Trial Outcomes & Findings for The Impact of Burnout on Patient-Centered Care: A Comparative Effectiveness Trial in Mental Health (NCT NCT02146326)

NCT ID: NCT02146326

Last Updated: 2017-04-14

Results Overview

Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were asked to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.

• Recruitment status: COMPLETED
• Study phase: NA
• Target enrollment: 679 participants
• Primary outcome timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months
• Results posted on: 2017-04-14

Participant Flow

Staff and clients were recruited from 2 community mental health centers. Up to 5 clients for each participating staff with adult caseloads were recruited. Enrollment occurred over 3 waves of recruitment at 2 sites between 2/24/2014 and 3/18/2016. Totals of 206 staff and 473 clients completed informed consent to participate.

Mental Health Care Staff: 206 completed informed consent: 14 were not randomized (12 did not complete the baseline survey, 1 withdrew, 1 resigned), 192 staff were randomized Mental Health Clients: 473 clients completed informed consent: 4 were not linked to randomized staff (3 screen failures, 1 linked to staff not randomized),

Participant milestones

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE) intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the Motivational Interviewing (MI) intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Overall Study STARTED	89	103	211	258
Overall Study Baseline	89	103	211	258
Overall Study 3 Months	71	83	0	0
Overall Study 6 Months	71	71	186	235
Overall Study 12 Months	61	66	168	210
Overall Study COMPLETED	61	66	168	210
Overall Study NOT COMPLETED	28	37	43	48

Reasons for withdrawal

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE) intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the Motivational Interviewing (MI) intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Overall Study Lost to Follow-up	3	3	11	19
Overall Study Withdrawal by Subject	2	1	15	11
Overall Study Separated from mental health center	23	33	0	0
Overall Study Incarcerated	0	0	3	8
Overall Study Death	0	0	4	4
Overall Study Unable to complete interview	0	0	10	6

Baseline Characteristics

This only applies to the staff population.

