Computer-Assisted Motivational Intervention (CAMI)

The Computer-Assisted Motivational Intervention (CAMI) was designed to delay repeat childbearing among adolescent girls by motivating them to change their contraceptive behaviors. During home visits, adolescents completed a computer-based survey assessing their sexual relationships, contraceptive intentions and plans, and current pregnancy prevention practices. An algorithm assessed the participant’s risk for repeat pregnancy, sexually transmitted infections, and readiness to use contraception and/or condoms. Following the survey, CAMI counselors conducted a 20- to 30-minute motivational interview in which they discussed how the teen’s goals and actions aligned, and encouraged the adolescent to change her behavior. Home visits lasted about one hour and were conducted once per quarter over a two-year period.

This report also includes a review of an enhancement to CAMI, called CAMI+. In addition to the standard program, CAMI+ provided participants with biweekly or monthly home-based parent training and case management services. The 16-module curriculum, designed specifically for African American adolescent mothers, covered topics such as child development and discipline. The home visits were initiated prenatally at about 32 weeks gestation.

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A variety of strategies have been explored to reduce repeat childbearing among adolescent girls, but the results have been modest. The Computer-Assisted Motivational Intervention (CAMI) was based on the premise that the limited success of previous programs might have been due to the lack of attention paid to teens’ level of motivation and ambivalence towards changing their contraceptive behaviors. CAMI was designed to delay repeat childbearing among adolescent girls by increasing the use of contraceptives.

CAMI provided quarterly home visits during which the participants completed a computer-based survey about their sexual relationships, contraceptive intentions and plans, and current pregnancy prevention practices such as condom use. An algorithm assessed the participant’s risk for repeat pregnancy and sexually transmitted infections and readiness to use contraception and/or condoms. A CAMI counselor used these algorithm results to conduct a 20 to 30 minute tailored, motivational interview with the participant. During the interview, the teen participant and her counselor discussed how the teen’s goals and actions aligned and the counselor encouraged the participant to change her behavior.

No information was available about the curriculum used.

CAMI enrolled pregnant and parenting African American adolescents between ages 12 and 18.

A variety of strategies have been explored to reduce repeat childbearing among adolescent girls, but the results have been modest. The Computer-Assisted Motivational Intervention (CAMI) was based on the premise that the limited success of previous programs might have been due to the lack of attention paid to teens’ level of motivation and ambivalence towards changing their contraceptive behaviors. CAMI was designed to delay repeat childbearing among adolescent girls by increasing the use of contraceptives.

CAMI was developed by faculty and staff of the University of Maryland Schools of Medicine and Social Work, the Johns Hopkins University School of Medicine, and the University of Pittsburgh School of Medicine.

Technical assistance is not available.

CAMI enrolled pregnant and parenting African American adolescents between ages 12 and 18.

CAMI aimed to reduce the percentage of adolescents who had another child within two years.

CAMI provided quarterly home visits during which the participants completed a computer-based survey about their sexual relationships, contraceptive intentions and plans, and current pregnancy prevention practices such as condom use. An algorithm assessed the participant’s risk for repeat pregnancy and sexually transmitted infections and readiness to use contraception and/or condoms. A CAMI counselor used these algorithm results to conduct a 20 to 30 minute tailored, motivational interview with the participant. During the interview, the teen participant and her counselor discussed how the teen’s goals and actions aligned and the counselor encouraged the participant to change her behavior.

No information was available about the curriculum used.

Every quarter, the adolescents completed the computer-based survey assessing their sexual relationships, contraceptive intentions and plans, and current pregnancy prevention practices and participated in a motivational interview with the CAMI counselor. Each CAMI session lasted about 1 hour and included the computer-based survey and the 20 to 30 minute motivational interview.

The intervention began within six weeks postpartum (range 1-6 weeks postpartum) and continued for two years.

The model developers enhanced the program by pairing CAMI with home-visiting services called CAMI+. In addition to the standard program, CAMI+ provided participants with biweekly or monthly home-based parent training and case management services to help the participants address issues related to housing or child care, for example. The 16-module curriculum, designed specifically for African American adolescent mothers, drew on social cognitive theory and covered topics such as child development and discipline. The home visits were initiated prenatally at about 32 weeks gestation. 

No specific requirements exist for eligible implementing agencies, although agencies best suited to implement the model have staff with knowledge and training in motivational interviewing and knowledge of adolescent health issues, contraceptive methods, and condom use.

No information was available about the fidelity guidelines that implementing programs or CAMI counselors were required to meet.

CAMI was administered by a program director and coordinator. The counselors, who conducted the motivational interviews, were paraprofessionals from the participants’ communities. A motivational interviewing consultant provided training and supervision to the CAMI counselors.

There were no education requirements for staff; however, the CAMI counselors had experience working with adolescents and were knowledgeable about the participants’ communities. In addition, the counselors were required to achieve a level of motivational interviewing proficiency as measured by videotaped standardized patient interviews.

A motivational interviewing consultant held biweekly group training and supervision meetings during the first four months of the project during which recorded CAMI sessions were reviewed. A program coordinator supervised the five counselors to ensure that activities were being conducted per protocol.

The CAMI counselors received 2.5 days of pre-service training. Each counselor was videoed delivering a session, and the interview was assessed using the Motivational Interviewing Process Code, a measure used to evaluate an interviewer’s proficiency with the technique.

Beth Barnet, MD
University of Maryland
Family Medicine
29 S. Paca St., Lower Level
Baltimore, MD 21201

Email: bbarnet@som.umaryland.edu