Effectiveness of Motivational Interviewing Supervision in Community Programs

描述(由申请人提供)：物质滥用项目使用循证治疗(EBT)的虚拟要求促使了传播战略的发展，以促进EBT技术转让。实施研究、临床试验培训方法和临床医生培训研究表明，包括直接观察、基于保真度评级的反馈和治疗技能指导的临床监督是一种很有前途的推广方法。然而，现场监督员在药物滥用计划中提供的临床监督从未在随机对照试验中进行过直接测试，以确定监督对临床医生EBT技能和客户治疗结果的影响。两个NIDA CTN方案测试动机访谈(MI)有效性的最新结果表明，社区项目临床医生在研讨会培训结束后接受项目主管的MI监督时，可以学习如何准确地提供MI，并且他们在治疗早期实施MI可以改善客户保留率和主要物质使用结果。一份名为MIA：STEP(动机面试评估：提高熟练程度的监督工具)的MI监督手册就是根据这些协议开发的，并已开始由NIDA与SAMHSA合作广泛分发，供社区项目使用。MIA：分步监督方法的有效性尚不清楚。这项研究将通过随机分配康涅狄格州12个社区项目的60名临床医生和420名使用药物的门诊患者到两种情况之一直接测试MIA的有效性：对临床医生MI保真度和客户结果的步骤监督，在这两种情况下，临床医生将向客户提供一次会议MI干预作为进入治疗。条件是：1)车间培训+MIA：分步监督；2)车间培训，除每个项目使用的标准监督做法外，不进行监督。该项目将是第一个检验临床监督对临床医生和患者结果影响的经验性治疗的随机试验。此外，由于它将完全在社区计划的背景下提供讲习班培训和监督，并利用内部计划监督员，它将对传播EBT(如MI)的可行模式进行严格评估。公共卫生相关性：该项目将评估社区药物滥用治疗项目中临床监督的有效性。该项目将确定新发布的名为动机访谈评估：提高熟练程度的监督工具(MIA：STEP)的联邦政府支持的监督工具包是否会导致1)改善临床医生使用称为动机访谈的循证治疗的技能；以及2)增加客户在药物滥用治疗中的留存率和主要药物戒断的天数。

DESCRIPTION (provided by applicant): The virtual requirement that substance abuse programs use evidence-based treatments (EBT) has prompted the development of dissemination strategies to promote EBT technology transfer. Implementation research, clinical trial training methods, and clinician training studies suggest that clinical supervision that involves direct observation, fidelity rating-based feedback, and coaching of therapeutic skills is a promising dissemination approach. However, clinical supervision delivered within substance abuse programs by on-site supervisors has never been directly tested in a randomized controlled trial to determine the impact of supervision on both clinician EBT skills and client treatment outcomes. Recent results from two NIDA CTN protocols testing the effectiveness of Motivational Interviewing (MI) have shown that community program clinicians can learn to deliver MI with fidelity when receiving MI supervision from their program supervisors after workshop training and that their implementation of MI early in treatment improves client retention and primary substance use outcomes. A MI supervision manual called MIA: STEP (Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency) was developed from these protocols and has begun to be widely distributed by NIDA in partnership with SAMHSA for community program use. The effectiveness of the MIA: STEP supervision approach is unknown. This study will directly test the effectiveness of MIA: STEP supervision on clinician MI fidelity and on client outcomes by randomly assigning 60 clinicians and 420 substance-using outpatients from 12 community programs within Connecticut to one of two conditions in which clinicians in both conditions will deliver a 1- session MI intervention to clients as the enter treatment. The conditions are: 1) workshop training plus MIA: STEP supervision, and 2) workshop training alone with no supervision beyond standard supervisory practices used at each program. This project will be the first randomized trial to examine the impact of clinical supervision in an empirically based treatment on both clinician and client outcomes. Moreover, because it will provide workshop training and supervision completely within the context of community programs and utilize in- house program supervisors, it will provide a rigorous evaluation of a feasible model for disseminating EBTs such as MI. Public Health Relevance: This project will evaluate the effectiveness of clinical supervision in community substance abuse treatment programs. The project will determine if a newly released federally-supported supervision toolkit called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) results in 1) improved clinician skills in using an evidence-based treatment called motivational interviewing; and 2) increased client retention in substance abuse treatment and days of primary substance abstinence.