Preconception interventions to reduce the risk of alcohol-exposed pregnancies: A systematic review.

BACKGROUND: The preconception period provides a unique opportunity to optimize the health of women and children. High rates of alcohol use and unintended pregnancies are common across many Western societies, and alcohol-exposed pregnancies (AEPs) are a possible unintended outcome. The aim of the current study was to evaluate preconception interventions for the prevention of AEPs. METHODS: A systematic search of four electronic databases (PubMed, Embase, CINAHL, and PsycINFO) was undertaken for relevant peer-reviewed articles published from 1970 onward. Studies were included if they enrolled women and/or their support networks during the preconception period. RESULTS: Nineteen studies met the inclusion criteria. The majority of studies (n = 14) evaluated CHOICES-based interventions, which incorporate motivational interviewing approaches to change alcohol and/or contraceptive behavior. The other five interventions included a range of different approaches and modes of delivery. The majority of interventions were successful in reducing AEP risk. Changes in AEP risk were more often driven by changes in contraceptive behavior, although some approaches led to changes in both alcohol and contraceptive behavior. CONCLUSIONS: The review indicated that many interventions were efficacious at reducing AEP risk during the preconception period through preventing unplanned pregnancy. The effectiveness estimated from these clinical trials may be greater than that seen in interventions when implemented in practice where there is a lack of blinding and greater attrition of participants during follow-up. Further research investigating the real-world effectiveness of these intervention approaches implemented across a wide range of clinical settings would be beneficial.

Cost-Effectiveness of the Wellness Incentives and Navigation (WIN) Program.

OBJECTIVES: Promoting patient involvement in managing co-occurring physical and mental health conditions is increasingly recognized as critical to improving outcomes and controlling costs in this growing chronically ill population. The main objective of this study was to conduct an economic evaluation of the Wellness Incentives and Navigation (WIN) intervention as part of a longitudinal randomized pragmatic clinical trial for chronically ill Texas Medicaid enrollees with co-occurring physical and mental health conditions. METHODS: The WIN intervention used a personal navigator, motivational interviewing, and a flexible wellness expense account to increase patient activation, that is, the patient's knowledge, skills, and confidence in managing their self-care and co-occurring physical and mental health conditions. Regression models were fit to both participant-level quality-adjusted life years (QALYs) and total costs of care (including the intervention) controlling for demographics, health status, poverty, Medicaid managed care plan, intervention group, and baseline health utility and costs. Incremental costs and QALYs were calculated based on the difference in predicted costs and QALYs under intervention versus usual care and were used to calculate the incremental cost-effectiveness ratios (ICERs). Confidence intervals were calculated using Fieller's method, and sensitivity analyses were performed. RESULTS: The mean ICER for the intervention compared with usual care was $12 511 (95% CI $8971-$16 842), with a sizable majority of participants (70%) having ICERs below $40 000. The WIN intervention also produced higher QALY increases for participants who were sicker at baseline compared to those who were healthier at baseline. CONCLUSION: The WIN intervention shows considerable promise as a cost-effective intervention in this challenging chronically ill population.

Motivational Interviewing Adapted to Group Setting for the Treatment of Relapse in the Behavioral Therapy of Obesity. A Clinical Audit.

Motivational interviewing (MI) is devised to change unhealthy behaviors by increasing motivation. We adapted MI to a group format for the treatment of relapse during the behavioral treatment of obesity and performed a clinical audit to evaluate its effectiveness in stopping weight regain. The program was structured in seven weekly sessions, plus a 6-month follow-up. Patients (n = 86) completed a questionnaire on motivation to change in both healthy diet and physical activity, and a self-reported measurement of calorie intake and physical activity at baseline, at program end and at 6-month follow-up. The attendance to the program was high, with only 13 patients (15%) not completing the program and 24% not attending the 6-month follow-up. By the end of follow up, the prevalence of patients in either precontemplation or contemplation was reduced from over 60% at enrollment to approximately 20%, whereas the sum of patients in action or maintenance stages was increased from 9.5% in healthy diet and 14% in physical activity to 39.7% and 41.3%, respectively. These changes translated into significant behavioral changes (mean calorie intake, -13%; total physical activity, +125%; sedentary time, -8%) and finally into reduced body weight ( -3%). We conclude that MI programs adapted for groups may be used to stop relapse in individuals following a behavioral intervention for obesity.

