HOW DO TRAINERS IN EMPIRICALLY SUPPORTED TREATMENTS DECIDE WHAT TO TRAIN?: AN INVESTIGATION OF THE TRAINER’S ROLE IN THE SCIENCE-TO-SERVICE PATHWAY

BACKGROUND: Despite significant progress in identifying empirically supported elements of psychotherapy treatments over the last 20 years, the integration of these findings into clinical practice remains low. Practitioner training has been identified as a core component of successful translation of scientific findings into practice. Yet, little research has been conducted on the role of the trainer in the dissemination of empirically supported treatments (ESTs). This exploratory study investigated the practices and attitudes of trainers of an EST, Motivational Interviewing (MI), to identify potential factors related to successful and/or unsuccessful dissemination efforts. METHOD: A measure of Motivational Interviewing components (MIC) and a measure of Trainer Attitudes towards Motivational Interviewing (TAM) training were developed and administered to 111 members of the Motivational Interviewing Network of Trainers. The MIC asked trainers to select training content for a hypothetical training scenario, from a list of items that included both empirically supported components and those that had no AN INVESTIGATION OF THE TRAINER’S ROLE iv empirical support, based on a review of the MI literature. Factor Analyses were conducted on the two measures, and associations between the two measures were examined. RESULTS: A two-factor solution of Unsupported and Supported training components emerged from the MIC. A three-factor solution emerged from the TAM, including a factor of Pro-Technical attitudes, a factor of Pro-Relational attitudes, and a third factor indicating disinterest in training either. A correlational analysis showed that trainers who expressed disinterest in training on both the technical and relational components of Motivational Interviewing (MI) had a less favorable balance of supported vs. unsupported training components in a hypothetical training (r = -.228, p = 016), although the reliability of these measures was low. DISCUSSION: Based on this sample, there appears to be considerable uniformity in the training practices and attitudes of MI trainers. Trainers consistently include empirically supported MI components in their trainings, likely contributing to the positive findings for MI’s effectiveness. However, some trainers also appear to include components for which no empirical support exists, or which appear inconsistent with MI’s focus on active change. This study had serious limitations, including the use of new and unreliable measures and a small sample size. AN INVESTIGATION OF THE TRAINER’S ROLE v TABLE OF CONTENTS INTRODUCTION . 1 Background . 2 Barriers to EST implementation . 2 Training components . 2 Motivational Interviewing . 4 Motivational Interviewing Network of Trainers . 4 Current study . 5 METHODS . 5 Participants . 5 Instruments . 6 Trainer characteristics . 6 Training components measure . 6 Trainer attitudes measure . 8 Procedure . 9 Data analytic plan . 9 RESULTS . 10 Sample characteristics . 10 Training activity . 11 Which training components do MI trainers select? 11 What are trainers’ attitudes about including the technical and relational components of MI in their training? 12 Exploratory factor analyses . 13 AN INVESTIGATION OF THE TRAINER’S ROLE vi Is there any underlying structure to the training components that trainers selected? 13 Is there an underlying structure to the attitudes MI trainers endorse about training the technical and relational components? 15 Factor 1, “Not These” . 17 Factor 2, “Pro-Technical” . 17 Factor 3, “Pro-Relational” . 18 Training balance score . 19 Correlational analyses . 20 Are there trainer characteristics that are related to their attitudes about including the technical or relational components in training? 20 Are there trainer characteristics or attitudes that are related to the balance of supported vs. unsupported components they include in their training? 20 Are trainers’ attitudes about training the technical and relational components of MI related to how much they include specific vs. common factors in their training? 21 DISCUSSION . 21 Strengths . 25 Limitations . 26 CONCLUSIONS . 27 APPENDIX A: STUDY MATERIALS . 28 REFERENCES . 32 AN INVESTIGATION OF THE TRAINER’S ROLE