Baseline characteristics by cohort

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Total n=661 Participants Total of all reporting groups
Actual number of work hours (Staff)	41.6 hours STANDARD_DEVIATION 6.4 • n=89 Participants • This only applies to the staff population.	41.6 hours STANDARD_DEVIATION 7.0 • n=102 Participants • This only applies to the staff population.	—	—	41.6 hours STANDARD_DEVIATION 6.7 • n=191 Participants • This only applies to the staff population.
Employment (Clients) Paid employment	—	—	26 Participants n=211 Participants • This measure only applies to the client population.	36 Participants n=258 Participants • This measure only applies to the client population.	62 Participants n=469 Participants • This measure only applies to the client population.
Employment (Clients) Other	—	—	185 Participants n=211 Participants • This measure only applies to the client population.	222 Participants n=258 Participants • This measure only applies to the client population.	407 Participants n=469 Participants • This measure only applies to the client population.
Age, Continuous	41.3 years STANDARD_DEVIATION 12.5 • n=89 Participants • Age of client population reported separately.	39.5 years STANDARD_DEVIATION 12.0 • n=103 Participants • Age of client population reported separately.	45.2 years STANDARD_DEVIATION 13.6 • n=211 Participants • Age of staff population reported separately.	45.2 years STANDARD_DEVIATION 12.7 • n=258 Participants • Age of staff population reported separately.	45.2 years STANDARD_DEVIATION 13.1 • n=469 Participants • Age of staff population reported separately.
Sex: Female, Male Female	64 Participants n=89 Participants	89 Participants n=103 Participants	104 Participants n=211 Participants	138 Participants n=258 Participants	395 Participants n=661 Participants
Sex: Female, Male Male	25 Participants n=89 Participants	14 Participants n=103 Participants	107 Participants n=211 Participants	120 Participants n=258 Participants	266 Participants n=661 Participants
Race/Ethnicity, Customized African American	13 Participants n=89 Participants	6 Participants n=103 Participants	84 Participants n=211 Participants	118 Participants n=258 Participants	221 Participants n=661 Participants
Race/Ethnicity, Customized White	71 Participants n=89 Participants	91 Participants n=103 Participants	115 Participants n=211 Participants	129 Participants n=258 Participants	406 Participants n=661 Participants
Race/Ethnicity, Customized Other	4 Participants n=89 Participants	6 Participants n=103 Participants	12 Participants n=211 Participants	9 Participants n=258 Participants	31 Participants n=661 Participants
Race/Ethnicity, Customized Missing/Unknown	1 Participants n=89 Participants	0 Participants n=103 Participants	0 Participants n=211 Participants	0 Participants n=258 Participants	1 Participants n=661 Participants
Education (Staff) Bachelors degree or above	69 Participants n=89 Participants • Education was analyzed in relation to bachelors degree for staff only. Education for clients was analyzed in relation to High School/GED completion and is reported separately.	88 Participants n=103 Participants • Education was analyzed in relation to bachelors degree for staff only. Education for clients was analyzed in relation to High School/GED completion and is reported separately.	—	—	157 Participants n=192 Participants • Education was analyzed in relation to bachelors degree for staff only. Education for clients was analyzed in relation to High School/GED completion and is reported separately.
Education (Staff) Less than bachelors degree	20 Participants n=89 Participants • Education was analyzed in relation to bachelors degree for staff only. Education for clients was analyzed in relation to High School/GED completion and is reported separately.	14 Participants n=103 Participants • Education was analyzed in relation to bachelors degree for staff only. Education for clients was analyzed in relation to High School/GED completion and is reported separately.	—	—	34 Participants n=192 Participants • Education was analyzed in relation to bachelors degree for staff only. Education for clients was analyzed in relation to High School/GED completion and is reported separately.
Education (Staff) Missing/Unknown	0 Participants n=89 Participants • Education was analyzed in relation to bachelors degree for staff only. Education for clients was analyzed in relation to High School/GED completion and is reported separately.	1 Participants n=103 Participants • Education was analyzed in relation to bachelors degree for staff only. Education for clients was analyzed in relation to High School/GED completion and is reported separately.	—	—	1 Participants n=192 Participants • Education was analyzed in relation to bachelors degree for staff only. Education for clients was analyzed in relation to High School/GED completion and is reported separately.
Education (Clients) Completed at least high school/GED	—	—	150 Participants n=211 Participants • Education was analyzed in relation to completion of high school/GED for the client population only. Education for staff was analyzed in relation to bachelors degree or above and is reported separately.	178 Participants n=258 Participants • Education was analyzed in relation to completion of high school/GED for the client population only. Education for staff was analyzed in relation to bachelors degree or above and is reported separately.	328 Participants n=469 Participants • Education was analyzed in relation to completion of high school/GED for the client population only. Education for staff was analyzed in relation to bachelors degree or above and is reported separately.
Education (Clients) Less than high school/GED	—	—	61 Participants n=211 Participants • Education was analyzed in relation to completion of high school/GED for the client population only. Education for staff was analyzed in relation to bachelors degree or above and is reported separately.	80 Participants n=258 Participants • Education was analyzed in relation to completion of high school/GED for the client population only. Education for staff was analyzed in relation to bachelors degree or above and is reported separately.	141 Participants n=469 Participants • Education was analyzed in relation to completion of high school/GED for the client population only. Education for staff was analyzed in relation to bachelors degree or above and is reported separately.
Years in position (Staff)	3.5 years STANDARD_DEVIATION 4.7 • n=89 Participants • This only applies to the staff population. One participant did not answer the question.	3.1 years STANDARD_DEVIATION 4.7 • n=102 Participants • This only applies to the staff population. One participant did not answer the question.	—	—	3.3 years STANDARD_DEVIATION 4.7 • n=191 Participants • This only applies to the staff population. One participant did not answer the question.
Years at agency (Staff)	4.8 years STANDARD_DEVIATION 5.7 • n=89 Participants • This only applies to the staff population. One participant did not answser the question.	5.3 years STANDARD_DEVIATION 6.7 • n=102 Participants • This only applies to the staff population. One participant did not answser the question.	—	—	5.0 years STANDARD_DEVIATION 6.3 • n=191 Participants • This only applies to the staff population. One participant did not answser the question.
Percentage of interactions with adult clients (Staff)	80 Participants n=89 Participants • This only applies to staff participants. One participant did not answer the question.	94 Participants n=102 Participants • This only applies to staff participants. One participant did not answer the question.	—	—	174 Participants n=191 Participants • This only applies to staff participants. One participant did not answer the question.
Years in field (Staff)	9.4 years STANDARD_DEVIATION 9.2 • n=89 Participants • This only applies to the staff population. Two participants did not answer the question.	8.4 years STANDARD_DEVIATION 8.8 • n=101 Participants • This only applies to the staff population. Two participants did not answer the question.	—	—	8.9 years STANDARD_DEVIATION 9.0 • n=190 Participants • This only applies to the staff population. Two participants did not answer the question.
Hours of burnout training in past year (Staff)	0.7 hours STANDARD_DEVIATION 3.4 • n=87 Participants • This only applies to the staff population. Four participants (two from each condition) did not answer this question.	0.8 hours STANDARD_DEVIATION 2.4 • n=101 Participants • This only applies to the staff population. Four participants (two from each condition) did not answer this question.	—	—	0.8 hours STANDARD_DEVIATION 2.9 • n=188 Participants • This only applies to the staff population. Four participants (two from each condition) did not answer this question.
Hours of motivational interviewing training in past year (Staff)	3.1 hours STANDARD_DEVIATION 8.2 • n=88 Participants • This only applies to the staff population. Three participants (1 assigned to BREATHE and 2 assigned to MI) did not answer the question.	1.9 hours STANDARD_DEVIATION 4.5 • n=101 Participants • This only applies to the staff population. Three participants (1 assigned to BREATHE and 2 assigned to MI) did not answer the question.	—	—	2.5 hours STANDARD_DEVIATION 6.5 • n=189 Participants • This only applies to the staff population. Three participants (1 assigned to BREATHE and 2 assigned to MI) did not answer the question.
Official number of work hours (Staff)	39.1 hours STANDARD_DEVIATION 4.6 • n=89 Participants • This only applies to the staff population. One participant did not answer the question.	38.5 hours STANDARD_DEVIATION 5.4 • n=102 Participants • This only applies to the staff population. One participant did not answer the question.	—	—	38.8 hours STANDARD_DEVIATION 5.0 • n=191 Participants • This only applies to the staff population. One participant did not answer the question.
Housing (Clients) Independent living	—	—	143 Participants n=211 Participants • This only applies to the client population.	161 Participants n=258 Participants • This only applies to the client population.	304 Participants n=469 Participants • This only applies to the client population.
Housing (Clients) Other	—	—	68 Participants n=211 Participants • This only applies to the client population.	97 Participants n=258 Participants • This only applies to the client population.	165 Participants n=469 Participants • This only applies to the client population.
Required to attend treatment (Clients) Yes, required to attend treatment	0 Participants This only applies to the client population.	0 Participants This only applies to the client population.	30 Participants n=211 Participants • This only applies to the client population.	50 Participants n=258 Participants • This only applies to the client population.	80 Participants n=469 Participants • This only applies to the client population.
Required to attend treatment (Clients) No, not required or unknown/refused	0 Participants This only applies to the client population.	0 Participants This only applies to the client population.	181 Participants n=211 Participants • This only applies to the client population.	208 Participants n=258 Participants • This only applies to the client population.	389 Participants n=469 Participants • This only applies to the client population.
Wants to attend treatment (Clients) Yes, want to attend treatment	0 Participants This only applies to the client population.	0 Participants This only applies to the client population.	197 Participants n=211 Participants • This only applies to the client population.	236 Participants n=258 Participants • This only applies to the client population.	433 Participants n=469 Participants • This only applies to the client population.
Wants to attend treatment (Clients) No, does not want or unknown/refused	0 Participants This only applies to the client population.	0 Participants This only applies to the client population.	14 Participants n=211 Participants • This only applies to the client population.	22 Participants n=258 Participants • This only applies to the client population.	36 Participants n=469 Participants • This only applies to the client population.
Primary Diagnosis Category (Clients) Anxiety Disorder	—	—	19 Participants n=211 Participants • This only applies to the client population.	12 Participants n=258 Participants • This only applies to the client population.	31 Participants n=469 Participants • This only applies to the client population.
Primary Diagnosis Category (Clients) Bipolar Disorder	—	—	35 Participants n=211 Participants • This only applies to the client population.	45 Participants n=258 Participants • This only applies to the client population.	80 Participants n=469 Participants • This only applies to the client population.
Primary Diagnosis Category (Clients) Major Depression	—	—	55 Participants n=211 Participants • This only applies to the client population.	53 Participants n=258 Participants • This only applies to the client population.	108 Participants n=469 Participants • This only applies to the client population.
Primary Diagnosis Category (Clients) Other	—	—	8 Participants n=211 Participants • This only applies to the client population.	12 Participants n=258 Participants • This only applies to the client population.	20 Participants n=469 Participants • This only applies to the client population.
Primary Diagnosis Category (Clients) Schizophrenia	—	—	86 Participants n=211 Participants • This only applies to the client population.	127 Participants n=258 Participants • This only applies to the client population.	213 Participants n=469 Participants • This only applies to the client population.
Primary Diagnosis Category (Clients) Missing/Unknown	—	—	8 Participants n=211 Participants • This only applies to the client population.	9 Participants n=258 Participants • This only applies to the client population.	17 Participants n=469 Participants • This only applies to the client population.
Substance Use (Clients) Substance Use Not Present	—	—	142 Participants n=211 Participants • This only applies to the client population.	169 Participants n=258 Participants • This only applies to the client population.	311 Participants n=469 Participants • This only applies to the client population.
Substance Use (Clients) Substance Use Present	—	—	60 Participants n=211 Participants • This only applies to the client population.	80 Participants n=258 Participants • This only applies to the client population.	140 Participants n=469 Participants • This only applies to the client population.
Substance Use (Clients) Missing/Unknown	—	—	9 Participants n=211 Participants • This only applies to the client population.	9 Participants n=258 Participants • This only applies to the client population.	18 Participants n=469 Participants • This only applies to the client population.

PRIMARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were asked to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day).

Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Maslach Burnout Inventory (MBI): Emotional Exhaustion Baseline	2.3 units on a scale Standard Deviation 1.3	2.7 units on a scale Standard Deviation 1.3	—	—
Maslach Burnout Inventory (MBI): Emotional Exhaustion 3 months	2.3 units on a scale Standard Deviation 1.2	2.7 units on a scale Standard Deviation 1.4	—	—
Maslach Burnout Inventory (MBI): Emotional Exhaustion 6 months	2.5 units on a scale Standard Deviation 1.4	2.6 units on a scale Standard Deviation 1.3	—	—
Maslach Burnout Inventory (MBI): Emotional Exhaustion 12 months	2.4 units on a scale Standard Deviation 1.2	2.5 units on a scale Standard Deviation 1.3	—	—

PRIMARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number due to participant drop out and/or missing data.

Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were ased to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day).

Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Maslach Burnout Inventory (MBI): Depersonalization Baseline	1.3 units on a scale Standard Deviation 0.9	1.5 units on a scale Standard Deviation 1.1	—	—
Maslach Burnout Inventory (MBI): Depersonalization 3 months	1.2 units on a scale Standard Deviation 0.8	1.4 units on a scale Standard Deviation 1.0	—	—
Maslach Burnout Inventory (MBI): Depersonalization 6 months	1.3 units on a scale Standard Deviation 0.9	1.5 units on a scale Standard Deviation 1.2	—	—
Maslach Burnout Inventory (MBI): Depersonalization 12 months	1.3 units on a scale Standard Deviation 1.1	1.3 units on a scale Standard Deviation 0.9	—	—

PRIMARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were ased to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day).

Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Maslach Burnout Inventory (MBI): Personal Accomplishment Baseline	4.9 units on a scale Standard Deviation 0.8	4.9 units on a scale Standard Deviation 0.7	—	—
Maslach Burnout Inventory (MBI): Personal Accomplishment 3 months	4.9 units on a scale Standard Deviation 0.7	4.9 units on a scale Standard Deviation 0.7	—	—
Maslach Burnout Inventory (MBI): Personal Accomplishment 6 months	4.9 units on a scale Standard Deviation 0.9	4.9 units on a scale Standard Deviation 0.7	—	—
Maslach Burnout Inventory (MBI): Personal Accomplishment 12 months	4.8 units on a scale Standard Deviation 0.8	4.8 units on a scale Standard Deviation 0.8	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Job satisfaction was assessed with one item from the Job Diagnostics Survey: Overall, I am satisfied with my job. Scale: 1 (Strongly Disagree) to 7 (Strongly Agree)

Hackman JR, Oldham GR. The Job Diagnostic Survey: An Instrument for the Diagnosis of Jobs and the Evaluation of Job Redesign Projects. 1974.

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Job Satisfaction Baseline	5.7 units on a scale Standard Deviation 1.4	5.2 units on a scale Standard Deviation 1.6	—	—
Job Satisfaction 3 months	5.4 units on a scale Standard Deviation 1.6	5.1 units on a scale Standard Deviation 1.5	—	—
Job Satisfaction 6 months	5.3 units on a scale Standard Deviation 1.7	4.9 units on a scale Standard Deviation 1.7	—	—
Job Satisfaction 12 months	5.6 units on a scale Standard Deviation 1.4	5.2 units on a scale Standard Deviation 1.5	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

This is the first of two questions in which staff were asked about turnover intentions. Staff were asked, "How often have you seriously considered leaving your job in the past six months?" Scale: 1 (Never), 2 (Once every few months), 3 (Once a month), 4 (several times a month), 5 (Once a week), 6 (Several times a week)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Turnover Intentions-Considered Leaving Baseline	2.0 units on a scale Standard Deviation 1.2	2.6 units on a scale Standard Deviation 1.7	—	—
Turnover Intentions-Considered Leaving 3 months	2.4 units on a scale Standard Deviation 1.4	2.6 units on a scale Standard Deviation 1.6	—	—
Turnover Intentions-Considered Leaving 6 months	2.5 units on a scale Standard Deviation 1.7	2.8 units on a scale Standard Deviation 1.8	—	—
Turnover Intentions-Considered Leaving 12 months	2.6 units on a scale Standard Deviation 1.5	2.7 units on a scale Standard Deviation 1.6	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

