Training Clinicians in Motivational Interviewing

New evidence-based treatments have been slow to be adopted into the routine practice of
addiction treatment, and traditional training methods are of limited effectiveness. In this
study, the investigators propose to continue development of methods for training clinicians
in Motivational Interviewing (MI), based on the principle of live supervision. Live
supervision (supervisor and trainee seeing a patient together) is common in basic training,
but rarely used in continuing education. In the initial funding period we developed
Teleconference Supervision (TCS), which implements live supervision by an expert through
teleconferencing technology, harnessing the principles of context-dependent learning,
differential reinforcement with immediacy of feedback, and modeling. Clinicians interview
standard patients at their home clinics, while Supervisors listen via telephone. The
clinician wears an earpiece, through which the Supervisor provides immediate feedback and
coaching designed to differentially reinforce and shape MI skills. In a randomized controlled
trial with community clinicians (N= 100), TCS produced superior overall MI skill, compared to
control conditions where clinicians received Workshop only training, or standard tape-based
supervision. Findings were encouraging yet the proportion of clinicians achieving expert
proficiency was limited, and there were trends toward loss of skill at follow-up, suggesting
longer training is needed to maximize and sustain MI skill.

In the new funding period, the investigators propose to build and improve upon TCS by testing
an extended model of Teleconference Supervision (TCS-Plus), which will preserve the elements
of live supervision from an expert supervisor but will also provide 4 sessions of enhanced
tape review supervision on a bi-weekly basis after the initial TCS training. Using telephone
technology, enhanced taped review allows the Supervisor and Clinician to listen to the taped
session together before discussing the session. Practice sessions will increase from 5 to 9
and be spread out from 8 to 16 weeks. Providing both TCS and enhanced tape review supervision
maximizes supervision style advantages. While both offer context dependent learning, TCS
provides for modeling and differential reinforcement with immediacy of feedback, and enhanced
tape review provides ample time to role play and discuss technique. TCS-Plus will be compared
to standard Tape Review supervision. The proposed project will be a StageI trial, intent on
maximizing the gains already detected with the TCS model. The investiators will assess if
TCS-Plus produces superior MI skill to standard Tape Review supervision in a randomized trial
with 130 community based-clinicians. It is hoped that, if successful, TCS-Plus could be a
model for remote training and supervision at community treatment programs, promoting adoption
of a variety of evidence-based treatments for substance use disorders into routine practice.

Inclusion Criteria:

1. Clinician, aged 18 to 75, employed in good standing at least 50% time at a licensed
substance abuse treatment program.

2. Carries a regular caseload of patients or clients for whom he/she serves as primary
therapist.

3. Interested in learning Motivational Interviewing and willing to follow treatment
guidelines and training protocol, including random assignment to groups.

4. Willing and able to attend a 2 day workshop, to tape subsequent sessions with patients
for evaluation of MI skillfulness by Training Team members and raters, and to
participate in supervision, including taping of sessions for review by Training Team
members and raters and/or having supervisor listen to, and comment on, live sessions.

Exclusion Criteria:

1. Planning to terminate employment at the current treatment program within the next six
months.

2. Has received credentialing as a Motivational Interviewing trainer, or served as a
Motivational Interviewing or Motivational Enhancement Therapy therapist in a clinical
trial which provided feedback on MI skill.

3. Has received formal training in Motivational Interviewing within the last three months