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

描述（由申请人提供）：在适应基于证据的实践以适应现实世界的药物滥用治疗方案方面存在着充分记录的挑战。大多数做法需要更多的培训和监督，而不是以社区为基础的治疗方案。面对教学行业的类似问题，教育研究人员将新的和复杂的主题划分为可在单个课程中教授的关键要素，使用多媒体资源（视频，音频）和预包装的教学辅助工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。我们建议将这种方法应用到成瘾治疗领域：我们将开发、实施和测试一套工具包课程的概念真实性、实用性和吸引力，以帮助药物滥用顾问提供基于经验推导的12步康复主题的小组会议，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名咨询师到常规治疗组（TAU）或工具包组（TK）。传统知识咨询师将收到四个“工具包”——四个12步主题各一个——每个包含一个简短的DVD，演员在其中说明小组主题，以及各种易于使用的教学辅助工具，所有这些都包装在一个塑料工具包中（字面意思是工具包）。这些基于证据的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 TIPS和项目匹配手册以及已被证明有效促进12步参与的策略。咨询师的结果域涉及可接受的项目实施结构：依从性、质量、剂量和参与者反应性。我们将在干预前对所有辅导员就我们课程中的四个12步主题进行小组会议，并在1个月和6个月后对相同的主题进行录音和评分（N=960次会议），以比较研究小组之间和小组内部的概念保真度和一般技能。咨询师还将评估工具包的可接受性和价值，并在干预后的12个月内每月报告他们的工具包使用情况。除了咨询师评估外，我们还将收集对四个12步康复疗程（N=2,400）的满意度，并跟踪酒精问题筛查呈阳性的患者子样本（N= 400, 200 TK和200 TAU/对照）。患者在治疗后1、3和6个月的12步参与（会议出席和12步康复参与）将在研究条件之间进行比较；这些数据将证明干预措施在促进治疗后12步参与方面的最终效果。如果成功，这种创新的、易于使用的、成本效益高的技术转移方法可以帮助将基于证据的概念和信息转化为科学的、经过验证的临床工具，这些工具将适应当代药物滥用治疗项目的资源挑战环境。

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.