This is the second of two questions in which staff were asked about turnover intentions. Staff were asked, "How likely are you to leave your job in the next six months?" Scale: 1 (Not likely at all), 2 (Not very likely), 3 (Somewhat likely), 4 (Very likely)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Turnover Intentions-Likely to Leave 3 months	1.8 units on a scale Standard Deviation 1.0	2.0 units on a scale Standard Deviation 1.0	—	—
Turnover Intentions-Likely to Leave Baseline	1.6 units on a scale Standard Deviation 0.8	1.9 units on a scale Standard Deviation 1.0	—	—
Turnover Intentions-Likely to Leave 6 months	1.9 units on a scale Standard Deviation 1.0	2.2 units on a scale Standard Deviation 1.0	—	—
Turnover Intentions-Likely to Leave 12 months	1.8 units on a scale Standard Deviation 0.9	2.1 units on a scale Standard Deviation 1.1	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Work-Life Balance was assessed with a six-item measure adapted from an 18-item measure developed by Carlson et al. The measure assesses three types (time-, strain-, and behavior-based) and two directions (work conflict with family and family conflict with work) of balance. The outcome described here is work conflict with family. The measure consists of a series of statements regarding one's work and family situation, to which participants are asked to indicate their level of agreement or disagreement on a 5-point Likert-type scale: 1 (Strongly disagree) to 5 (Strongly agree). The item scores were averaged.

Carlson DS, Kacmar KM, Williams LJ. Construction and initial validation of a multidimensional measure of work-family conflict. Journal of Vocational Behavior. 2000;56(2):249-276.

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Work Interference With Home Life Baseline	2.7 units on a scale Standard Deviation 0.9	2.9 units on a scale Standard Deviation 1.0	—	—
Work Interference With Home Life 3 months	2.7 units on a scale Standard Deviation 0.9	2.9 units on a scale Standard Deviation 1.1	—	—
Work Interference With Home Life 6 months	2.7 units on a scale Standard Deviation 1.0	2.9 units on a scale Standard Deviation 1.0	—	—
Work Interference With Home Life 12 months	2.7 units on a scale Standard Deviation 0.8	2.9 units on a scale Standard Deviation 1.0	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Work-Life Balance was assessed with a six-item measure adapted from an 18-item measure developed by Carlson et al. The measure assesses three types (time-, strain-, and behavior-based) and two directions (work conflict with family and family conflict with work) of balance. The outcome described here is family conflict with work. The measure consists of a series of statements regarding one's work and family situation, to which participants are asked to indicate their level of agreement or disagreement on a 5-point Likert-type scale: 1 (Strongly disagree) to 5 (Strongly agree). The item scores were averaged.

Carlson DS, Kacmar KM, Williams LJ. Construction and initial validation of a multidimensional measure of work-family conflict. Journal of Vocational Behavior. 2000;56(2):249-276.

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Home Life Interference With Work Baseline	1.9 units on a scale Standard Deviation 0.7	1.9 units on a scale Standard Deviation 0.7	—	—
Home Life Interference With Work 3 months	1.8 units on a scale Standard Deviation 0.7	1.9 units on a scale Standard Deviation 0.7	—	—
Home Life Interference With Work 6 months	1.9 units on a scale Standard Deviation 0.8	1.8 units on a scale Standard Deviation 0.7	—	—
Home Life Interference With Work 12 months	1.9 units on a scale Standard Deviation 0.7	1.8 units on a scale Standard Deviation 0.7	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

The Emotional Labor Scale includes 14 questions regarding the relationship between emotions and interactions with clients. Surface Acting is a subset of these questions (e.g., I put on an act in order to deal with clients in an appropriate way). The item scores were averaged. Scale: 1 (strongly disagree) to 5 (strongly agree)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Emotional Labor Scale: Surface Acting Baseline	2.1 units on a scale Standard Deviation 0.8	2.2 units on a scale Standard Deviation 0.8	—	—
Emotional Labor Scale: Surface Acting 3 months	2.2 units on a scale Standard Deviation 0.8	2.3 units on a scale Standard Deviation 0.9	—	—
Emotional Labor Scale: Surface Acting 6 months	2.1 units on a scale Standard Deviation 0.9	2.2 units on a scale Standard Deviation 1.0	—	—
Emotional Labor Scale: Surface Acting 12 months	2.2 units on a scale Standard Deviation 0.9	2.1 units on a scale Standard Deviation 0.9	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

The Emotional Labor Scale includes 14 questions regarding the relationship between emotions and interactions with clients. Deep Acting is a subset of these questions (e.g., I try to actually experience the emotions that I must show to clients). The item scores were averaged. Scale: 1 (strongly disagree) to 5 (strongly agree)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Emotional Labor Scale: Deep Acting Baseline	3.4 units on a scale Standard Deviation 0.9	3.2 units on a scale Standard Deviation 0.9	—	—
Emotional Labor Scale: Deep Acting 3 months	3.4 units on a scale Standard Deviation 0.7	3.1 units on a scale Standard Deviation 1.0	—	—
Emotional Labor Scale: Deep Acting 6 months	3.1 units on a scale Standard Deviation 0.9	3.2 units on a scale Standard Deviation 1.0	—	—
Emotional Labor Scale: Deep Acting 12 months	3.2 units on a scale Standard Deviation 0.8	3.0 units on a scale Standard Deviation 1.0	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

