Effectiveness of Motivational Interviewing Supervision in Community Programs

The virtual requirement that substance abuse programs use evidence-based treatments (EBT) has prompted the development of dissemination strategies to promote EBT technology transfer. Implementation research, clinical trial training methods, and clinician training studies suggest that clinical supervision that involves direct observation, fidelity rating-based feedback, and coaching of therapeutic skills is a promising dissemination approach. However, clinical supervision delivered within substance abuse programs by on-site supervisors has never been directly tested in a randomized controlled trial to determine the impact of supervision on both clinician EBT skills and client treatment outcomes.

Recent results from two NIDA CTN protocols testing the effectiveness of Motivational Interviewing (MI) have shown that community program clinicians can learn to deliver MI with fidelity when receiving MI supervision from their program supervisors after workshop training and that their implementation of MI early in treatment improves client retention and primary substance use outcomes. A MI supervision manual called MIA: STEP (Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency) was developed from these protocols and has begun to be widely distributed by NIDA in partnership with SAMHSA for community program use. The effectiveness of the MIA: STEP supervision approach is unknown.

This study will directly test the effectiveness of MIA: STEP supervision on clinician MI fidelity and on client outcomes by randomly assigning 60 clinicians and 420 substance-using outpatients from 11 community programs within Connecticut to one of two conditions in which clinicians in both conditions will deliver a 1-session MI intervention to clients as the enter treatment. The conditions are: 1) workshop training plus MIA: STEP supervision, and 2) workshop training alone with supervision-as-usual practices used at each program. This project will be the first randomized trial to examine the impact of clinical supervision in an empirically based treatment on both clinician and client outcomes. Moreover, because it will provide workshop training and supervision completely within the context of community programs and utilize in-house program supervisors, it will provide a rigorous evaluation of a feasible model for disseminating EBTs such as MI.

• Signs and Symptoms
• Clinical Supervision

• Behavioral: SAU
  Supervision-as-usual
• Behavioral: MIA: STEP
  Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP

• Experimental: MIA: STEP
  Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP)
  Intervention: Behavioral: MIA: STEP
• Active Comparator: Supervision-as-usual
  Supervision-as-usual consists of the typical clinical supervision services provided to clinicians by their supervisors in their community programs.
  Intervention: Behavioral: SAU

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For Clinicians

Inclusion Criteria:

• age 18 or older who work at one of the 12 participating programs
• willing to serve as study clinicians and learn the MI assessment intake
• working at least 20 hours per week at the program
• are not intending to give notice to their employer that they intend to leave the agency or are not scheduled for medical or family leave during the study period
• willing to record clinical sessions for review by the MI expert and/or independent raters
• willing to have supervision sessions recorded if randomized to MIA: STEP condition
• deemed capable by program administrative leadership to manage the responsibilities of being a clinician in a randomized trial

Exclusion Criteria:

• served as MI therapists in prior clinical trial studies.
• received formal supervision in MI based on direct observation, session ratings, and related feedback and coaching.
• trained as MI trainers through the Motivational Interviewing Network of Trainers (MINT).

For Clients

Inclusion Criteria:

• English-speaking
• seeking non-opiate replacement outpatient treatment for any substance use problem and have used primary substance (alcohol or illicit drug) at least once in the prior 28 days
• 18 years of age or older
• willing to participate in the protocol (randomization to clinicians contact for follow-up assessments, MI session recording for supervisor and independent review)

Exclusion Criteria:

• insufficiently medically or psychiatrically stable to participate in outpatient treatment.
• highly unlikely to be reached for follow-up due to residential instability or imminent incarceration.
• seeking detoxification only, opiate replacement treatment, or residential inpatient treatment.