Training substance abuse clinicians in motivational interviewing using live supervision via teleconferencing.

Abstract

Background Training through traditional workshops is relatively ineffective for changing counseling practices. Tele-conferencing Supervision (TCS) was developed to provide remote, live supervision for training motivational interviewing (MI). Method 97 community drug treatment counselors completed a 2-day MI workshop and were randomized to: live supervision via tele-conferencing (TCS; n=32), standard tape-based supervision (Tape; n=32), or workshop alone (Workshop; n=33). Supervision conditions received 5 weekly supervision sessions at their sites using actors as standard patients. Sessions with clients were rated for MI skill with the Motivational Interviewing Treatment Integrity (MITI) coding system pre-workshop and 1, 8, and 20 weeks post-workshop. Mixed effects linear models were used to test training condition on MI skill at 8 and 20 weeks. Results TCS scored better than Workshop on the MITI for Spirit (mean difference = 0.76; p < .0001; d = 1.01) and Empathy (mean difference = 0.68; p < .001; d = 0.74). Tape supervision fell between TCS and Workshop, with Tape superior to Workshop for Spirit (mean difference = 0.40; p < .05). TCS was superior to Workshop in reducing MI non-adherence and increasing MI adherence, and was superior to Workshp and Tape in increasing the reflection to question ratio. Tape was superior to TCS in increasing complex reflections. Percentage of counselors meeting proficiency differed significantly between training conditions for the most stringent threshold (Spirit and Empathy scores ≥ 6), and were modest, ranging from 13% to 67%, for TCS and Tape. Conclusion TCS shows promise for promoting new counseling behaviors following participation in workshop training. However, further work is needed to improve supervision methods in order to bring more clinicians to high levels of proficiency and facilitate the dissemination of evidence-based practices.

Influence of Counselor Characteristics and Behaviors on the Efficacy of a Brief Motivational Intervention for Heavy Drinking in Young Men-A Randomized Controlled Trial

“…Clinicians having intrinsic competence for MI techniques and spirit, or those acquiring it rapidly might be as efficacious as more experienced ones. Counselors' training and supervision might lead in this direction (Miller et al, 2004;de Roten et al, 2013;Smith et al, 2012). Second, the present study supports the importance of counselor expectancy in relation to outcome within this young male sample.…”

Sustaining motivational interviewing: a meta‐analysis of training studies

“…Several studies have demonstrated this empirically, showing diminished skills among workshop participants at follow-up times as short as 2 months [2,6,7]. Whether enhancements or structural changes to a typical training workshop can influence the sustainability of MI skills has been a seldom-asked question.…”

Live-Supervision: Vom Einwegspiegel zur videobasierten Online-Supervision

“…In der Empirie gibt es Hinweise auf eine Verbesserung der therapeutischen Allianz, der Behandlungskompetenz und der Behandlungsadhärenz unter Live-Supervision [Frankel und Piercy, 1990;Kivlighan, et al, 1991;Smith et al, 2012]. Diese Studien sind die einzigen uns bekannten methodisch fundierteren Untersuchungen, die die Effektivität von Live-Supervision untersuchten.…”

“…Die in den Studien von Kivlighan et al [1991], Frankel und Piercy [1990] sowie Smith et al [2012] genutzten Live-Supervisionsformate gelten durch das für den Therapeuten unkontrollierbare Einwirken des Supervisors auf die Therapiesitzung als invasiv [Scherl und Haley, 2000]. Wenn man die verschiedenen Formate einzeln betrachtet, ergibt sich jedoch ein differenzierteres Bild.…”

“…Im Anschluss an eine BITE-Supervisionssitzung wurden die Therapeuten in Ausbildung, ihre Patienten und die Supervisoren gebeten, verschiedene auf die Sitzung bezogene Aussagen auf einer 4-stufigen Likert-Skala (1 = stimme gar nicht zu, 2 = stimme eher nicht zu, 3 = stimme eher zu, 4 = stimme völlig zu) zu treffen. Der Fragebogen basiert auf der «Purdue Live Observation Satisfaction Scale» [Sprenkle, et al, 1982] [Frankel und Piercy, 1990;Kivlighan et al, 1991;Smith et al, 2012]. Auch für die BITE-Supervisionsmethode als eine Form von Live-Supervision gibt es diesbezüglich erste Hinweise [Thurber, 2005].…”