Training Clinicians in Motivational Interviewing
Condition: Substance Abuse
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      This study aims to train Substance Abuse Treatment Clinicians in the use of Motivational
      Interviewing techniques through live supervision.
    

Detailed description: 
      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.
    

Intervention name(s): Live teleconference supervision; Taped Review Supervision
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants receive live teleconference supervision during a session with a client on their use of Motivational Interviewing (MI) in the session. MI is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with nondirective counselling, it is more focused and goal-directed. The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal.; Participants audio record a session with a client and receive supervision after the session on their use of Motivational Interviewing during the session.
Other intervention name(s): Motivational Enhancement Therapy; MI; MET
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Training; Substance Abuse; Counseling; Motivational Interviewing