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Coding
What is coding?
Coding involves evaluating statements in a conversation using a reliable, standardized manual. Coding of the counselor's statements in a conversation is done according to the Motivational Interviewing Treatment Integrity Manual (MITI 4.2.1) and provides answers to: 'To what extent is MI used during the conversation?'
what is coding?how does coding worktraining of codersquality assurance of operationsIMPORTANT TO CONSIDERTNT applicationConversations with actorsPrivacy
What is coding?
Coding involves evaluating the counselor's statements reliably using a standardized manual.
Coding involves evaluating statements in a conversation using a reliable, standardized manual. Coding of the counselor's statements in a conversation is done according to the Motivational Interviewing Treatment Integrity Manual (MITI 4.2.1) and provides answers to: 'To what extent is MI used during the conversation?'
Coding of the client's statements in a conversation is done according to Client Language EAsy Rating (CLEAR) and provides information on which client statements are neutral and do not contribute to the client's future change, as well as which statements constitute change talk (in favor of change) and which constitute sustain talk (against change).
How does coding work?
Coding is done using coding manuals. Counselor statements are coded using the 'Motivational Interviewing Treatment Integrity Coding Manual 4.2.1' (MITI). Client statements are coded using the CLEAR manual. The client's level of self-disclosure can also be coded on a 7-point scale.
SELF-DISCLOSURE
The client's level of self-disclosure in a conversation is assessed on a 7-point Likert scale. The client's coded level of self-disclosure has been found to be related to the client's future change in research.
Self-Disclosure/ Self-Exploration
CLEAR
With CLEAR ('Client Language EAsy Rating'), two variables are coded with seven subcategories each. The two types of client statements are client's talk in the conversation that speaks to the client's future change (Change talk) and statements that speak against the client's future change (Sustain talk).
Statements for and against change are defined in six subcategories and are coded as frequency counts. The coding is summarized as a percentage of change talk (the frequency of change talk / the frequency of change talk + the frequency of sustain talk).
MITI
With MITI, 14 variables are coded, which define the counselor's statements in the conversation and the overall performance of the conversation. The four overarching variables are summarized into two components: the Relationship variable - engagement (Empathy and Partnership) and the Technical variable - change talk (Elicit-Provide-Elicit and Soften sustain talk). Ten types of conversational statements are defined and frequency counted (Giving Information, Persuade, Persuade with permission, Open Question, Simple Reflection, Complex Reflection, Affirm, Seek Collaboration, Autonomy, and Confrontation).
The first version of the 'Motivational Interviewing Treatment Integrity Coding Manual' was published in 2003 (MITI 2.0). It was updated based on new research to versions MITI 3.0 and MITI 3.1. In 2015, MIC Lab published the latest update (MITI 4.2.1) in Swedish.
Manuals and protocols
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Training of coders
The coding at MIC Lab is done in the same way as in scientific trials of MI. Regardless of who codes at MIC Lab, the same assessment is made, and the assessment should not vary from one year to another. To work as a professional coder at MIC Lab, continuous training and reliability testing are required.
Training of coders
The coding at MIC Lab is done in the same way as in scientific trials of MI. Regardless of who codes at MIC Lab, the same assessment is made, and the assessment should not vary from one year to another. To work as a professional coder at MIC Lab, continuous training and reliability testing are required.
Training history
To become a professional MITI coder at MIC Lab, a basic training is required, which is examined with a reliability check. Continuous training is then required.
When MIC Lab was established in 2005 as a research group at Karolinska Institute, the first coders were trained at the University of New Mexico, USA by Dr Theresa Moyers, who, together with colleagues, developed MITI. In 2005, Dr Moyers and Dr Ernst trained the coders at MIC Lab. In 2006, Dr Denise Ernst and Dr Carolina Yahne provided training, and in 2007, MIC Lab coders were trained in both MITI and CLAMI (the precursor to CLEAR) by Dr Ernst. In 2015, Dr Ernst trained MIC Lab coders in MITI 4.2.1.
Training meetings
The coders at MIC Lab train together for 2 hours every week. During the meetings, the same conversations are coded independently of each other. Difficulties in coding are discussed. In the case of complex assessments that are not covered by the MITI manual, supplements are created as additions to the manual. During training meetings, the pedagogy of providing feedback on coding results to the person providing the conversation is developed and improved.
Inter-rater reliability
A measure of reliability for each of the coders is obtained each year by coding randomly selected conversations submitted to MIC Lab. The reliability between coders in each variable in MITI has been found to range from 'good' to 'excellent' according to the statistical guidelines indicated by Cicchetti (1994).
Quality Assurance of Operations
Different organizations, such as institutions, treatment centers, medical centers, and the local environmental office, can have their MI practice quality assured. Quality assurance is done at two different levels: 'Scientific assessment of MI competence' and 'Monitoring of MI competence'. Please contact MIC Lab for more information on quality assurance of operations. kontakt@miclab.se
Scientific Assessment of MI Competence
The 'Scientific Assessment of MI Competence' requires the same procedures as in scientific trials of MI. This type of quality assurance is used to demonstrate that the MI performed is evidence-based. The organization records all conversations in which MI is used over a certain period of time. Three randomly selected conversations per quarter and counselor are then coded by MIC Lab.
After the quality assurance is completed, a certificate is issued, and MIC Lab prepares a brief report in which the coding results are anonymized and summarized so that no individual counselor can be identified. The MI competence of the counseling group is presented and related to the recommended proficiency levels for basic competence and proficiency in MI according to MITI.
The quality assurance can be combined with providing counselors with feedback on their performance, either through the organization arranging supervision sessions where the coding protocols are used as a basis or by MIC Lab giving counselors feedback over the phone on one or more of their coded conversations. The counselor is given the opportunity to discuss the conversation and the coding directly with the coder.
Monitoring of MI Competence
With 'Monitoring of MI Competence', one conversation per counselor per quarter is used for coding. The counselor or organization chooses which conversation to submit to MIC Lab. After the quality assurance is completed, MIC Lab issues a certificate stating that the organization continuously obtains independent feedback on its MI practice.