discrimination. However, several individuals reported decreased substance use in response to changes to their housing status, with those placed in secure housing attributing their decreased use to this change. These accounts can help guide housing and social support interventions best suited to meet the unique needs of people experiencing homelessness with substance use disorders.

Socio-Economic and Occupational Variations in Cardiovascular Risk Among Irish Male Livestock Farmers: Baseline Findings from the Farmers Have Hearts–Cardiovascular Health Program

Irish farmers are recognized as a high-risk group for premature cardiovascular disease (CVD) mortality compared to other occupation groups. To better characterize CVD risk within farming subpopulations, there is a need for real-world data examining socio-demographic, economic, and occupational determinants of cardiovascular risk. This study reports baseline data from health checks and face-to-face questionnaire capturing socio-demographic and farm characteristics from the Farmers Have Hearts – Cardiovascular Health Program. Farmers were recruited at livestock marts, where live cattle are sold and bought through bidding and predominantly visited by beef farmers, and agri-branches, local retail outlets linked to agribusinesses, commonly visited by dairy farmers. Descriptive statistics characterized the sample, and regression analysis was performed with and without recruitment venue to examine its influence on associations between socio-demographic and cardiovascular risk factors. Most farmers had a higher cardiovascular risk, with 74.0% having ≥4 CVD risk factors. Mart-recruited farmers had a significantly higher prevalence of multiple risk factors compared to agri-branch-recruited farmers (79.3% vs 68.8%). This disparity aligned with distinct socio-demographic profiles, as mart-recruited farmers were more likely to be older, single, have lower educational attainment, and operate smaller farms. Including recruitment venue in regression models changed associations between education and low HDL-C and between age and smoking, reflecting contextual influences beyond individual factors. This study demonstrates that cardiovascular risk is unequally distributed among Irish farmers, with mart-recruited farmers carrying a higher burden. Socio-demographic and occupational differences captured by recruitment venue influence cardiovascular risk, emphasizing the need for targeted health interventions, and agricultural health policy.

Thinking about repair

Colonialism, racialization and the making of modern Britain Book Review of Lucky Valley: Edward Long and the History of Racial Capitalism, by Catherine Hall, Reviewed by Gurminder K Bhambra

Mapping racial capitalism in 18th century Jamaica: debts and disavowals Book Review of Lucky Valley: Edward Long and the History of Racial Capitalism , by Catherine Hall, Reviewed by Sarah   Bufkin

Violent abstractions Book Review of Lucky Valley: Edward Long and the History of Racial Capitalism , by Catherine Hall, Reviewed by Andrew Smith

The Receipt of Substance Use Disorder Treatment Among Individuals Under Community Supervision at Risk for HIV

Objectives : Individuals under community supervision (e.g., probation and parole) have high rates of illicit substance use (ISU) and substance use disorders (SUDs), increasing their risk for numerous health issues, including HIV transmission. While SUD treatment can reduce substance use and HIV transmission risk, gaps remain in our understanding of its receipt among community-supervised individuals at risk for HIV. Methods : Using baseline data from the Southern Pre-Exposure Prophylaxis Study (SPECS), we examined the prevalence and demographic characteristics associated with SUD treatment receipt among community-supervised individuals at risk for HIV. Two participant subsets from SPECS were analyzed: those with a history of ISU ( n  = 346) and, among these participants, those specifically reporting a history of illicit opioid use (IOU; n  = 211). Results : A high prevalence of SUD treatment receipt was found among participants reporting ISU (58.7%) and IOU (73.9%). Among participants with a history of ISU, Black non-Hispanic individuals had a significantly lower prevalence of treatment receipt than White non-Hispanic individuals (aPR = 0.68, 95% CI: 0.51, 0.90, p  = 0.007). Among participants reporting IOU, White non-Hispanic individuals were 2.7 (95% CI: 1.2, 6.3) times more likely to receive medication for an SUD than individuals of any other race or ethnicity. Conclusions : Study findings highlight missed opportunities to engage people on community supervision who are at risk for HIV in evidence-based SUD care. Targeted efforts are needed to promote the adoption of medications for opioid use disorders (MOUDs) among individuals under community supervision, particularly for racially minoritized populations.

Use of Electronic Nicotine Delivery Systems for Weight Control Among Sexual and Gender Minority Individuals Who Smoke Cigarettes

Sexual and gender minority (SGM) individuals report higher dual use of cigarettes and electronic nicotine delivery system (ENDS) use than heterosexual individuals. Weight control intentions may contribute to these differences, as SGM individuals experience greater body dissatisfaction and engagement in disordered eating behaviors, which may increase the likelihood of using tobacco/nicotine products for weight control. This study examined correlates of ENDS and cigarette use for weight control among SGM individuals who report dual use. Between June-July 2023, 545 SGM adults who reported past 30-day cigarette use completed an online survey. We focused on individuals who also reported past 30-day ENDS use ( n   =  174). Bivariate correlations explored associations with ENDS and cigarette use for weight control indexed by the adapted version of the Smoking-Related Weight and Eating Episodes Test for ENDS (SWEET-EC) and original the SWEET for cigarettes. Variables with significant associations were entered into regression models to understand their relationship with using ENDS and cigarettes for weight control. Most participants identified as bisexual (∼48%), women (∼51%), and White (∼68%) with an average age of 35 years (SD = 9.5). Across regression models, gender identity discrimination, disordered eating behaviors and ENDS or cigarette dependence were all positively associated with ENDS and cigarette use for weight control (all ps  < 0.05). Tobacco prevention/intervention programs for SGM populations should consider the impacts of gender-based discrimination and disordered eating behaviors on the use of ENDS and cigarettes for weight control. Given effects observed for dependence additional supports for cessation also may be needed.