Promoting Hispanic Immigrant Health via Community Health Workers and Motivational Interviewing.

Hispanic immigrant health disparities are among the highest in the nation, especially related to obesity and access to health services. Healthy Fit (En Forma Saludable) is a health promotion program that leverages public health department infrastructure to address these disparities through the use of three key innovations explored in this article: community health workers (CHWs), motivational interviewing (MI), and vouchers for free preventative health services. CHWs trained in MI conduct a health screening and then distribute preventive service vouchers and health resources as needed based on screening results. Vouchers cover breast, cervical, and colorectal cancer screening, and several vaccinations including flu and human papillomavirus. Resources to support exercise, to support a healthy diet, to quit smoking, and to reduce risky drinking are also distributed as needed. CHWs then use MI to address perceived barriers and strengthen intrinsic motivation to make use of the health resources. Integrating these strategies provides a low-cost approach to promote healthy behavior in an underserved immigrant population.

Testing the effectiveness of a weight loss intervention to enhance self-regulation in adults who are obese: protocol for a randomised controlled trial.

INTRODUCTION: Previous trials finding an effect of self-monitoring on weight loss have considered the effect to be mediated by self-regulatory processes. However, a qualitative think-aloud study asking people to record thoughts and feelings during weighing showed that self-regulation occurs only rarely without further instruction. The aim of this trial is to test a novel intervention guiding people through the self-regulatory processes to see whether it facilitates weight loss. METHODS AND ANALYSES: A parallel group, randomised controlled trial will be conducted to test the concept that a self-regulation intervention for weight loss increases weight loss compared with daily self-weighing without further support. One hundred participants with a body mass index ≥30 kg/m2 will be randomised to either the control or intervention group. The control group will be asked to weigh themselves daily for 8 weeks, the intervention group will be encouraged to follow the self-regulation intervention. They will be prompted to weigh daily, track their weight using an app, plan daily actions for weight loss and reflect on their action plans on a weekly basis. This self-regulation cycle will allow them to experiment with different weight loss strategies and identify effective and sustainable actions. Primary and process outcomes will be measured at baseline and 8 weeks' follow-up. Linear regression analysis of the primary outcome, weight change, will assess the early effectiveness of the intervention. The process outcomes liking, perceived effectiveness, as well as usage and barriers with regard to the self-regulation intervention, will be assessed through qualitative analysis of follow-up interviews and quantitative analysis of adherence rates and responses to a final questionnaire. ETHICS AND DISSEMINATION: This trial was reviewed and approved by the NHS National Research Ethics Committee and the Health Research Authority (reference number: 18/SC/0482). The findings of the trial will be published in peer reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: ISRCTN14148239, prerecruitment. PROTOCOL VERSION: Version 1.1, 7 December 2018.

Integrating Evidence-Supported Psychotherapy Principles in Mental Health Case Management: A Capacity-Building Pilot.

OBJECTIVES: Mental health case managers comprise a large workforce who help patients who struggle with complex mental illnesses and unmet needs with respect to the social determinants of health. This mixed-methods capacity-building pilot examined the feasibility, experiences, and outcomes of training community-based mental health case managers to integrate evidence-based psychotherapy principles into their case conceptualization and management practices. METHODS: Case-based, once-weekly, group consultations and training in applied therapeutic principles from mentalizing, interpersonal psychotherapy, motivational interviewing, and other evidence-based psychotherapies were provided to case managers over 8 months. A trauma-informed and culturally sensitive approach was emphasized to improve therapeutic alliances and to foster adaptive expertise and an appreciation of individual patient differences. RESULTS: Qualitative analyses of focus groups and individualized interviews identified a shift toward being more reflective rather than reactive, with improved empathy, patient engagement, morale, and confidence resulting from the training (N = 16). Self-reported pre-post counseling self-efficacy changes revealed significant improvements overall, driven by improved microskills and an ability to deal with challenging client behaviors (N = 10; P < 0.05). CONCLUSIONS: This pilot demonstrated that case-based consultations and training of mental health case managers within a community-of-practice in trauma-informed, culturally sensitive application of evidence-supported psychotherapy principles were feasible and acceptable with scalable potential to improve case managers' counseling self-efficacy, reflective capacity, empathy, and morale. Further research in this area is needed with a larger sample, and patient and health systems outcomes.

