Training, supervision and quality monitoring of the COMBINE Study behavioral interventions.

Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico 87131-0001, USA.
Journal of studies on alcohol. Supplement 08/2005; DOI: 10.15288/jsas.2005.s15.188
Source: PubMed

ABSTRACT Current standards for clinical trials require that behavioral interventions be thoroughly specified, that clinicians be well trained and closely supervised and that performance be carefully monitored to ensure and document treatment fidelity. This article describes procedures developed and implemented for this purpose in the COMBINE Study, a multisite trial combining medications and behavioral interventions for alcohol dependence.
Two behavioral treatments were tested in COMBINE: a Medical Management (MM) protocol to accompany the delivery of trial medications and a Combined Behavioral Intervention (CBI) designed as a comprehensive and flexible evidence-based psychotherapy.
Information is provided concerning (1) screening and qualifications of practitioners, (2) training and certification in the interventions, (3) on-site supervision and coordination of the two treatments, (4) central monitoring and coding of treatment sessions and (5) maintenance and documentation of treatment fidelity.
Both interventions were delivered with fidelity. Problems encountered and important choices made in the implementation of training and quality assurance for CBI and MM are briefly described.

Download full-text


Available from: Theresa B Moyers, Jan 08, 2015
  • Source
    • "; assessing suicide risk, stress, and resource needs; providing education about PTSD; engaging the patient to actively participate in their PTSD treatments; and using motivational interviewing techniques to encourage behavior change [59] [60] [61] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Posttraumatic stress disorder (PTSD) is a common problem in primary care. Although effective treatments are available, little is known about whether such treatments are effective within the context of Federally Qualified Health Centers (FQHCs) that serve as national "safety nets" for providing primary care for low income and underinsured patients. The Violence and Stress Assessment (ViStA) study is the first randomized controlled trial (RCT) to test the impact of a care management intervention for treating PTSD in FQHCs. To develop a PTSD management intervention appropriate for lower resource FQHCs and the predominantly Latino patients they serve, formative work was conducted through a collaborative effort between researchers and an FQHC practice-based research network. This article describes how FQHC stakeholders were convened to review, assess, and prioritize evidence-based strategies for addressing patient, clinician, and system-level barriers to care. This multi-component care management intervention incorporates diagnosis with feedback, patient education and activation; navigation and linkage to community resources; clinician education and medication guidance; and structured cross-disciplinary communication and continuity of care, all facilitated by care managers with FQHC experience. We also describe the evaluation design of this five-year RCT and the characteristics of the 404 English or Spanish speaking patients enrolled in the study and randomized to either the intervention or to usual care. Patients are assessed at baseline, six months, and 12months to examine intervention effectiveness on PTSD, other mental health symptoms, health-related quality-of-life, health care service use; and perceived barriers to care and satisfaction with care.
    Contemporary clinical trials 04/2014; 38(2). DOI:10.1016/j.cct.2014.04.005 · 1.99 Impact Factor
  • Source
    • "). Relapse rates at 6, 12, and 18 months. attributes tend to be highly intercorrelated (Elliot et al., 2011; Moyers, Miller, & Hendrickson, 2005). With clients randomly assigned to counselors, Valle compared the relapse rates for therapists who were high, medium, and low in Rogerian skills (Figure 1). "
    [Show abstract] [Hide abstract]
    ABSTRACT: One of the largest determinants of client outcomes is the counselor who provides treatment. Therapists often vary widely in effectiveness, even when delivering standardized manual-guided treatment. In particular, the therapeutic skill of accurate empathy originally described by Carl Rogers has been found to account for a meaningful proportion of variance in therapeutic alliance and in addiction treatment outcomes. High-empathy counselors appear to have higher success rates regardless of theoretical orientation. Low-empathy and confrontational counseling, in contrast, has been associated with higher drop-out and relapse rates, weaker therapeutic alliance, and less client change. The authors propose emphasis on empathic listening skills as an evidence-based practice in the hiring and training of counselors to improve outcomes and prevent harm in addiction treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
    Psychology of Addictive Behaviors 10/2012; 27(3). DOI:10.1037/a0030274 · 2.09 Impact Factor
  • Source
    • "Such a procedure has seldom been employed in MI training studies. An exception is the study by Miller et al. (2005), which used a pre-screen of demonstrated empathy prior to acceptance of practitioners for training. Other variables that might be useful for pre-screening are suggested by studies showing that basic clinical skills consistent with MI, educational level, and motivation to learn, result in better training outcomes (Baer et al., 2004, 2009; Miller et al., 2004; Moyers et al., 2008), as do lower endorsement of disease model beliefs and organizations encouraging staff to learn new treatment methods (Baer et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Acquiring proficiency in motivational interviewing (MI) may be more difficult than generally believed, and training research suggests that the standard one-time workshop format may be insufficient. Although nurses represent one of the professions that have received most training in MI, training in this group has rarely been systematically evaluated using objective behavioral measures. Aims: To evaluate an enhanced MI training program, comprising a 3.5-day workshop, systematic feedback on MI performance, and four sessions of supervision on practice samples. Methods: Nurses (n = 36) in Swedish child health services were trained in MI. Skillfulness in MI was assessed using the Motivational Interviewing Treatment Integrity (MITI) Code. Effects of training were compared to beginning proficiency thresholds. Results: Participants did not reach beginning proficiency thresholds on any of the indicators of proficiency and effect sizes were small. Conclusions: The present study adds to a growing body of literature suggesting that the current standard MI training format may not provide practitioners with enough skillfulness. Moreover, the results indicate that even enhanced training, including systematic feedback and supervision, may not be sufficient. Suggestions for improved MI training are made.
    Behavioural and Cognitive Psychotherapy 05/2012; 41(3):1-15. DOI:10.1017/S1352465812000331 · 1.69 Impact Factor
Show more