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Computer-Assisted Motivational Intervention (CAMI)

Topic Areas
Scientific Rating
Child Welfare Relevance
Teen Pregnancy Services
3  — Promising Research Evidence
Medium

About This Program

Target Population: Pregnant and/or parenting adolescents ages 18 and younger

For children/adolescents ages: 13 – 18

Program Overview

The purpose of the CAMI is to increase motivation among adolescent mothers to consistently use condoms and contraception with the long-term goal of reducing rapid repeat births. CAMI consists of 60-minute sessions conducted in two-parts by trained counselors who meet one-on-one with pregnant and/or parenting adolescent mothers, ages 12 through 18 years old. During the first part of each session, participants use the computer-based CAMI program to answer questions about current sexual relationships and contraceptive use intentions and behaviors. Based on the responses generated, CAMI counselors conduct a stage-matched Motivational Interviewing session to enhance participant's motivation to consistently use condoms and contraception in order to reduce the risk for a repeat pregnancy.

Program Goals

The goals of Computer-Assisted Motivational Intervention (CAMI) are:

  • Encourage consistent condom and hormonal contraceptive use
  • Assist adolescent mothers to understand their own motivations and goals
  • Help them see the inconsistencies between their goals and current behaviors in a non-judgmental manner. CAMI counselors use Motivational Interviewing techniques to help adolescent mothers make healthier choices to reduce their risk for repeat pregnancies and sexually transmitted infections

Logic Model

The program representative did not provide information about a Logic Model for Computer-Assisted Motivational Intervention (CAMI).

Essential Components

The essential components of Computer-Assisted Motivational Intervention (CAMI) include:

  • Each 60-minute CAMI session is divided into three parts:
    • Computer-Based CAMI Program (20-25 min): The participant answers questions about her current sexual relationships and contraceptive use intentions and behaviors. Based on these responses, the CAMI Program assesses the participant's risk of pregnancy and sexually transmitted infections (STIs), as well as her stage of readiness to change for contraceptive use.
    • Stage-Matched Motivational Interview (20-30 min): The counselor receives a summary printout containing all of the participant's responses in addition to results indicating the participant's pregnancy risk, STI risk, and stage of change for contraceptive use.

      • Based on this summary printout, the counselor conducts a stage-matched Motivational Interviewing session that aims to help increase the participant's motivation to consistently use condoms and contraception in order to prevent another pregnancy for at least two years after her previous birth.

    • Creating a Safe Plan (Optional) (5-10 min): The counselor offers the participant the opportunity to complete a Safe Plan that identifies specific steps that she will take to consistently use condoms and contraception in the near future. The participant will identify:
      • The reasons why her plan is important
      • Potential barriers to her plan
      • Possible solutions for overcoming these barriers
      • People who will help her with her plan
    • Both the participant and counselor will sign the plan and provide a copy to the participant for her to keep.

Program Delivery

Child/Adolescent Services

Computer-Assisted Motivational Intervention (CAMI) directly provides services to children/adolescents and addresses the following:

  • Pregnant or parenting – having given birth to a child when under the age of 18 years old

Recommended Intensity:

At least two 60-minute sessions conducted by trained counselors who meet one-on-one with pregnant and/or parenting adolescent mothers, ages 12 through 18 years old. It is recommended that the second session takes place at least 2-3 months after the initial session.

Recommended Duration:

A minimum of two months

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider

Homework

This program does not include a homework component.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • At least one CAMI counselor who possesses empathetic qualities, rapport with adolescents, and knowledge of the community
  • Facilities for conducting one-on-one CAMI sessions (e.g., community-based setting, clinic, or participant's home)
  • CAMI Software Program
  • Laptop or desktop computer
  • CAMI Counselor's Manual
  • Set of four worksheets
  • User's Guide

Manuals and Training

Prerequisite/Minimum Provider Qualifications

When recruiting CAMI counselors, it is highly recommended that agencies seek individuals who possess empathetic qualities, excellent communication skills, experience working with adolescents, and a familiarity with the community. There is no set minimum educational requirement.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

On-site

Number of days/hours:

The length of the standard training for CAMI is one day. A two-day training is also available for agencies that would like to receive standard training plus an additional day for training in Motivational Interviewing techniques.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Computer-Assisted Motivational Intervention (CAMI).