Population Approaches Targeting Metabolic Syndrome Focusing on Japanese Trials.

The clinical importance of assessment of metabolic syndrome lies in the selection of individuals with multiple risk factors based on visceral fat accumulation, and helping them to reduce visceral fat. Behavioral modification by population approach is important, which adds support to the personal approach. The complexity of visceral fat accumulation requires multicomponent and multilevel intervention. Preparation of food and physical environments could be useful strategies for city planners. Furthermore, actions on various frameworks, including organizational, community, and policy levels, have been recently reported. There are universal public health screening programs and post-screening health educational systems in Japan, and diseases management programs in Germany. Understanding one's own health status is important for motivation for lifestyle modification. The U.S. Preventive Services Task Force recommends that primary care practitioners screen all adults for obesity and offer behavioral interventions and intensive counseling. Established evidence-based guidelines for behavioral counseling are needed within the primary care setting.

The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.

BACKGROUND: Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. We present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research. METHODS/DESIGN: Participants are patients at a Federally Qualified Health Center in Portland, Oregon that serves patients experiencing homelessness or who have substance use disorders. Participants meet at least one of the following criteria: > 1 hospitalization over past 6 months; at least one medical co-morbidity including uncontrolled diabetes, heart failure, chronic obstructive pulmonary disease, liver disease, soft-tissue infection; and 1 mental health diagnosis or substance use disorder. We exclude patients if they have < 6 months to live, have cognitive impairment preventing consent, or are non-English speaking. Following consent and baseline assessment, we randomize participants to immediate SUMMIT intervention or wait-list control group. Participants receiving the SUMMIT intervention transfer care to a clinic-based team of physician, complex care nurse, care coordinator, social worker, and pharmacist with reduced panel size and flexible scheduling with emphasis on motivational interviewing, patient goal setting and advanced care planning. Wait-listed participants continue usual care plus engagement with community health worker intervention for 6 months prior to joining SUMMIT. The primary outcome is hospital utilization at 6 months; secondary outcomes include emergency department utilization, patient activation, and patient experience measures. We follow participants for 12 months after intervention initiation. DISCUSSION: The SUMMIT A-ICU is an intensive primary care intervention for high-utilizers impacted by homelessness. Use of a wait-list control design balances community and staff stakeholder needs, who felt all participants should have access to the intervention, while addressing research needs to include control populations. Design limitations include prolonged follow-up period that increases risk for attrition, and conflict between practice and research; including partner stakeholders and embedded researchers familiar with the population in study planning can mitigate these barriers. Trial registration ClinicalTrials.gov NCT03224858, Registered 7/21/17 retrospectively registered https://clinicaltrials.gov/ct2/show/NCT03224858.

The effectiveness of consultation for clinicians learning to deliver motivational interviewing with fidelity.

Despite the emerging literature documenting gains in clinician competence following consultation, little empirical work has examined consultation as an implementation strategy. To this end, the present study examined consultation in the context of implementing motivational interviewing in four community child and youth mental health organizations. We used qualitative methods with a dual goal: to describe the consultation process and to explore trainees' perspectives on consultation. Participants included 22 clinicians and 9 supervisors who received monthly, group, phone-based consultation for seven months following training in motivational interviewing. Analyses showed that consultation was perceived as effective because it helped to "keep motivational interviewing alive," fulfilled a profound learning function through collaboration and connection with others, and served as protected time for reflection on practice change. Our findings contribute to a body of knowledge about consultation elements that appear to be effective when implementing research-supported interventions in child and youth mental health.

Using Motivational Interviewing to Impact Readiness of RNs to Return to the Classroom.

Supporting nurses with associate degrees in nursing (ADNs) to return to school is challenging for nurse executives. Strategies include tuition reimbursement, scholarships, and flexible scheduling. Despite these measures, it is anticipated that we will fall short of a goal of 80% bachelor's degree-prepared nurses by 2020. The aim of this project was to increase ADN-prepared RN readiness to return to school through motivational interviewing.

Jail-to-community treatment continuum for adults with co-occurring substance use and mental disorders: study protocol for a pilot randomized controlled trial.

