Effectiveness of Motivational Interviewing Supervision in Community Programs

描述（由申请人提供）：药物滥用项目使用循证治疗（EBT）的虚拟要求促使了传播策略的发展，以促进EBT技术的转移。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在内的临床监督是一种很有前途的传播方法。然而，在药物滥用项目中，现场监督人员提供的临床监督从未在随机对照试验中直接进行过测试，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协议测试动机访谈（MI）有效性的最新结果表明，社区项目临床医生在工作坊培训后接受项目主管的MI监督时，可以学会忠实地提供MI，并且他们在治疗早期实施MI可以提高客户保留率和主要物质使用结果。一本名为MIA: STEP（动机访谈评估：提高熟练程度的监督工具）的MI监督手册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: STEP监管方法的有效性尚不清楚。本研究将直接测试MIA: STEP监督对临床医生心肌梗死保真度和客户结果的有效性，方法是随机分配来自康涅狄格州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中的一种，在两种情况下，临床医生将向客户提供1次心肌梗死干预作为进入治疗。条件是：1)车间培训加上MIA: STEP监督；2)车间培训单独进行，除了每个项目使用的标准监督实践之外，没有任何监督。该项目将是第一个随机试验，以检验临床监督对临床医生和客户结果的影响。此外，由于该项目将完全在社区项目的背景下提供讲习班培训和监督，并利用内部项目监督员，它将为传播像MI这样的ebt的可行模式提供严格的评估。公共卫生相关性：该项目将评估社区药物滥用治疗项目临床监督的有效性。该项目将确定新发布的由联邦政府支持的监督工具包“动机性访谈评估：提高熟练程度的监督工具”（MIA: STEP）是否能提高临床医生使用基于证据的动机性访谈治疗的技能；2)增加了患者在药物滥用治疗中的保留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.