Formal Support for Implementation

There is formal support available for implementation of Computer-Assisted Motivational Intervention (CAMI) as listed below:

Train-the-trainer training is offered. Basic technical assistance is provided for agencies implementing CAMI, typically via email and telephone. More extensive technical assistance can be provided, upon request, for a fee, to be negotiated based on agency needs. Support is typically provided via email, telephone, and web-conferencing, though in-person consultation is available if necessary. The extent of support is based on agency needs, and can include assistance with fidelity monitoring, program adaptation, implementation, and evaluation.

Fidelity Measures

There are no fidelity measures for Computer-Assisted Motivational Intervention (CAMI).

Implementation Guides or Manuals

There are implementation guides or manuals for Computer-Assisted Motivational Intervention (CAMI) as listed below:

CAMI is available for purchase through Sociometrics at https://www.socio.com/products/pasha-computer-assisted-motivational-interviewing-cami-preventing-repeat-births-among-adolescent-mothers. Users can subscribe to CAMI online, giving them access to all the materials needed to implement and evaluate CAMI, 24/7. A hard-copy of CAMI is also available. In addition to the Counselor's Manual and all materials necessary for implementation, the CAMI program package includes the following:

  • User's Guide: This booklet provides a general overview of the program, its design/logic model, and information about the setting, training for counselors, and other parameters that may be helpful for agencies to know while planning an implementation, adapting CAMI, etc.
  • Motivational Interviewing Training Workshop (PowerPoint Slides): This packet contains a slide set of a motivational interviewing training workshop presentation by Dr. Beth Barnet, principal investigator of the CAMI evaluation study. In the original study of CAMI, counselors received 2.5 days of training prior to beginning the intervention, during which they focused heavily on motivational interviewing. These slides can be used to help train counselors prior to CAMI implementation.
  • CAMI Original Evaluation Instruments: This booklet contains copies of the original evaluation instruments used during the structured participant interviews conducted at baseline and at 2 years postpartum.

Implementation Cost

There have been studies of the costs of implementing Computer-Assisted Motivational Intervention (CAMI) which are listed below:

Barnet, B., Rapp, T., DeVoe, M., & Mullins, C. D. (2010). Cost-effectiveness of a motivational intervention to reduce rapid repeated childbearing in high-risk adolescent mothers: A rebirth of economic and policy considerations. Archives of Pediatrics & Adolescent Medicine, 164(4), 370–376. https://doi.org/10.1001/archpediatrics.2010.16

Research on How to Implement the Program

Research has not been conducted on how to implement Computer-Assisted Motivational Intervention (CAMI).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Barnet, B., Liu, J., DeVoe, M., Duggan, A. K., Gold, M. A., & Pecukonis, E. (2009). Motivational intervention to reduce rapid subsequent births to adolescent mothers: A community-based randomized trial. Annals of Family Medicine, 7(5), 436–445. https://doi.org/10.1370/afm.1014

Type of Study: Randomized controlled trial
Number of Participants: 235

Population:

  • Age — 12–18 years
  • Race/Ethnicity — 97% African American
  • Gender — 100% Female
  • Status — Participants were pregnant teenagers recruited from urban prenatal clinics serving low-income, predominantly African American communities.

Location/Institution: Baltimore, Maryland

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of the Computer-Assisted Motivational Intervention (CAMI) in preventing adolescent mothers from having rapid subsequent births. Participants were randomly assigned to 3 groups: (1) those in CAMI plus enhanced home visit received a multi-component home-based intervention (CAMI+); (2) those in CAMI-only received a single component home-based intervention; and (3) those in the usual-care control received standard usual-care. Measures utilized include the Decision-Making-Competency Inventory (DMCI) and the Center for Epidemiologic Studies Depression Scale (CES-D). Results indicate that the CAMI+ group compared with the usual-care control group exhibited a non-significant trend toward lower birth rates, whereas the CAMI-only group did not. Controlling for baseline group differences, the hazard ratio (HR) for repeat birth was significantly lower for the CAMI+ group than it was in the usual care group. Complier average causal effects models were used to produce unbiased estimates of intervention effects accounting for differences in participation across the groups. Analyses showed that completing 2 or more CAMI sessions significantly reduced the risk of repeat birth in both groups. Limitations include differences in subject participation across the intervention groups and concerns about the generalizability of the sample to other populations. Note: Significant effects were seen in the CAMI-only group for those teens who received 2 or more sessions of CAMI.