BACKGROUND: Adults with co-occurring mental and substance use disorders (CODs) are overrepresented in jails. In-custody barriers to treatment, including a lack of evidence-based treatment options and the often short periods of incarceration, and limited communication between jails and community-based treatment agencies that can hinder immediate enrollment into community care once released have contributed to a cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among this vulnerable and high-risk population. This paper describes a study that will develop research and communication protocols and adapt two evidence-based treatments, dual-diagnosis motivational interviewing (DDMI) and integrated group therapy (IGT), for delivery to adults with CODs across a jail-to-community treatment continuum. METHODS/DESIGN: Adaptations to DDMI and IGT were guided by the Risk-Need-Responsivity model and the National Institute of Corrections' implementation competencies; the development of the implementation framework and communication protocols were guided by the Evidence-Based Interagency Implementation Model for community corrections and the Inter-organizational Relationship model, respectively. Implementation and evaluation of the protocols and adapted interventions will occur via an open trial and a pilot randomized trial. The clinical intervention consists of two in-jail DDMI sessions and 12 in-community IGT sessions. Twelve adults with CODs and four clinicians will participate in the open trial to evaluate the acceptability and feasibility of, and fidelity to, the interventions and research and communication protocols. The pilot controlled trial will be conducted with 60 inmates who will be randomized to either DDMI-IGT or treatment as usual. A baseline assessment will be conducted in jail, and four community-based assessments will be conducted during a 6-month follow-up period. Implementation, clinical, public health, and treatment preference outcomes will be evaluated. DISCUSSION: Findings have the potential to improve both jail- and community-based treatment services for adults with CODs as well as inform methods for conducting rigorous pilot implementation and evaluation research in correctional settings and as inmates re-enter the community. Findings will contribute to a growing area of work focused on interrupting the cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among adults with CODs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02214667 . Registered on 10 August 2014.

[Improving Mental Health Care in People at Risk for Getting Homeless]. / Verbesserung der psychiatrischen Behandlungsprävalenz bei Risikopersonen vor dem Abrutschen in die Wohnungslosigkeit.

Objective: Overall aim was to reduce the untreated prevalence in persons with untreated mental disorders and at risk for loosing accommodation and descending into homelessness. Primary aim was treatment initiation and treatment adherence by motivational interviewing. Secondary aims were to reduce social or financial problems. Methods: Persons at risk were identified in social welfare services or labour agencies, diagnosed and motivated to initiate treatment in a community mental health service. Results: 58 persons were included, 24 were referred to regular mental health care, 8 were stabilized enough after the initial motivational to refrain from acute treatment, 26 dropped out. During a 6-month follow-up quality of life and social support was improved (partly statistically significant) and psycho-social needs for care decreased. Conclusion: Motivational interviewing is likely to increase insight into illness and acceptance of mental health care in untreated persons with mental disorders at risk for social decline.

Results From 10 Years of Interprofessional Training on Motivational Interviewing.

Motivational interviewing (MI) is a popular evidence-based method to support health behavior change. We examined evaluations from 10 years of interprofessional workshops on MI to identify trends in trainees' MI-related knowledge, attitude, and behavior. From 2006 to 2015, 394 trainees participated in continuing education MI workshops with our team and completed a validated posttraining questionnaire. Participants were 90% female and 66% White, with M = 12 years in practice. They worked in pediatric and adult care; urban and rural locations; and inpatient, outpatient, and nonhealth settings. The largest groups were nurses (20%), allied health professionals (20%), and health educators or case managers (15%). Trainees' professional diversity increased over time, their average age and years in practice decreased, and the percentage with prior MI training increased. Practitioners in telehealth and nonhealth settings had lower scores overall. Outcomes varied significantly by professional discipline: Mental health professionals, case managers, health educators, and nurses had higher scores on some outcome variables than nonhealth professionals. Years of clinical experience predicted MI-consistent attitude, but prior training, other demographic variables, and training process variations had no consistent effects. Although many trainees had already received MI training, outcome measures showed room for improvement. MI presents continued opportunities for interprofessional education.

Training peer specialists with mental illness in motivational interviewing: A pilot study.

