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）的实际要求促使了传播策略的制定，以促进EBT技术转让。实施研究、临床试验培训方法和临床医生培训研究表明，涉及直接观察、基于保真度评级的反馈和治疗技能辅导的临床监督是一种有前途的传播方法。然而，在药物滥用项目中由现场监督员提供的临床监督从未在随机对照试验中进行过直接测试，以确定监督对临床医生EBT技能和客户治疗结果的影响。最近的结果从两个NIDA CTN协议测试动机访谈（MI）的有效性表明，社区项目的临床医生可以学习提供MI与保真度时，从他们的项目主管接受MI监督车间培训后，他们的实施MI早期治疗改善客户保留和主要物质使用的结果。一个名为MIA：STEP（动机面试评估：提高熟练度的监督工具）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监督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MI保真度和客户结局的有效性，方法是将来自康涅狄格州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随机分配到两种情况之一中，两种情况下的临床医生将向客户提供1次MI干预作为输入治疗。这些条件是：1）车间培训加MIA：STEP监督，以及2）单独的车间培训，除了每个程序中使用的标准监督实践外，没有监督。该项目将是第一个随机试验，以检查临床监督的影响，在一个经验为基础的治疗对临床医生和客户的结果。此外，由于它将完全在社区方案的范围内提供讲习班培训和监督，并利用内部方案监督员，它将为传播多元智能等EBT的可行模式提供严格的评估。公共卫生相关性：本项目将评估社区药物滥用治疗计划中临床监督的有效性。该项目将确定一个新发布的联邦支持的监督工具包，称为动机访谈评估：提高熟练程度的监督工具（MIA：STEP）是否会导致1）提高临床医生使用循证治疗的技能，称为动机访谈;和2）增加药物滥用治疗的客户保留和主要物质戒断的天数。

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.