Multimedia Toolkits to Implement 12-Step Recovery Concepts in Group Counseling

描述(由申请人提供)：在调整以证据为基础的做法以适应物质滥用治疗计划的真实世界方面，有很好的文件证明的挑战。大多数做法需要更多的培训和监督，而不是社区治疗计划的实际情况。面对教师职业中的类似问题，教育研究人员将新的和复杂的主题划分为关键元素，可以在单个课程中使用多媒体资源(视频、音频)和预先包装的教具来吸引参与者并激发课堂讨论。课程材料被包装在一个吸引人的、多用途的“工具包”中，以帮助教师在最少的指导或监督下准确地传递复杂的信息。我们建议将这一方法转化到成瘾治疗领域：我们将开发、实施和测试工具包课程的概念保真度、实用价值和吸引力，以帮助药物滥用顾问提供小组会议，讨论经验派生的12步康复主题，包括寻找会议和家庭小组，积极参与12步小组，解决误解和参与障碍等。我们将从10个住院治疗项目中随机分配80名咨询师到照常治疗(TAU)组或工具箱组(TK)。TK辅导员将收到四个“工具包”--四个12步主题中的每一个--每个都包含一张简短的DVD，演员在DVD中演示小组主题，以及各种易于使用的教具，所有这些都包装在一个塑料工具包(字面上是工具包)中。这些循证12步主题的内容将基于广泛使用的手册，例如NIAAA治疗手册、SAMHSA提示和已被证明有效促进12步参与的项目匹配手册和战略。辅导员结果域利用项目实施的公认结构：坚持、质量、剂量和参与者反应。我们将在干预前录制所有辅导员在课程中就四个12步主题进行小组会议的录音并对其进行评分，并在1个月和6个月后再次就相同主题(N=960次会议)进行评估，以比较研究小组之间和小组内随时间推移的概念保真度和一般技能。咨询师还将对工具包的可接受性和价值进行评级，并在干预后12个月内每月报告工具包的使用情况。除了辅导员评估，我们还将收集四个12步康复课程(N=2400)的满意度，并跟踪筛查酒精问题呈阳性的患者的子样本(N=400、200 TK和200 TAU/Control)。患者在治疗后1、3和6个月的12步参与(参加会议和12步康复参与)将在不同的研究条件下进行比较；这些数据将说明促进治疗后12步参与的干预措施的最终效果。如果成功，这种创新的、易于使用的、具有成本效益的技术转让方法可以帮助将基于证据的概念和信息设计成基于科学的、经过验证的临床工具，这些工具将适合当代药物滥用治疗计划的资源挑战环境。 公共卫生相关性：将经验证明的或“基于证据的”做法纳入以社区为基础的药物滥用治疗计划是非常必要的，但这需要大量的资源(时间、人员和财政)，而在这种情况下，这些资源往往是有限的。这个创新的项目将开发一个吸引人的、具有成本效益和易于使用的多媒体“工具包”课程，以帮助辅导员在团体咨询课程中准确和全面地介绍12步康复的核心主题，经验表明，这种方法可以促进物质使用的减少。如果成功，这种传播经过科学验证的实践的方法将推动NIAAA将研究成果转化和传播到全美13,371个治疗项目中的关键组成部分，这些治疗项目每天提供近100万次门诊就诊，并每天治疗另外12万人的住院/住院治疗。

DESCRIPTION (provided by applicant): There are well documented challenges in adapting evidence based practices to fit the real world of substance abuse treatment programs. Most practices require more training and supervision than is practical for community-based treatment programs. Faced with a similar problem in the teaching profession, educational researchers have divided new and complex topics into key elements teachable in single sessions using multimedia resources (video, audio) and pre-packaged teaching aids to engage participants and stimulate class discussion. Session materials are packaged in an appealing, multi-use "toolkit" to assist teachers in delivering complex information accurately with minimal instruction or supervision. We propose to translate this approach to the addiction treatment field: We will develop, implement and test the conceptual fidelity, practical utility, and attractiveness of a curriculum of toolkits to help substance abuse counselors deliver group sessions on empirically derived 12-Step recovery topics including finding meetings and a home group, active participation in 12-Step groups, addressing misconceptions and barriers to participation, and others. We will randomly assign 80 counselors from 10 inpatient treatment programs to either treatment-as- usual (TAU) or the Toolkits group (TK). TK counselors will receive four "toolkits" - one on each of four 12-Step topics - each containing a brief DVD where actors illustrate the group topic, and assorted easy-to-use teaching aids, all packaged in a plastic kit (literally, a tool-kit). Content on these evidence-based 12-step topics will be based on widely used manuals e.g., NIAAA Therapy Manuals, SAMHSA TIPS and Project MATCH Manuals and strategies that have been shown to effectively promote 12-Step participation. Counselor outcome domains tap into accepted constructs of program implementation: adherence, quality, dose, and participant responsiveness. We will audiotape and rate all counselors conducting group sessions on the four 12-Step topics in our curriculum before the intervention and again, on the same topics, 1 and 6 months later (N=960 sessions) to compare concept fidelity and general skills between the study groups and within groups, over time. Counselors will also rate the toolkits' acceptability and value, and report monthly on their toolkit utilization for 12 months post-intervention. In addition to counselor assessments, we will collect satisfaction with the four 12-Step Recovery sessions (N=2,400) and track a subsample of patients (N = 400, 200 TK and 200 TAU/Control) who screen positive for alcohol problems. Patient 12-Step participation (meeting attendance and 12-Step recovery involvement) at 1-, 3- and 6-months post treatment will be compared between study conditions; these data will speak to the ultimate efficacy of the intervention to promote post-treatment 12-Step participation. If successful, this innovative, easy to use and cost effective method of technology transfer could help engineer evidence based concepts and information into science-base, validated clinical tools that will fit within the resource-challenged environment of contemporary substance abuse treatment programs. PUBLIC HEALTH RELEVANCE: Incorporating empirically-proven or "evidence-based" practices into community-based substance abuse treatment programs is critically needed but it requires substantial resources (time, staff and financial) that are often limited in such settings. This innovative project will develop an appealing, cost-effective and easy-to-use curriculum of multimedia "toolkits" to assist counselors in accurately and comprehensively introducing the core topics of 12-Step recovery in group counseling sessions, an approach empirically demonstrated to promote reductions in substance use. If successful, this method of disseminating scientifically-validated practices will advance a critical component in NIAAA's mission of translating and disseminating research findings to the 13,371 treatment programs throughout the US that provide almost 1 million outpatient service visits daily and treat an additional 120,000 people in residential/inpatient treatment daily.