OBJECTIVE: The objective of this study was to evaluate the effects of providing motivational interviewing (MI) training to peer specialists in the Veterans Affairs (VA) health-care system. METHODS: Fourteen peer specialists at a local VA medical center received a 2-day workshop on MI and 2 monthly booster sessions afterward. A total of 55 therapy sessions between peer specialists and their peer service recipients were audio-recorded and independently rated on MI fidelity before the workshop and each month after the workshop for 3 months. Sessions were rated on fidelity scales assessing Fundamental MI Adherence and Competence, Advanced MI Adherence and Competence, and MI Inconsistent Adherence scales. One item was created for this study that assessed Sharing Lived Experiences. Repeated measures analysis was conducted to examine change in MI fidelity over time. RESULTS: Peer specialists had a significant decline in MI Inconsistent Adherence scale scores over time. Specifically, they showed reductions in providing unsolicited advice and emphasizing absolute abstinence. Peer specialists also showed a significant decline in the Sharing Lived Experience Adherence item score. There were no significant changes on MI Fundamental and Advance scale scores. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Training peer specialists in MI is feasible and may lead to some change in practices, but comprehensive training and ongoing supervision is needed to incur and sustain changes. Guidance and assessment of how peer specialists share their lived experiences with fellow veterans may be needed to capitalize on their unique experiences and skill sets. (PsycINFO Database Record

Behavioral Health in Prevention and Chronic Illness Management: Motivational Interviewing.

This article reviews the history, methodology, and evidence related to the effective use of motivational interviewing (MI) in the primary care setting. MI has been shown to have a positive effect in promotion and modification of health habits and to increase treatment engagement. MI is also effective when used in conjunction with other treatment modalities, such as educational programs and cognitive behavioral therapy. Practical application of MI can be accomplished in a variety of primary care settings by a wide range of practitioners, incorporates nicely into new health care delivery models, and may improve the patient-provider relationship.

Rationale and design of the Investigation of Motivational Interviewing and Prevention Consults to Achieve Cardiovascular Targets (IMPACT) trial.

BACKGROUND: Patients undergoing cardiovascular procedures remain at increased risk for myocardial infarction, stroke, and cardiovascular death. Risk factor control in this patient population remains suboptimal and would likely benefit from strategies targeting education, lifestyle, and healthy behaviors. DESIGN: The IMPACT trial is a 400-subject prospective randomized trial designed to compare different cardiovascular prevention strategies in subjects following a cardiovascular intervention. The trial began enrollment in the Spring of 2012 and is randomizing subjects in a 1:1:1 manner to usual care, a one-time cardiovascular prevention consult, or a one-time cardiovascular prevention consult plus behavioral intervention program (telephone-based motivational interviewing and tailored text messages) over a 6-month period. The primary end point is non-high-density lipoprotein cholesterol. Secondary end points include other plasma lipid values, metabolic risk, smoking cessation, physical activity, dietary intake, medication use and adherence, and quality of life. CONCLUSIONS: The IMPACT trial provides data on different management strategies for risk factor optimization in subjects following cardiovascular procedures. The results will provide a platform for the continued development of novel multidisciplinary interventions in this high-risk population.

Evaluation of a primary care-based programme designed to increase exercise and improve nutrition in patients at risk.

INTRODUCTION: Evidence is limited regarding the effectiveness of brief interventions delivered through primary care to improve healthy living and increase physical activity. The Healthy As programme delivering brief interventions programmes in primary care to promote physical activity, improved nutrition and weight management was developed, implemented and assessed. This study aimed to identify aspects of the programme that worked well, those that presented problems or barriers, along with suggestions for improvement. METHODS: Three provider organisations in Auckland were contracted to deliver the Healthy As intervention in primary care settings. Semi-structured interviews were conducted with those delivering the risk assessments and providing the intervention from each provider organisation. A thematic analysis approach based on grounded theory was used to analyse the emerging key themes. FINDINGS: The emerging themes related to the holistic nature of the programme, its structure, resources used with participants, engagement of the providers with the participants, and whether the programme was effective in changing behaviour. CONCLUSION: Initial engagement of participants was found to be particularly important for the success of the Healthy As programme. For a patient-centred approach, good communication between the patient and health provider is required to facilitate shared decision-making and self-management prior to implementation of an intervention. Patients need to indicate whether they want help to make changes. Advice on healthy eating and exercise should not be given in isolation. Patients may also need help with mental health or other lifestyle issues before they can actively engage in exercise or weight reduction programmes.

Modification of motivational interviewing for use with people with mild intellectual disability and challenging behaviour.

