No abstract

Few empirical studies are available to guide best practices for transferring evidenced-based treatments to community substance abuse providers. To maximize the learning and maintenance of new clinical skills, this study tested a context-tailored training model (CTT) which used standardized patient actors in role-plays tailored to agency clinical context, repetitive cycles of practice and feedback, and enhanced organizational support. This study reports the results of a randomized pilot evaluation of CTT for motivational interviewing (MI). Investigators randomly assigned community substance abuse treatment agencies to receive either CTT or a standard two-day MI workshop. The study also evaluated the effects of counselor-level and organizational-level variables on the learning of MI. No between-condition differences were observed on the acquisition and maintenance of MI skills, despite reported higher satisfaction with the more costly context tailored model. Analyses revealed that those counselors with more formal education and less endorsement of a disease model of addiction made the greatest gains in MI skills, irrespective of training condition. Similarly, agencies whose individual counselors viewed their organization as being more open to change and less supportive of autonomy showed greater average staff gains in MI skills, again, irrespective of training method. Post-training activities within agencies that supported the ongoing learning and implementation of MI mediated the effects of organizational openness to change. This pilot study suggests that tailored training methods may not produce better outcomes than traditional workshops for the acquisition of evidence-based practice and that efforts to enhance dissemination should be focused on characteristics of learners and ongoing organizational support of learning.

The notion that client language about change is related to actual behavioral change is central to the practice of motivational interviewing (MI), but has not been examined in adolescent clients. In this study homeless adolescents who used alcohol or illicit substances but were not seeking treatment (n = 54) were recorded during brief motivational interventions. Adolescent language during sessions was coded based on MI concepts, and ratings were tested as predictors of rates of substance use over time. Types of adolescent speech included global ratings of engagement and affect, as well as counts of commitment to change, statements about reasons for change, and statements about desire or ability to change. Results of multivariate linear regression indicate that statements about desire or ability against change, although infrequent (M = 0.61 per 5 minutes), were strongly and negatively predictive of changes in substance use rates (days of abstinence over the prior month) at both 1-and 3-months post baseline assessment (p < .001). In contrast, statements about reasons for change were associated with greater reductions in days substance use at 1-month assessment (p < .05). Commitment language was not associated with outcomes. Results suggest that specific aspects of adolescent speech in brief interventions may be important in the prediction of change in substance use. Future studies are needed to test the observed relationships in larger samples and other clinical contexts, and assess if youth language about change mediates effects of clinical interventions.Motivational interviewing (MI;Miller & Rollnick, 2002) is a popular, empirically-based counseling method for a range of health-related problems. Defined as a "client-centered, directive method for facilitating intrinsic motivation to change by exploring and resolving ambivalence," (Rollnick & Miller, 1995), MI emphasizes formation of collaborative therapeutic relationships with clients through which client language about change may be strategically elicited and reinforced. "Change language" is defined as client expressions of problems with the current state, benefits of change, and hope and optimism about future change (Miller & Rollnick, 2002). In articulating a theory for MI, Miller and colleagues have stated that "1) The practice of MI should elicit increased levels of change and decreased levels of resistance from clients, 2) The extent to which clients verbalize arguments against change (resistance) during MI will be inversely related to the degree of subsequent behavior change, and 3) The extent to which clients verbalize change talk (arguments for change) during MI will be directly related to the degree of subsequent behavior change" Hettema, Steele, & Miller, 2005, p. 106).

Prior efforts to estimate U.S. prevalence of substance use disorders (SUDs) in HIV care have been undermined by caveats common to single-site trials. The current work reports on a cohort of 10,652 HIV-positive adults linked to care at seven sites, with available patient data including geography, demography, and risk factor indices, and with substance-specific SUDs identified via self-report instruments with validated diagnostic thresholds. Generalized estimating equations also tested patient indices as SUD predictors. Findings were: 1) a 48% SUD prevalence rate (between-site range of 21–71%), with 20% of the sample evidencing polysubstance use disorder; 2) substance-specific SUD rates of 31% for marijuana, 19% alcohol, 13% methamphetamine, 11% cocaine, and 4% opiate; and 3) emergence of younger age and male gender as robust SUD predictors. Findings suggest high rates at which SUDs occur among patients at these urban HIV care sites, detail substance-specific SUD rates, and identify at-risk patient subgroups.

Objective The goal of measuring therapist adherence is to determine if a therapist can perform a given treatment. Yet the evaluation of therapist behaviors in most clinical trials is limited. Typically, randomized trials have few therapists and minimize therapist variability through training and supervision. Furthermore, therapist adherence is confounded with uncontrolled differences in patients across therapists. Consequently, the extent to which adherence measures capture differences in actual therapist adherence versus other sources of variance is unclear. Method We estimated intra-class correlations (ICCs) for therapist adherence in sessions with real and standardized patients (RPs and SPs), using ratings from a motivational interviewing (MI) dissemination trial (Baer et al., 2009) in which 189 therapists recorded 826 sessions with both patient types. We also examined the correlations of therapist adherence between SP and RP sessions, and the reliability of therapist level adherence scores with generalizability coefficients (GCs). Results ICC’s for therapist adherence were generally large (average ICC for SPs = 0.44, RPs = 0.40), meaning that a given therapist’s adherence scores were quite similar across their sessions. Both ICCs and GCs were larger for SP sessions as compared to RPs on global measures of MI adherence, such as Empathy and MI Spirit. Correlations between therapist adherence with real and standardized patients were moderate to large on three of five adherence measures. Conclusion Differences in therapist-level adherence ratings were substantial, and standardized patients have promise as tools to evaluate therapist behavior.

No abstract

Guided by a comprehensive implementation model, this study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a Clinical Trials Network-affiliate opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, and adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (intervention cost, feasibility, and sustainability) were assessed at study conclusion in a qualitative interview with OTP management. Intervention effectiveness was also assessed via independent chart review of trial CM implementation vs. a historical control period. Results included: 1) robust, durable increases in delivery skill, knowledge, and adoption readiness among trained staff; 2) positive managerial perspectives of intervention cost, feasibility, and sustainability; and 3) significant clinical impacts on targeted patient indices. Collective results offer support for the study’s collaborative intervention design and the applied, skills-based focus of staff training processes. Implications for CM dissemination are discussed.

The video assessment of simulated encounters-revised (VASE-R) is a video-based method, administered in individual or group settings, for assessing motivational interviewing (MI) skills. The 18-item instrument includes three video-based vignettes, in which actors portray substance abusers, with each vignette followed by questions that prompt examinees to write responses that are then scored against MI standards. The VASE-R was administered to two independent samples: (1) substance abuse practitioners participating in a study of MI training methods, and (2) MI training facilitators with a high level of MI skill and expertise. This multi-study report describes basic VASE-R psychometric properties -including scoring reliability, internal consistency, concurrent validity, and sensitivity to the effects of training -and then presents proficiency standards based on administration to a sample of MI training facilitators (MI Experts). The findings indicate excellent inter-rater reliability using intra-class correlations for the full-scale score (.85) and acceptable levels for subscales (.44 to .73). The instrument displayed strong concurrent validity with the Helpful Responses Questionnaire (HRQ) and a behavioral sample of clinician behavior with a standardized patient scored using the MI Treatment Integrity (MITI) system, as well as good sensitivity to improvement in MI skill as a result of training. The findings provide an empirical basis for suggesting VASE-R benchmarks for beginning proficiency and expert MI practice.