The Emotional Labor Scale includes 14 questions regarding the relationship between emotions and interactions with clients. Genuine Emotions is a subset of these questions (e.g., The emotions that I express to clients are genuine). The item scores were averaged. Scale: 1 (strongly disagree) to 5 (strongly agree)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Emotional Labor Scale: Genuine Emotions Baseline	4.0 units on a scale Standard Deviation 0.8	4.0 units on a scale Standard Deviation 0.6	—	—
Emotional Labor Scale: Genuine Emotions 3 months	4.1 units on a scale Standard Deviation 0.8	4.0 units on a scale Standard Deviation 0.7	—	—
Emotional Labor Scale: Genuine Emotions 6 months	3.9 units on a scale Standard Deviation 0.7	4.0 units on a scale Standard Deviation 0.8	—	—
Emotional Labor Scale: Genuine Emotions 12 months	4.0 units on a scale Standard Deviation 0.7	4.1 units on a scale Standard Deviation 0.7	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Staff were asked, "How important is it for you to reduce your work-related stress right now?" This single item score was averaged. Scale: 1 (not at all important) to 10 (extremely important)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Importance: Reduce Work-Related Stress Baseline	6.5 units on a scale Standard Deviation 3.0	6.4 units on a scale Standard Deviation 2.8	—	—
Importance: Reduce Work-Related Stress 3 months	6.4 units on a scale Standard Deviation 2.9	7.3 units on a scale Standard Deviation 2.6	—	—
Importance: Reduce Work-Related Stress 6 months	6.5 units on a scale Standard Deviation 3.0	7.5 units on a scale Standard Deviation 2.6	—	—
Importance: Reduce Work-Related Stress 12 months	6.6 units on a scale Standard Deviation 2.8	6.6 units on a scale Standard Deviation 3.0	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Staff were asked, "How confident are you that you can reduce your work-related stress in your life?" Scale: 1 (not at all confident) to 10 (extremely confident)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Confidence: Reduce Work-Related Stress Baseline	7.0 units on a scale Standard Deviation 2.3	6.0 units on a scale Standard Deviation 2.6	—	—
Confidence: Reduce Work-Related Stress 3 months	6.5 units on a scale Standard Deviation 2.6	6.3 units on a scale Standard Deviation 2.5	—	—
Confidence: Reduce Work-Related Stress 6 months	6.6 units on a scale Standard Deviation 2.5	5.7 units on a scale Standard Deviation 2.5	—	—
Confidence: Reduce Work-Related Stress 12 months	6.5 units on a scale Standard Deviation 2.8	5.5 units on a scale Standard Deviation 2.6	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Staff were asked, "How important is it for you to consistently interact with consumers/clients in a relaxed, non-judgmental way?" Scale: 1 (not at all important) to 10 (extremely important)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Importance: Client Interaction Baseline	9.4 units on a scale Standard Deviation 1.0	9.5 units on a scale Standard Deviation 1.2	—	—
Importance: Client Interaction 3 months	9.5 units on a scale Standard Deviation 0.9	9.3 units on a scale Standard Deviation 1.3	—	—
Importance: Client Interaction 6 months	9.3 units on a scale Standard Deviation 1.2	9.2 units on a scale Standard Deviation 1.8	—	—
Importance: Client Interaction 12 months	9.3 units on a scale Standard Deviation 1.2	9.3 units on a scale Standard Deviation 1.7	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Staff were asked, "How confident are you that you can consistently interact with consumers/clients in a relaxed, non-judgmental way?" Scale: 1 (not at all confident) to 10 (extremely confident)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Confidence: Client Interaction Baseline	8.5 units on a scale Standard Deviation 1.5	8.3 units on a scale Standard Deviation 1.7	—	—
Confidence: Client Interaction 3 months	8.5 units on a scale Standard Deviation 1.5	8.1 units on a scale Standard Deviation 1.7	—	—
Confidence: Client Interaction 6 months	8.5 units on a scale Standard Deviation 1.4	8.1 units on a scale Standard Deviation 1.7	—	—
Confidence: Client Interaction 12 months	8.8 units on a scale Standard Deviation 1.4	8.2 units on a scale Standard Deviation 1.9	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Perceived Quality of Care was assessed with a 31 item scale developed with one of the mental health agencies as part of this project. Person Centered Care was measured with a subset of questions from this scale (e.g., I felt like I was able to really show compassion to a client.). The item scores were averaged. Scale: 0 (never) to 5 (always)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Quality of Care: Person Centered Care Baseline	3.7 units on a scale Standard Deviation 0.8	3.6 units on a scale Standard Deviation 0.6	—	—
Quality of Care: Person Centered Care 3 months	3.8 units on a scale Standard Deviation 0.6	3.7 units on a scale Standard Deviation 0.6	—	—
Quality of Care: Person Centered Care 6 months	3.8 units on a scale Standard Deviation 0.6	3.8 units on a scale Standard Deviation 0.6	—	—
Quality of Care: Person Centered Care 12 months	3.8 units on a scale Standard Deviation 0.6	3.8 units on a scale Standard Deviation 0.6	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Perceived Quality of Care was assessed with a 31 item scale developed with one of the mental health agencies as part of this project. Discordant Care was measured with a subset of questions from this scale (e.g., I had conflicts with clients.). The item scores were averaged. Scale: 0 (never) to 5 (always)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Quality of Care: Discordant Care Baseline	3.8 units on a scale Standard Deviation 0.5	3.8 units on a scale Standard Deviation 0.5	—	—
Quality of Care: Discordant Care 3 months	3.8 units on a scale Standard Deviation 0.5	3.8 units on a scale Standard Deviation 0.6	—	—
Quality of Care: Discordant Care 6 months	3.9 units on a scale Standard Deviation 0.5	3.8 units on a scale Standard Deviation 0.7	—	—
Quality of Care: Discordant Care 12 months	3.8 units on a scale Standard Deviation 0.6	3.9 units on a scale Standard Deviation 0.5	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Perceived Quality of Care was assessed with a 31 item scale developed with one of the mental health agencies participating in this project and then refined to 22 items through data collected and analyzed in this study. Items were related to person or client centered care, work conscientiousness, errors, interactions with clients, and how stress affects client interactions or outcomes. The item scores were averaged. Scale: 0 (never) to 5 (always)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Quality of Care-Total Baseline	3.8 units on a scale Standard Deviation 0.5	3.7 units on a scale Standard Deviation 0.5	—	—
Quality of Care-Total 3 months	3.8 units on a scale Standard Deviation 0.4	3.7 units on a scale Standard Deviation 0.5	—	—
Quality of Care-Total 6 months	3.8 units on a scale Standard Deviation 0.5	3.8 units on a scale Standard Deviation 0.5	—	—
Quality of Care-Total 12 months	3.8 units on a scale Standard Deviation 0.5	3.9 units on a scale Standard Deviation 0.4	—	—

SECONDARY outcome

Timeframe: Measured with staff at baseline, 3 months, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

The 19 item Perceptions of Supervisory Support Scale was used to gather information on staff's experience of interactions with their supervisors (e.g., How often did you think supervision improved your relationship with your supervisor?). The item scores were averaged. Scale: 1 (never) to 6 (always)

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Perceptions of Supervisory Support Baseline	4.1 units on a scale Standard Deviation 1.1	3.9 units on a scale Standard Deviation 1.0	—	—
Perceptions of Supervisory Support 3 months	4.0 units on a scale Standard Deviation 1.2	3.9 units on a scale Standard Deviation 1.0	—	—
Perceptions of Supervisory Support 6 months	3.9 units on a scale Standard Deviation 1.2	3.8 units on a scale Standard Deviation 1.0	—	—
Perceptions of Supervisory Support 12 months	4.0 units on a scale Standard Deviation 1.1	4.0 units on a scale Standard Deviation 1.2	—	—

SECONDARY outcome

Timeframe: Measured with staff at 12 months

Number of staff participants who separated from their respective agency before their anticipated study completion date. The mental health agencies provided separation dates, if applicable, for staff study participants.

