Supervision in Substance Use Disorder Treatment Programs

December 4, 2025 updated by: University of Arkansas

Supervision Strategy for Substance Use Disorder Treatment Programs: A Pilot Study

Substance use disorders such as opioid addiction affect millions of adults in the United States each year, but the delivery of high-quality, effective addiction services is disrupted by organizational issues such as counselor burnout and turnover. Clinical supervisors are essential for supporting counselors in specialty addiction treatment programs, but few supervisors receive supervision-focused training. This project seeks to develop and pilot an evidence-based supervision strategy that has a high potential to enhance supervision and result in improved counselors' well-being and performance and, in turn, to improve client outcomes.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Substance use disorders (SUDs) such as addiction to opioids, methamphetamines and alcohol are a significant burden in the US, affecting almost 50 million individuals annually. Community specialty SUD treatment programs ("SUD programs") are a key type of SUD providers and while effective treatments for SUD exist, significant issues in the organization and delivery of SUD programs (e.g., burnout, turnover) undermine the delivery of high-quality services. Clinical supervisors are centrally positioned to support SUD counselors (frontline clinical providers) and ensure high service quality. For clinical supervisors to effectively support counselors, they need evidence-based supervision strategies. Currently, supervisors in community SUD programs receive very little training, support, and direction for supervision, and thus their supervision practices are highly variable, raising concern about the effectiveness of clinical supervision as currently provided in these programs. Evidence-based supervision strategies can help fill the gap, and evidence from child welfare settings shows they improve leadership, climate, and client outcomes. Based on our preliminary formative work with SUD providers in Arkansas, a reinforcement-based supervision strategy developed for counselors was deemed acceptable and feasible in SUD programs, and had high perceived potential to improve supervision quality, counselor well-being and performance, and client outcomes. Participants thought the structure and content of the strategy were a good fit for SUD settings. However, for a supervision strategy to be supportive of the work they do, it needs to be developed to reflect the language, case examples, and organizational factors relevant to the SUD settings. The goals of our study are to iteratively develop and refine a supervision strategy for SUD settings, and to pilot it in residential treatment programs using quality improvement and implementation science tools and approaches. Aim 1 involves leveraging previous experience developing supervision strategies and partnering with SUD providers to develop and refine the supervision strategy for SUD. Using the Evidence-Based Quality Improvement (EBQI) process, we will engage SUD partners in a series of collaborative meetings to review and discuss the supervision strategy and related study materials, and to make key decisions. The output of this work will be a refined and optimized SUD supervision strategy. Aim 2 involves conducting two pilot cycles with supervisors and counselors in a sample of SUD residential treatment programs to assess the feasibility and acceptability of the supervision strategy, examine its impact on key organizational, counselor, and client outcomes, and to document barriers and facilitators for its implementation and sustained use in routine practice. This study will provide key information to inform planning and design of a future fully powered study to assess the effectiveness of the new supervision strategy in a large sample of SUD programs.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
43

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • United States
    • Arkansas
      • Little Rock, Arkansas, United States, 72205
        • Recruiting
        • University of Arkansas for Medical Sciences
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Serves as a supervisor (i.e., oversee work of counselors) or counselor (i.e., directly work with clients) at a substance use treatment facility/program
  • Program/facility provides residential services

Exclusion Criteria:

  • Supervisors contracted (not employed) by the facility

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Supervision arm
Supervisors will be trained and coached in a new supervision strategy (FOCUS)
Other: FOCUS supervision strategy
The FOCUS supervision strategy provides a strenghts-based model for supervision. It is built around three core components: (1) Five pillars for effective supervision interactions, (2) practical skills that operationalize these principles, and (3) a set of experiential activities that provide foundational learnings for staff to practice the skills around real-life situations (from which future client-specific interventions can be built). In this study, FOCUS is being tailored for SUD treatment settings.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Counselor self-efficacy
Time Frame: Every 6 months for 2 years
Self-reported survey response at the counselor level (Efficacy subscale on TCU ORC; 1-5 Likert scale, higher scores are better; Lehman WEK, Greener JM, Simpson DD. Assessing organizational readiness for change. J Subst Abuse Treat. 2002;22(4):197-209. doi: 10.1016/S0740-5472(02)00233-7.)
Every 6 months for 2 years

