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采用得很慢，培训社区临床医生了解这种新治疗方法的传统方法效果有限。在这次更新中，我们建议继续开发基于现场监督原则的激励访谈(MI)培训临床医生的方法。现场督导(主管和受训人员一起看病人)在基础培训中很常见，但在继续教育中很少使用。在最初的融资阶段，我们开发了电话会议监督(TCS)，它通过电话会议技术实现专家的现场监督，利用上下文相关学习、即时反馈的差异强化和建模的原则。临床医生在他们的家庭诊所采访标准患者，而监督员通过电话倾听。临床医生佩戴耳机，主管通过耳机提供即时反馈和指导，旨在与众不同地强化和塑造心肌梗死技能。在一项与社区临床医生(N=100)进行的随机对照试验中，与只接受研讨会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MI技能。研究结果令人鼓舞，但临床医生达到专家熟练程度的比例有限，而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，我们建议测试改进版的电话会议监督(TCS)，该版本将保留和完善最初的5次现场监督会议，并将在完成最初的TCS培训后的2个月内增加4次助推会议。对于助推器会议，临床医生之前将录制与实际患者的会议，主管和临床医生将能够通过电话一起收听会议，同时进行讨论。现场培训课程和基于磁带的助教课程都提供与情景相关的学习，而现场课程则提供建模和差异化强化，并提供即时反馈，而磁带回顾助教课程则提供充足的时间进行角色扮演和讨论技术和战略。拟议项目将首先在1a阶段的试点试验中提炼TCS，然后进入随机的Ib阶段试验，以标准监督为对照条件。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，并在患者中产生更多的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该领域。未来的方向可能包括更大的TCS第二阶段或第三阶段试验，使TCS适应其他治疗技术，以及开发团体监督模式以增加可持续性并更有效地利用专家监督员的时间。 与公共卫生相关：新的循证治疗在成瘾治疗的常规做法中采用的速度很慢；会议或讲习班等标准培训方法的有效性有限。如果TCS被证明是有希望在MI方面培训临床医生的，它有望成为将其他循证治疗传播到基于社区的药物滥用治疗计划的模式。这可能有相当大的潜力推动将新的治疗方法应用于现实世界的实践，提高临床工作人员的质量和药物滥用治疗系统提供的护理质量。

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. PUBLIC HEALTH RELEVANCE: New evidence-based treatments have been slow to be adopted into the routine practice of addiction treatment; standard training methods such as the conference or workshop are of limited effectiveness. If shown to be promising for training clinicians in MI, it is hoped that TCS could become a model for disseminating other evidence-based treatments to community-based substance abuse treatment programs. This could have considerable potential to promote the adoption of new treatments into real-world practice, improving the quality of the clinical workforce and the quality of care delivered in the substance abuse treatment system.