The Effectiveness and Cost of Clinical Supervision for Motivational Interviewing: A Randomized Controlled Trial

Abstract

The effectiveness of a competency-based supervision approach called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) was compared to Supervision-As-Usual (SAU) for increasing clinicians’ motivational interviewing (MI) adherence and competence and client retention and primary substance abstinence in a multisite Hybrid Type 2 effectiveness-implementation randomized controlled trial. Participants were 66 clinicians and 450 clients within one of eleven outpatient substance abuse programs. An independent evaluation of audio recorded supervision sessions indicated that MIA: STEP and SAU were highly and comparably discriminable across sites. While clinicians in both supervision conditions improved their MI performance, clinician supervised with MIA: STEP, compared to those in SAU, showed significantly greater increases in the competency in which they used fundamental and advanced MI strategies when using MI across seven intakes through a 16-week follow-up. There were no retention or substance use differences among the clients seen by clinicians in MIA: STEP or SAU. MIA: STEP was substantially more expensive to deliver than SAU. Innovative alternatives to resource-intensive competency-based supervision approaches such as MIA: STEP are needed to promote the implementation of evidence-based practices.

Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again.

“…Miller, Yahne, Moyers, Martinez, & Pirritano, 2004; Schoenwald, Sheidow, & Chapman, 2009), including CBT (Rakovshik, McManus, Vazquez-Montes, Muse, & Ougrin, 2016; Rakovshik et al, 2013; Sholomskas et al, 2005). The lack of supervision and monitoring of clinician implementation of evidence-based treatments in clinical practice suggests that CBT and other EBPs, in practice, may bear little resemblance to the more closely monitored versions of those treatments as implemented in randomized clinical trials demonstrating their efficacy (Martino et al, 2016). …”

Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial

“…Referring to audio or video tapes enables the supervisee to receive specific competencebased feedback, which is considered relevant for skills development [23]. Comparing supervision based on verbal reports (i.e., supervision as usual) with those based on video recordings of therapy sessions, Martino et al [24] demonstrated that the latter contributed more to competence development. Even so, regarding clinical supervision, only a limited number of systematic and controlled studies have been published to date [12,25].…”

“…Considering prior studies [24,52], we assume moderate competence differences between the groups (Cohens d = 0.60) and high correlations between competence ratings (r = 0.50). Given an α of 0.05 and a 1-β of 0.80 (power), a sample of 68 participants will be necessary in each experiment, resulting in an overall sample size of 136 (G*Power Version 3.1.9.2) [53].…”

Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists (Preprint)

“…The currently accepted method of training typically involves attending a specialist workshop, reading relevant texts and a subsequent period of supervision from someone expert in the treatment [6]. As this method is both labour-intensive and costly [7,8] and vulnerable to the shortage of treatment experts it limits the number of therapists that can be trained and therefore the number of people who might potentially receive effective treatment.…”