MOVING MOTIVATIONAL INTERVIEWING INTO PRACTICE

有疗效证据的治疗方法不容易转化为常规临床实践。一个特别的挑战是通过继续专业教育来改变既定的实践行为。临床医生的平均执业时间为30年以上，在此期间，最佳执业可能发生重大变化。通常的一次性研讨会的继续教育形式不太可能实质性地改变稳定的实践行为。本研究采用随机临床试验的基本设计来检验动机访谈（MI）的临床干预风格的传播程序的有效性。MI被选中的原因是：(1)有强有力的证据表明其在解决物质使用障碍方面的有效性，(2)其程序有很好的规定，(3)它与管理式医疗的当前趋势一致，(4)它具有埃弗雷特·罗杰斯（Everett Rogers）指定的许多属性，以促进将创新应用于既定实践。一项初步研究表明，仅仅两天的研讨会不足以改变咨询师的实践行为，从而对客户产生影响。140名药物滥用从业人员将通过组合组间和组内效果的设计来评估两种有希望的培训增强程序（向临床医生提供个性化反馈和通过个人咨询加强实践）。将使用两种完善的磁带过程编码系统来评估培训的效果，并提高动机性访谈中操作的主动过程的理论相关知识。一个平行的子研究将实施和评估西班牙语临床医生的心肌梗死培训。

Treatments with evidence of efficacy do not readily transfer into routine clinical practice. A particular challenge is changing established practice behaviors through continuing professional education. The average clinician practices for 30 years or more, during which time optimal practice is likely to undergo major changes. The usual continuing education format of a one-time workshop is unlikely to modify stable practice behavior substantially. The proposed study applies the basic design of a randomized clinical trial to test the efficacy of procedures for disseminating the clinical intervention style of motivational interviewing (MI). MI was selected because (1) there is strong evidence of its efficacy in addressing substance use disorders, (2) its procedures are well specified, (3) it is consonant with current trends in managed care, and (4) it has many of the attributes specified by Everett Rogers as promoting adoption of an innovation into established practice. A pilot study showed that a 2-day workshop alone was insufficient to change counselors' practice behavior enough to make a difference for clients. Two promising training enhancement procedures (individualized feedback to clinicians, and reinforced practice through individual consultations) will be evaluated via a design combining between-group and within-group effects with 140 substance abuse practitioners. Two well-developed systems for process coding of tapes will be used both to evaluate the efficacy of training, and to advance theory-relevant knowledge of active processes operating in motivational interviewing. A parallel substudy will implement and evaluate MI training of Spanish-speaking clinicians.