Outcome measures

Measure	BREATHE-Mental Health Care Staff n=89 Participants Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff n=103 Participants Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Staff Turnover Separated from Agency	23 Participants	33 Participants	—	—
Staff Turnover Not Separated from Agency	66 Participants	70 Participants	—	—

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Hope was assessed with clients using the 12-item Adult State Hope Scale (e.g., I can think of many ways to get the things in life that are most important to me.). The item scores were averaged. Scale: 1 (Definitely False) to 8 (Definitely True)

Snyder CR, Sympson SC, Ybasco FC, Borders TF, Babyak MA, Higgins RL. Development and validation of the State Hope Scale. Journal of Personality and Social Psychology. 1996;70(2):321 - 335.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Adult State Hope Scale Baseline	—	—	5.78 units on a scale Standard Deviation 1.3	5.78 units on a scale Standard Deviation 1.2
Adult State Hope Scale 6 months	—	—	5.75 units on a scale Standard Deviation 1.3	5.85 units on a scale Standard Deviation 1.2
Adult State Hope Scale 12 months	—	—	5.77 units on a scale Standard Deviation 1.3	5.85 units on a scale Standard Deviation 1.1

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out, clients reporting they are not prescribed medications for their mental health, and/or missing data.

Medication adherence (for clients who are prescribed medications for their mental health) was rated with a subset of 4 items from the MARS, a 10-item scale assessing attitudes toward medication (e.g., Do you ever forget to take your medication? Are you careless at times about taking your medicine?). The item scores were summed and averaged (range: 0-4). Scale: 0 (No) to 1 (Yes)

Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research. May 5 2000;42(3):241-247.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item Baseline	—	—	1.9 units on a scale Standard Deviation 1.0	2.0 units on a scale Standard Deviation 1.0
Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item 6 months	—	—	1.8 units on a scale Standard Deviation 1.0	2.0 units on a scale Standard Deviation 1.1
Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item 12 months	—	—	1.6 units on a scale Standard Deviation 0.9	1.9 units on a scale Standard Deviation 1.1

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out, clients who reported they are not prescribed medications for their mental health, and/or missing data.

Medication attitudes (for clients who are prescribed medications for their mental health) was rated with the MARS, a 10-item scale assessing attitudes toward medication (e.g., It is unnatural for my mind and body to be controlled by medication.). The items scores were summed and averaged (range: 0-10). Scale: 0 (No) to 1 (Yes)

Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research. May 5 2000;42(3):241-247.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item Baseline	—	—	3.0 units on a scale Standard Deviation 1.7	3.3 units on a scale Standard Deviation 1.9
Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item 6 months	—	—	2.9 units on a scale Standard Deviation 1.9	3.2 units on a scale Standard Deviation 2.1
Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item 12 months	—	—	2.8 units on a scale Standard Deviation 1.7	3.1 units on a scale Standard Deviation 1.9

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data. Some clients did not recall the clinician being asked about and/or discontinued treatment with that clinician during their study participation.

Perceived autonomy support was assessed with this 15-item scale (e.g., I am able to be open with [name] at our meetings.). Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The item scores were averaged. Scale: 1 (Strongly Disagree) to 7 (Strongly Agree)

Williams GC, McGregor HA, King D, Nelson CC, Glasgow RE. Variation in perceived competence, glycemic control, and patient satisfaction: relationship to autonomy support from physicians. Patient Education & Counseling. Apr 2005;57(1):39-45.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Health-Care Climate Questionnaire Baseline	—	—	6.0 units on a scale Standard Deviation 1.2	5.9 units on a scale Standard Deviation 1.1
Health-Care Climate Questionnaire 6 months	—	—	5.8 units on a scale Standard Deviation 1.5	5.9 units on a scale Standard Deviation 1.2
Health-Care Climate Questionnaire 12 months	—	—	6.0 units on a scale Standard Deviation 1.2	5.9 units on a scale Standard Deviation 1.3

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data. Some clients did not recall the clinician being asked about and/or discontinued treatment with that clinician during their study participation.

Perceived relatedness was assessed with this short form of the patient version of the WAI and is 12 items (e.g., We agree on what is important for me to work on.). Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The item scores were averaged. Scale: 1 (Never) to 7 (Always)

Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Working Alliance Inventory (WAI) Baseline	—	—	5.6 units on a scale Standard Deviation 1.2	5.5 units on a scale Standard Deviation 1.2
Working Alliance Inventory (WAI) 6 months	—	—	5.4 units on a scale Standard Deviation 1.4	5.6 units on a scale Standard Deviation 1.2
Working Alliance Inventory (WAI) 12 months	—	—	5.7 units on a scale Standard Deviation 1.3	5.6 units on a scale Standard Deviation 1.3

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data. Some clients did not recall the clinician being asked about and/or discontinued treatment with that clinician during their study participation.

Perceived relatedness was assessed with this short form of the patient version of the WAI and has 12 items in total. This outcome is for the tasks subscale. Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The item scores were summed and averaged (range: 4-28). Scale: 1 (Never) to 7 (Always)

Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Working Alliance Inventory (WAI) - Tasks Subscale Baseline	—	—	22.0 units on a scale Standard Deviation 5.4	21.5 units on a scale Standard Deviation 5.3
Working Alliance Inventory (WAI) - Tasks Subscale 6 months	—	—	21.3 units on a scale Standard Deviation 6.4	22.2 units on a scale Standard Deviation 5.3
Working Alliance Inventory (WAI) - Tasks Subscale 12 months	—	—	22.6 units on a scale Standard Deviation 5.6	22.4 units on a scale Standard Deviation 5.1

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data. Some clients did not recall the clinician being asked about and/or discontinued treatment with that clinician during their study participation.

