MOVING MOTIVATIONAL INTERVIEWING INTO PRACTICE

有疗效证据的治疗方法不容易转变为常规的临床实践。一个特别的挑战是通过继续专业教育改变既定的实践行为。临床医生平均执业30年或更长时间，在此期间，最佳执业可能会经历重大变化。通常的一次性研讨会的继续教育形式不太可能大幅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，测试动机访谈(MI)临床干预方式传播程序的有效性。MI之所以被选中，是因为(1)有强有力的证据表明它在解决物质使用障碍方面的有效性，(2)它的程序很具体，(3)它符合管理医疗的当前趋势，以及(4)它具有埃弗雷特·罗杰斯指定的许多属性，即促进将一项创新纳入既定实践。一项初步研究表明，仅仅是两天的研讨会不足以改变咨询师的实践行为，从而为客户带来不同的影响。两个有希望的培训增强程序(向临床医生提供个性化反馈，以及通过个人会诊加强实践)将通过一项结合组间和组内影响的设计对140名药物滥用从业者进行评估。两个完善的磁带过程编码系统将用于评估培训的效果，并促进动机访谈中积极过程的理论相关知识。一项平行的子研究将实施和评估讲西班牙语的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.