Length of controlled postintervention follow-up: None.

Barnet, B., Rapp, T., DeVoe, M., & Mullins, C. D. (2010). Cost-effectiveness of a motivational intervention to reduce rapid repeated childbearing in high-risk adolescent mothers: A rebirth of economic and policy considerations. Archives of Pediatrics & Adolescent Medicine, 164(4), 370–376. https://doi.org/10.1001/archpediatrics.2010.16

Type of Study: Randomized controlled trial
Number of Participants: 235

Population:

  • Age — 12–18 years
  • Race/Ethnicity — 97% African American
  • Gender — 100% Female
  • Status — Participants were pregnant teenagers aged 18 years and older.

Location/Institution: Baltimore, Maryland

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Barnet et al. (2009). The purpose of the study was to evaluate the effectiveness of the Computer-Assisted Motivational Intervention (CAMI) in preventing adolescent mothers from having rapid subsequent births. Participants were randomly assigned to 3 groups: (1) those in CAMI plus enhanced home visit received a multi-component home-based intervention (CAMI+); (2) those in CAMI-only received a single component home-based intervention; and (3) those in the usual-care control received standard usual care. Measures utilized include the Decision-Making-Competency Inventory (DMCI) and the Center for Epidemiologic Studies Depression Scale (CES-D). Results indicate that, compared to usual care, subjects in the combined group of CAMI+ and CAMI-only had significantly reduced repeated births. However, significant differences were not seen for the CAMI-only group. Limitations include lack of generalizability due to population and ethnicity, lack of post-intervention follow-up, and relatively small sample size.

Length of controlled postintervention follow-up: None.

Gold, M. A., Tzilos, G. K., Stein, L. A. R., Anderson, B. J., Stein, M. D., Ryan, C. M., Zuckoff, A., & DiClemente, C. (2016). A randomized controlled trial comparing Computer-Assisted Motivational Intervention to Didactic Educational Counseling to reduce unprotected sex in female adolescents. Journal of Pediatric and Adolescent Gynecology, 29(1), 26–32. https://doi.org/10.1016/j.jpag.2015.06.001

Type of Study: Randomized controlled trial
Number of Participants: 572

Population:

  • Age — 13–21 years (Mean=17 years)
  • Race/Ethnicity — 59% African American
  • Gender — 100% Female
  • Status — Participants were females at risk for pregnancy and sexually transmitted diseases (STDs).

Location/Institution: Pittsburgh, Pennsylvania

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of the Computer-Assisted Motivational Intervention (CAMI) at reducing the risk of unprotected sexual intercourse. Participants were randomized to either the CAMI or Didactic Educational Counseling (DEC) condition stratified by age, race, and sexual history. Measures utilized include 90-day Timeline Follow-back calendar and a computerized assessment to collect demographic information, sexual, contraceptive, pregnancy and STD history, and other variables. Results indicate that the CAMI was rated easy to use. Compared to the DEC, there was a significant effect of the intervention suggesting that the CAMI helped reduce unprotected sex among participants who completed the study. However, due to the high attrition rate, the intent-to-treat analysis did not demonstrate a significant effect of the CAMI on reducing unprotected sex. Limitations include high attrition rate, limited generalizability due to predominantly minority sample of female adolescents, reliability on self-reported measures, and length of follow-up.

Length of controlled postintervention follow-up: 3 months.

Additional References

No reference materials are currently available for Computer-Assisted Motivational Intervention (CAMI).

Contact Information

Josefina J. Card, PhD
Title: CEO/President
Agency/Affiliation: Sociometrics Corporation
Website: www.socio.com/products/pasha-computer-assisted-motivational-interviewing-cami-preventing-repeat-births-among-adolescent-mothers
Email:
Phone: (650) 949-3282
Fax: (650) 949-3299

Date Research Evidence Last Reviewed by CEBC: July 2023

Date Program Content Last Reviewed by Program Staff: April 2019

Date Program Originally Loaded onto CEBC: March 2014