Training Motivational Interviewing Using Live Supervision

描述（由申请人提供）：新的循证治疗方法在成瘾治疗的常规实践中被采用的速度很慢，而培训社区临床医生这种新治疗方法的传统方法效果有限。在这一更新中，我们建议继续开发基于现场监督原则的临床医生动机访谈（MI）培训方法。现场监督（主管和学员一起看病人）在基础培训中很常见，但在继续教育中很少使用。在最初的资助阶段，我们开发了电话会议监督（TCS），它通过电话会议技术实现了专家的现场监督，利用了上下文依赖学习的原则，反馈的即时性的差分强化和建模。临床医生在他们的家庭诊所采访标准患者，而主管则通过电话听取。临床医生佩戴耳机，主管通过耳机提供即时反馈和指导，以不同的方式加强和塑造心肌梗死技能。在一项社区临床医生（N= 100）的随机对照试验中，与临床医生只接受工作坊培训或标准磁带监督的对照条件相比，TCS产生了更好的整体心肌梗死技能。研究结果令人鼓舞，但达到专家熟练程度的临床医生比例有限，并且在随访中有技能丧失的趋势，这表明需要更长的培训来最大限度地提高和维持心肌梗死技能。在新的资助期内，我们建议测试一个改进版本的电话会议监管（TCS），该版本将保留和完善最初的5个现场监管课程，并在完成初始TCS培训后的2个月内增加4个强化课程。对于强化会话，临床医生将事先录下与实际患者的会话，并且主管和临床医生将能够通过电话一起听会话，同时讨论它。虽然现场TCS和基于磁带的强化课程都提供了上下文依赖的学习，但现场课程提供了建模和即时反馈的差异强化，磁带复习强化课程提供了充足的时间来进行角色扮演和讨论技术和策略。拟议的项目将首先在1a阶段试点试验中完善TCS，然后进入随机Ib阶段试验，以标准监督为控制条件。我们假设TCS将在社区临床医生中产生卓越的心肌梗死技能，并在患者中更多地改变谈话和改善物质使用结果。如果它继续显示出希望，像TCS这样的方法可能会在传播新的治疗技术方面重塑这个领域。未来的方向可能包括更大规模的二期或三期TCS试验，将TCS与其他治疗技术相适应，以及开发小组监督模式，以提高可持续性，并更有效地利用专家监督的时间。

DESCRIPTION (provided by applicant): New evidence-based treatments have been slow to be adopted into the routine practice of addiction treatment, and traditional methods for training community-based clinicians in such new treatments are of limited effectiveness. In this renewal, we propose to continue development of methods for training clinicians in Motivational Interviewing (MI), based on the principle of live supervision. Live supervision (supervisor and trainee seeing a patient together) is common in basic training, but rarely used in continuing education. In the initial funding period we developed Teleconference Supervision (TCS), which implements live supervision by an expert through teleconferencing technology, harnessing the principles of context-dependent learning, differential reinforcement with immediacy of feedback, and modeling. Clinicians interview standard patients at their home clinics, while Supervisors listen via telephone. The clinician wears an earpiece, through which the Supervisor provides immediate feedback and coaching designed to differentially reinforce and shape MI skills. In a randomized controlled trial with community clinicians (N= 100), TCS produced superior overall MI skill, compared to control conditions where clinicians received Workshop only training, or standard tape-based supervision. Findings were encouraging, yet the proportion of clinicians achieving expert proficiency was limited, and there were trends toward loss of skill at follow- up, suggesting longer training is needed to maximize and sustain MI skill. In the new funding period, we propose to test an improved version of Teleconference Supervision (TCS) that will preserve and refine the initial 5 live supervision sessions and will add 4 booster sessions over the 2 months after completing the initial TCS training. For the booster sessions, the Clinician will have previously audiotaped a session with an actual patient, and Supervisor and Clinician will be able to listen together to the session over the telephone, while discussing it. While both live TCS and tape-based booster sessions offer context dependent learning, the live sessions provide for modeling and differential reinforcement with immediacy of feedback, and tape review boosters provide ample time to role-play and discuss technique and strategy. The proposed project will first refine TCS in a Stage 1a pilot trial, then move to a randomized Stage Ib trial, with Standard Supervision as the control condition. We hypothesize that TCS will produce superior MI skill among community-based Clinicians, and more change talk and improved substance use outcome among patients. If it continues to show promise, methods like TCS could re-shape the field in terms of disseminating new treatment techniques. Future directions could include larger Stage 2 or 3 trials of TCS, adaptation of TCS to other treatment techniques, and development of group supervision models to increase sustainability and make more efficient use of expert supervisors' time.