Perceived relatedness was assessed with this short form of the patient version of the WAI and has 12 items in total. This outcome is for the goals subscale. Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The items scores were summed and averaged (range: 4-28). Scale: 1 (Never) to 7 (Always)

Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Working Alliance Inventory (WAI) - Goals Subscale Baseline	—	—	21.8 units on a scale Standard Deviation 5.1	21.4 units on a scale Standard Deviation 4.8
Working Alliance Inventory (WAI) - Goals Subscale 6 months	—	—	21.0 units on a scale Standard Deviation 5.4	21.8 units on a scale Standard Deviation 4.9
Working Alliance Inventory (WAI) - Goals Subscale 12 months	—	—	22.4 units on a scale Standard Deviation 5.0	21.7 units on a scale Standard Deviation 5.3

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data. Some clients did not recall the clinician being asked about and/or discontinued treatment with that clinician during their study participation.

Perceived relatedness was assessed with this short form of the patient version of the WAI and has 12 items in total. This outcome is for the bonds subscale. Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The items scores were summed and averaged (range: 4-28). Scale: 1 (Never) to 7 (Always)

Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Working Alliance Inventory (WAI) - Bonds Subscale Baseline	—	—	23.2 units on a scale Standard Deviation 5.1	23.0 units on a scale Standard Deviation 5.1
Working Alliance Inventory (WAI) - Bonds Subscale 6 months	—	—	22.6 units on a scale Standard Deviation 6.5	23.0 units on a scale Standard Deviation 5.4
Working Alliance Inventory (WAI) - Bonds Subscale 12 months	—	—	23.3 units on a scale Standard Deviation 5.5	22.8 units on a scale Standard Deviation 6.1

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Competence related to mental health management was assessed with the 13-item Patient Activation Measure-Mental Health (PAM-MH) (e.g., I know what each of my prescribed mental health medications does.). Each question was answered on a 4-point Likert-type scale: 1 (Strongly Disagree) to 4 (Strongly Agree). Higher scores=greater activation.

Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Services Research. Dec 2005;40(6 Pt 1):1918-1930.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale Baseline	—	—	62.5 units on a scale Standard Deviation 15.6	61.3 units on a scale Standard Deviation 14.8
Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale 6 months	—	—	63.6 units on a scale Standard Deviation 16.8	62.1 units on a scale Standard Deviation 17.3
Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale 12 months	—	—	64.8 units on a scale Standard Deviation 15.4	65.2 units on a scale Standard Deviation 16.9

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Physical and mental health functioning was assessed with the Short Form 12-Item Health Survey (SF-12). The SF-12 is a health-related quality of life measure, derived from the 36-item Medical Outcomes Study survey and containing items yielding a Mental Health Component Score and a Physical Health Component Score. Higher composite scores indicate higher health-related quality of life. Items are weighted and then transformed into norm-based scores (range: 0-100).

Ware JE, Jr. , Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care. 1996;34(3):220 -233.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Short-Form Health Survey (SF-12)-Physical Health Functioning Baseline	—	—	41.4 units on a scale Standard Deviation 8.7	41.9 units on a scale Standard Deviation 7.9
Short-Form Health Survey (SF-12)-Physical Health Functioning 6 months	—	—	42.3 units on a scale Standard Deviation 8.3	41.8 units on a scale Standard Deviation 7.8
Short-Form Health Survey (SF-12)-Physical Health Functioning 12 months	—	—	42.0 units on a scale Standard Deviation 7.9	41.7 units on a scale Standard Deviation 7.8

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Physical and mental health functioning was assessed with the Short Form 12-Item Health Survey (SF-12). The SF-12 is a health-related quality of life measure, derived from the 36-item Medical Outcomes Study survey and containing items yielding a Mental Health Component Score and a Physical Health Component Score. Higher composite scores indicate higher health-related quality of life. Items are weighted and then transformed into norm-based scores (range: 0-100).

Ware JE, Jr. , Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care. 1996;34(3):220 -233.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Short-Form Health Survey (SF-12)-Mental Health Functioning Baseline	—	—	42.6 units on a scale Standard Deviation 7.8	42.0 units on a scale Standard Deviation 8.1
Short-Form Health Survey (SF-12)-Mental Health Functioning 6 months	—	—	42.7 units on a scale Standard Deviation 7.7	43.0 units on a scale Standard Deviation 8.0
Short-Form Health Survey (SF-12)-Mental Health Functioning 12 months	—	—	43.2 units on a scale Standard Deviation 7.2	43.4 units on a scale Standard Deviation 8.0

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

The PHQ-9 is a brief, self-report assessment. It provides a summed total score that indicates likelihood of major depressive disorder. Scores ≥10 are considered a positive screen (sensitivity 88%, specificity 88%) and also effectively measures response to treatment (<5 indicate remission, of 5-9 indicate partial response, and ≥10 indicates no response). Item scores are summed and averaged (range: 0-27). Scale: 0 (Not at all), 1 (Several days), 2 (More than half the days), 4 (Nearly every day). When problems are identified, the difficulty of those problems are rated on 4 point scale (Not difficult at all to Extremely difficult).

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. Sep 2001;16(9):606-613.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders - Text Revision (4th ed.). Washington, DC: American Psychiatric Association; 2000.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Patient Health Questionnaire 9-item (PHQ-9) Baseline	—	—	9.6 units on a scale Standard Deviation 5.9	10.0 units on a scale Standard Deviation 6.0
Patient Health Questionnaire 9-item (PHQ-9) 6 months	—	—	8.8 units on a scale Standard Deviation 6.1	9.8 units on a scale Standard Deviation 6.3
Patient Health Questionnaire 9-item (PHQ-9) 12 months	—	—	9.1 units on a scale Standard Deviation 6.0	9.4 units on a scale Standard Deviation 5.8

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Anxiety was assessed with the 7-item Generalized Anxiety Disorder (GAD-7). It can be scored continuously on a 0-21 severity scale and cutpoints have been established for estimating the probability of the 4 most common and clinically relevant anxiety disorders - generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and social anxiety disorder. Scale: 0 (not at all), 1 (several days), 2 (more than half the days), 3 (nearly every day)

Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. May 22 2006;166(10):1092-1097.

Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. Mar 6 2007;146(5):317-325.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Generalized Anxiety Disorder (GAD-7) Baseline	—	—	9.4 units on a scale Standard Deviation 5.7	9.7 units on a scale Standard Deviation 5.9
Generalized Anxiety Disorder (GAD-7) 6 months	—	—	8.5 units on a scale Standard Deviation 5.7	8.4 units on a scale Standard Deviation 5.6
Generalized Anxiety Disorder (GAD-7) 12 months	—	—	8.5 units on a scale Standard Deviation 5.8	8.8 units on a scale Standard Deviation 5.5

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Engagement was assessed with patient satisfaction using the Client Satisfaction Questionnaire, an 8-item satisfaction checklist (e.g., How would you rate the quality of service you have received? and, If a friend were in need of similar help, would you recommend [name of agency] to him or her?). The item scores were averaged. Scale: 1 to 4 with response text dependent upon the question (e.g., 1-Poor to 4-Excellent, 1-No, definitely not to 4-Yes, definitely, or 1-Quite dissatisfied to 4-Very satisfied).

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Client Satisfaction Questionnaire Baseline	—	—	3.4 units on a scale Standard Deviation 0.6	3.5 units on a scale Standard Deviation 0.5
Client Satisfaction Questionnaire 6 months	—	—	3.4 units on a scale Standard Deviation 0.6	3.5 units on a scale Standard Deviation 0.5
Client Satisfaction Questionnaire 12 months	—	—	3.5 units on a scale Standard Deviation 0.5	3.5 units on a scale Standard Deviation 0.5

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.). This scale for clients was adapted from the one developed for staff. Person Centered Care was measured with a subset of questions from this scale. The item scores were averaged. Scale: 0 (never) to 5 (always)

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Quality of Care-Person Centered Care Baseline	—	—	3.8 units on a scale Standard Deviation 1.1	3.8 units on a scale Standard Deviation 1.0
Quality of Care-Person Centered Care 6 months	—	—	3.7 units on a scale Standard Deviation 1.1	3.8 units on a scale Standard Deviation 1.1
Quality of Care-Person Centered Care 12 months	—	—	3.6 units on a scale Standard Deviation 1.1	3.9 units on a scale Standard Deviation 1.1

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.). This scale for clients was adapted from the one developed for staff. Negative Interactions were measured with a subset of questions from this scale. Item scores were averaged. Scale: 0 (never) to 5 (always)

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Quality of Care-Negative Interactions Baseline	—	—	4.3 units on a scale Standard Deviation 0.9	4.3 units on a scale Standard Deviation 0.8
Quality of Care-Negative Interactions 6 months	—	—	4.8 units on a scale Standard Deviation 0.8	4.3 units on a scale Standard Deviation 0.9
Quality of Care-Negative Interactions 12 months	—	—	4.3 units on a scale Standard Deviation 0.8	4.4 units on a scale Standard Deviation 0.9

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.). This scale for clients was adapted from the one developed for staff. Inattentive care was measured with a subset of questions from this scale. Item scores were averaged. Scale: 0 (never) to 5 (always)

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Quality of Care-Inattentive Care Baseline	—	—	4.2 units on a scale Standard Deviation 0.9	4.2 units on a scale Standard Deviation 0.8
Quality of Care-Inattentive Care 6 months	—	—	4.3 units on a scale Standard Deviation 0.7	4.3 units on a scale Standard Deviation 0.8
Quality of Care-Inattentive Care 12 months	—	—	4.2 units on a scale Standard Deviation 0.8	4.3 units on a scale Standard Deviation 0.8

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.

Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.) and then refined to 22 items through data collected and analyzed in this study. This scale for clients was adapted from the one developed for staff. Item scores were averaged. Scale: 0 (never) to 5 (always)

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Quality of Care Total 6 months	—	—	4.0 units on a scale Standard Deviation 0.8	4.0 units on a scale Standard Deviation 0.8
Quality of Care Total Baseline	—	—	4.0 units on a scale Standard Deviation 0.8	4.0 units on a scale Standard Deviation 0.8
Quality of Care Total 12 months	—	—	3.9 units on a scale Standard Deviation 0.9	4.1 units on a scale Standard Deviation 0.8

SECONDARY outcome

Timeframe: Measured with clients at baseline, 6 months, and 12 months

Population: The number analyzed at each time point differs from the overall number enrolled due to missing data (medical records not available) and clients discontinuing treatment at their respective agency.

Patient engagement was assessed by the proportion of missed appointments (when the client cancelled or did not show for a scheduled appointment divided by the total scheduled). This data was retrieved from client medical records at the agencies. Data from 3 time periods were analyzed (6 months prior to baseline through baseline, baseline to 6 months, and 6 months to 12 months). The below table illustrates the missed appointments for each time period.

Outcome measures

Measure	BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months.	BREATHE-Clients n=211 Participants Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.	Motivational Interviewing-Clients n=258 Participants Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months.
Patient Engagement-Missed Appointments Baseline	—	—	11.96 appointments at mental health agency Standard Deviation 12.51	11.02 appointments at mental health agency Standard Deviation 12.68
Patient Engagement-Missed Appointments 6 months	—	—	14.47 appointments at mental health agency Standard Deviation 15.93	12.20 appointments at mental health agency Standard Deviation 14.91
Patient Engagement-Missed Appointments 12 months	—	—	14.52 appointments at mental health agency Standard Deviation 15.85	11.50 appointments at mental health agency Standard Deviation 16.08

Adverse Events

BREATHE-Mental Health Care Staff

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Motivational Interviewing-Mental Health Care Staff

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

BREATHE-Clients

Serious events: 0 serious events

Other events: 0 other events

Deaths: 4 deaths

Motivational Interviewing-Clients

Serious events: 0 serious events

Other events: 0 other events

Deaths: 4 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Michelle Salyers, PhD / Professor, Department of Psychology

Indiana University

Phone: 317-274-2904

Email: mpsalyer@iupui.edu

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place