Effectiveness of Motivational Interviewing Supervision in Community Programs

January 10, 2017 updated by: National Institute on Drug Abuse (NIDA)

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.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

450

Phase

  • Phase 2
  • Phase 3

Contacts and Locations

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

Study Locations

  • United States
    • Connecticut
      • West Haven, Connecticut, United States, 06516
        • VA Connecticut Healthcare System

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

Ages Eligible for Study

18 years to 100 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

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.

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: RANDOMIZED
  • Interventional Model: FACTORIAL
  • Masking: SINGLE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: MIA: STEP
Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP)
Behavioral: MIA: STEP
Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (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.
Behavioral: SAU
Supervision-as-usual

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
client retention
Time Frame: 4-week and 12-week follow-up
The main outcome for the client participant trial is program retention at 4-week and 12-week followups after having received a 1-session intake. Program retention is defined as the the percent days of program attendances (days attended/# days scheduled) and percent sessions attended (sessions attended/# sessions scheduled) verified by administrative record and interview with clinical staff
4-week and 12-week follow-up

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
motivational interviewing adherence and competence
Time Frame: baseline, post-trial and 16-weeks post-trial
Change in clinician participant motivational interviewing (MI) adherence and competence will be measured from baseline to a post-trial point and from baseline to a 16-week post-trial follow-up point. The timeframe for the trial phase for each clinician participant will vary depending on how long it takes to be assigned and deliver the MI-base intake to 7 client participants.
baseline, post-trial and 16-weeks post-trial

Collaborators and Investigators

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

Sponsor

National Institute on Drug Abuse (NIDA)

Investigators

  • Principal Investigator: Steve Martino, Ph.D., Yale University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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

January 1, 2009

Primary Completion (ACTUAL)

September 1, 2013

Study Completion (ACTUAL)

May 1, 2014

Study Registration Dates

First Submitted

April 25, 2012

First Submitted That Met QC Criteria

April 25, 2012

First Posted (ESTIMATE)

April 27, 2012

Study Record Updates

Last Update Posted (ESTIMATE)

January 11, 2017

Last Update Submitted That Met QC Criteria

January 10, 2017

Last Verified

October 1, 2015

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • DESPR DA023230
  • R01DA023230 (NIH)

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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