Training Clinicians in Motivational Interviewing (MI Training)

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, 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 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. We 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.

Substance Abuse Clinicians, Therapist and Counselors

• Clinicians/Therapists
  Clinicians from participating substance abuse treatment programs who volunteer to be trained in motivational interviewing.
  Intervention: Behavioral: Motivational Interviewing
• Substance Abuse Patients/Clients
  Patients at participating substance abuse treatment programs can volunteer to take part in clinicians motivational interviewing test sessions.
  Intervention: Behavioral: Motivational Interviewing

Inclusion/Exclusion Criteria: Clinician-Participants

Inclusion Criteria:

1. Clinician, aged 18 to 75, employed in good standing at least 50% time at a licensed substance abuse treatment program.
2. Carries a regular caseload of patients or clients for whom he/she serves as primary therapist.
3. Interested in learning Motivational Interviewing and willing to follow treatment guidelines and training protocol, including random assignment to groups.
4. Willing and able to attend a 2 day workshop, to tape subsequent sessions with patients for evaluation of MI skillfulness by Training Team members and raters, and to participate in supervision, including taping of sessions for review by Training Team members and raters and/or having supervisor listen to, and comment on, live sessions.

Exclusion Criteria:

1. Planning to terminate employment at the current treatment program within the next six months.
2. Has received credentialing as a Motivational Interviewing trainer, or served as a Motivational Interviewing or Motivational Enhancement Therapy therapist in a clinical trial which provided feedback on MI skill.
3. Has received formal training in Motivational Interviewing within the last three months

Inclusion/Exclusion Criteria: Patient-Participants

Inclusion Criteria:

1. Males and females, age 18 to 70.
2. Newly admitted to treatment for a substance use disorder at a licensed substance abuse treatment program, or patients not on the standing caseloads of participating counselors who otherwise meet inclusion-exclusion criteria.
3. Treatment program to which admitted or seeking treatment is an outpatient program (drug free), or a methadone maintenance program, or a therapeutic community treatment program.
4. Current active use of substances (other than nicotine) at least once per week in the past month, or, if incarcerated within the past month, was using substances regularly (at least once per week) in the month prior to incarceration.
5. Willing to participate in the study, including willing to participate in sessions that are audio-taped for review by the treating clinician, supervisor and Training Team, and/or to participate in a session where a supervisor listens to the interview by telephone conference.
6. Has a stable living arrangement with access to a telephone, and willing to be contacted by telephone by the research team for follow-up interviews.
7. Able to provide written informed consent.

Exclusion Criteria:

1. In need of immediate acute care for a severe psychiatric disorder (e.g. schizophrenia, bipolar illness, or severe major depression) which would interfere with ability to participate, or in need of acute detoxification.
2. In need of immediate acute care for a severe unstable, medical illness (e.g. acute infection, unstable diabetes mellitus, AIDS dementia complex or other organic mental syndrome) that would interfere with ability to participate.
3. Likely to be incarcerated for more than four weeks within the next three months.