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Supervisor fidelity to FOCUS
Time Frame: Monthly, 2 years
Expert rated fidelity to FOCUS at the supervisor level (measure to be developed as part of the study)
Monthly, 2 years
Counselor performance
Time Frame: Every 6 months, for 2 years
Supervisor ratings of counselor performance (based on annual performance evaluations in use at the facilities)
Every 6 months, for 2 years
Organizational performance/outcomes - turnover
Time Frame: Every 6 months, for 2 years
Objective measures of employee turnover rate (at program level)
Every 6 months, for 2 years
Organizational performance/outcomes - client treatment completion
Time Frame: Every 6 months, for 2 years
Objective measures of client treatment completion rate (at program level)
Every 6 months, for 2 years
Organizational performance/outcomes - client satisfaction
Time Frame: Every 6 months, for 2 years
Client-reported satisfaction levels (at program level; as routinely collected by programs)
Every 6 months, for 2 years
FOCUS acceptability
Time Frame: Every 6 months, for 2 years
Supervisor perceptions of acceptability (satisfaction, appeal) of FOCUS and related materials (Acceptability of Intervention Measure [AIM], 1-5 Likert scale, higher scores are better; Weiner BJ, Lewis CC, Stanick C, et al. Psychometric assessment of three newly developed implementation outcome measures. Implementation Science. 2017;12:1-12. doi: 10.1186/s13012-017-0635-3.)
Every 6 months, for 2 years
FOCUS feasibility
Time Frame: Every 6 months, for 2 years
Supervisor perceptions of feasibility (ease of use, "do-ability") of FOCUS and related materials (Feasibility of Intervention Measure [FIM], 1-5 Likert scale, higher scores are better; Weiner BJ, Lewis CC, Stanick C, et al. Psychometric assessment of three newly developed implementation outcome measures. Implementation Science. 2017;12:1-12. doi: 10.1186/s13012-017-0635-3.)
Every 6 months, for 2 years
Leadership - implementation leadership
Time Frame: Every 6 months, for 2 years
Counselor perceptions of supervisors' support for ESTs (Implementation Leadership Scale [ILS], 1-5 Likert scale, higher scores are better; Aarons GA, Ehrhart MG, Torres EM, Finn NK, Roesch SC. Validation of the implementation leadership scale (ILS) in substance use disorder treatment organizations. J Subst Abuse Treat. 2016;68:31-35. doi: 10.1016/j.jsat.2016.05.004.)
Every 6 months, for 2 years
Leadership - clinical supervision
Time Frame: Every 6 months, for 2 years
Counselor perceptions of supervisor instrumental assistance (Clinical Supervision, 1-5 Likert scale, higher scores are better; Knudsen HK, Ducharme LJ, Roman PM. Clinical supervision, emotional exhaustion, and turnover intention: A study of substance abuse treatment counselors in the clinical trials network of the national institute on drug abuse. J Subst Abuse Treat. 2008;35(4):387-395. doi: 10.1016/j.jsat.2008.02.003.)
Every 6 months, for 2 years
Organizational Social Context - implementation climate
Time Frame: Every 6 months, for 2 years
Supervisor and counselor shared perceptions of organizational expectations of, and support and reward for EST use (Implementation Climate Scale [ICS], 1-5 Likert scale, higher scores are better; Ehrhart MG, Torres EM, Hwang J, Sklar M, Aarons GA. Validation of the implementation climate scale (ICS) in substance use disorder treatment organizations. Substance abuse treatment, prevention, and policy. 2019;14(1):1-10. doi: 10.1186/s13011-019-0222-5.)
Every 6 months, for 2 years
Organizational Social Context - organizational climate
Time Frame: Every 6 months, for 2 years
Supervisor and counselor shared perceptions of organizational environment (Mission, Cohesion, and Stress subscales from TCU ORC; and Effort subscale from the Patterson Organizational Climate Measure; 1-5 Likert scale, higher scores are better; responses will be aggregated across subscales for primary analyses; Lehman WEK, Greener JM, Simpson DD. Assessing organizational readiness for change. J Subst Abuse Treat. 2002;22(4):197-209. and Patterson MG, West MA, Shackleton VJ, et al. Validating the organizational climate measure: Links to managerial practices, productivity and innovation. J Organ Behav. 2005;26(4):379-408. doi: 10.1002/job.312.)
Every 6 months, for 2 years
Counselor functioning - burnout
Time Frame: Every 6 months, for 2 years
Counselor perceptions of being overextended and depleted of emotional and physical resources (Emotional Exhaustion on Maslach Burnout Inventory; 1-5 Likert scale, lower scores are better; Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav. 1981;2(2):99-113. doi: 10.1002/job.4030020205.)
Every 6 months, for 2 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Arkansas

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
National Institute on Drug Abuse (NIDA)
Chestnut Health Systems

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
July 21, 2025

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
May 31, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
June 30, 2027

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
November 12, 2025

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 21, 2025

First Posted (Estimated)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
December 3, 2025

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
December 11, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
December 4, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
December 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 297361
  • R34DA060419 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Individual data will include observational data on supervisor fidelity (expert ratings); survey data on leadership, organizational social context, and counselor functioning (self-reported by counselors and/or supervisors); and interview data with leadership, supervisors, and counselors based on semi-structured interview guides informed by the study conceptual model and implementation science framework.

IPD Sharing Time Frame

Estimated in 2027 (at study conclusion and submission of manuscripts); We will archive our data in NAHDAP (https://www.icpsr.umich.edu/web/pages/NAHDAP/) following the Restricted-Use Data Deposit and Dissemination Procedures.

IPD Sharing Access Criteria

We will archive our data in NAHDAP following Restricted-Use Data Deposit and Dissemination Procedures.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • ANALYTIC_CODE

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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