BACKGROUND: Motivational interviewing is a promising method to increase treatment motivation for people with mild intellectual disability and challenging behaviour. The purpose of the present study was to identify how professionals could adapt motivational interviewing techniques for use with clients. METHOD: We conducted semistructured qualitative interviews and focus groups with 26 clients, parents, and professionals. A general inductive approach led to the identification of multiple core themes. RESULTS: The authors recommend several modifications to accommodate motivational interviewing for use with clients: adapt to language level, adjust to cognitive abilities, and control for social desirability of responding. In addition, certain characteristics of professionals were also found to be critical for effective motivational interviewing: trustworthiness, engagement, acceptance, empathy, and honesty. CONCLUSIONS: Concrete recommendations for the adaptation of the motivational interviewing techniques for use with people with mild intellectual disability and challenging behaviour are identified. Certain characteristics of professionals are also critical for maximising the treatment motivation of clients.

Feasibility and acceptability of a pediatric emergency department alcohol prevention intervention for young adolescents.

OBJECTIVE: The objective of this study was to determine feasibility and acceptability of a brief pediatric emergency department (PED) prevention intervention to delay/prevent initiation of alcohol use in 12-to 14-year-olds. METHODS: Medically stable 12- to 14-year-olds presenting to the PED who were accompanied by a parent and who had not initiated alcohol use were eligible. Adolescent-parent dyads completed a computerized assessment and were randomized to either brief targeted prevention intervention (BPI) or enhanced standard care (ESC). Families randomized to BPI participated in a PED-based motivational interviewing and skill building-based session with a trained counselor. Parents randomized to BPI had telephone boosters at 1 and 3 months. Families randomized to ESC received standard care and adolescent substance use pamphlets. All dyads completed 6-month follow-up assessments to assess alcohol use-related outcomes. RESULTS: Two hundred twenty-eight families were approached: 122 were eligible and 104 were enrolled (85%). Mean youth age was 13 (SD, 0.83) years, 51% were female, and 90% of parents were females. Of the 104 enrolled, 5 withdrew; 99 (94%) completed the assessment battery in the PED in less than 30 minutes. All BPI dyads completed the counseling session in the PED. However, only 53% of BPI parents completed the booster telephone sessions. Brief targeted prevention intervention acceptability items were rated favorably (82%-100%) by both parents and adolescents. There were no differences between BPI and ESC on substance-related outcomes, although the study was not adequately powered for this purpose because it was designed as a feasibility study. CONCLUSIONS: A BPI in the PED is both feasible and acceptable, but phone boosters proved less feasible. Larger samples and further study are needed to identify efficacy of the BPI in delaying onset of alcohol use in teens.

Feasibility and promise of a remote-delivered preconception motivational interviewing intervention to reduce risk for alcohol-exposed pregnancy.

BACKGROUND: Alcohol-exposed pregnancy (AEP) is a leading cause of birth defects. Effective face-to-face preconception interventions based on motivational interviewing (MI) exist and should be translated into remote formats for maximum public health impact. This study investigated the feasibility and promise of a one-session, remote-delivered, preconception, MI-based AEP intervention (EARLY Remote) for non-treatment-seeking community women. SUBJECTS AND METHODS: This was a single-arm, prospective pilot intervention study. All participants received the intervention via telephone and mail. Feasibility of remote-delivery methods, treatment engagement, treatment credibility, MI treatment integrity, and therapeutic alliance were examined. Outcomes were 3- and 6-month drinks per drinking day (DDD), rate of unreliable contraception, and proportion of women at risk for AEP due to continued risk drinking and no or unreliable contraception use. RESULTS: Feasibility of remote delivery was established; participants were engaged by the intervention and rated it as credible. Integrity to MI and therapeutic alliance were good. Both DDD and rate of unreliable contraception decreased significantly over time. Proportions of women who drank at risk levels, used unreliable or no contraception, and/or were at risk for AEP in the past 90 days decreased significantly from baseline to 6 months. CONCLUSIONS: Remote delivery was feasible, and the translated remote intervention may reduce AEP risk. Refinement of EARLY Remote may facilitate its placement within a spectrum of effective MI-based preconception AEP interventions as part of a stepped-care approach. EARLY Remote may have an important role within a stepped-care model for dissemination to geographically disperse women at risk for AEP. This could result in substantial public health impact through reduction of AEP on a larger scale.