Substance Abuse Clinical Trial
Official title:
Training Motivational Interviewing Using Live Supervision
This study aims to train Substance Abuse Treatment Clinicians in the use of Motivational Interviewing techniques through live supervision.
New evidence-based treatments have been slow to be adopted into the routine practice of
addiction treatment, and traditional training methods are of limited effectiveness. In this
study, the investigators 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, the investigators propose to build and improve upon TCS by testing
an extended model of Teleconference Supervision (TCS-Plus), which will preserve the elements
of live supervision from an expert supervisor but will also provide 4 sessions of enhanced
tape review supervision on a bi-weekly basis after the initial TCS training. Using telephone
technology, enhanced taped review allows the Supervisor and Clinician to listen to the taped
session together before discussing the session. Practice sessions will increase from 5 to 9
and be spread out from 8 to 16 weeks. Providing both TCS and enhanced tape review supervision
maximizes supervision style advantages. While both offer context dependent learning, TCS
provides for modeling and differential reinforcement with immediacy of feedback, and enhanced
tape review provides ample time to role play and discuss technique. TCS-Plus will be compared
to standard Tape Review supervision. The proposed project will be a StageI trial, intent on
maximizing the gains already detected with the TCS model. The investiators will assess if
TCS-Plus produces superior MI skill to standard Tape Review supervision in a randomized trial
with 130 community based-clinicians. It is hoped that, if successful, TCS-Plus could be a
model for remote training and supervision at community treatment programs, promoting adoption
of a variety of evidence-based treatments for substance use disorders into routine practice.
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