Regular article Measures of fidelity in motivational enhancement: A systematic review Michael B. Madson, (Ph.D.) a, 4 , Todd C. Campbell, (Ph.D.) b a Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS, USA b The Center for Addiction and Behavioral Health Research, Marquette University, Milwaukee, WI, USA Received 25 October 2005; received in revised form 1 March 2006; accepted 22 March 2006 Abstract The movement to use empirically supported treatments has increased the need for researchers and clinical supervisors to evaluate therapists’ adherence to and competence in particular empirically supported interventions. Motivational interviewing (MI) is an empirically supported intervention for substance abuse and other behavioral problems. However, for this intervention to work, it must be provided with fidelity and skill. This article provides a systematic review of MI adherence and competence measures that have been developed and described independently elsewhere. Recommendations for refinement of the measures and future research are also discussed. D 2006 Elsevier Inc. All rights reserved. Keywords: Treatment fidelity; Motivational interviewing; Training and supervision; Substance abuse treatment 1. Introduction The demand for evidence-based practice in the substance use disorder field has required clinicians, researchers, and educators to focus on how knowledge is best transferred from research to professional practice (Campbell, Catlin, & Melchert, 2003; Campbell, Daood, Catlin, & Moskovitz, 2005; Institute of Medicine, 1998). As a result, the field is advancing in addressing the issue of adherence and com- petence regarding how interventions are being implemented. For example, Carroll et al. (2002) suggested that a major challenge faced in technology transfer involves ensuring therapists’ adherence to and competence in the implemen- tation of interventions through assessment. This form of assessment will be particularly important in examining the change process to help understand how interventions work, find ways to improve them, and learn how to overcome barriers to implementation and enhance future execution of the intervention as these are vital factors emerging in relation to evidence-based practice (Orwin, 2000). Evidence-based practice also calls for educators and clinical supervisors to provide more rigorous evaluations of clinicians that include adherence and competence assess- ment (Bernard & Goodyear, 1998). Furthermore, Falender and Shafranske (2004) suggested that assessment of com- petent practice would be enhanced by establishing assess- ment tools that are operationalized to yield data with good reliability and validity. Quality measurement tools would assist many supervisors in conducting empirically based evaluations, as opposed to relying solely on clinical expe- rience. These instruments are especially important when an intervention involves complex concepts. Motivational inter- viewing (MI), for example, which is a complex behavioral intervention often used with substance use disorders, would benefit from empirically based evaluation tools. Motivational interviewing is a directive client-centered approach for eliciting behavior change by assisting clients in exploring and resolving ambivalence (Miller & Rollnick, 0740-5472/06/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jsat.2006.03.010 4 Corresponding author. Department of Psychology, The University of Southern Mississippi, 118 College Drive No. 5025, Hattiesburg, MS 39406-5025, USA. E-mail address: michael.madson@usm.edu (M.B. Madson). Journal of Substance Abuse Treatment 31 (2006) 67 – 73