Training Clinicians in Motivational Interviewing Using Tele- Conferencing Technology Bruce Goldman and Kenneth Carpenter

Training Clinicians in Motivational Interviewing Using Tele- Conferencing Technology Principal Investigator: E.V. Nunes, M.D. Project Director: Jennifer L. Smith, Ph.D. Carpenter, K.M., Brooks A., Amrhein, P., Levin, D., Schreiber, E.A., Travaglini, L.A.

Overview Disseminating new treatment techniques into community based practices remains a significant challenge. Traditional dissemination techniques include: – Distribution of printed materials – Didactic interactions: conferences, lectures, and workshops

Didactic Dissemination Outcome of Didactic Strategies: – BEST: increase knowledge and produce short term shifts in counseling behaviors. – WORST: have no effect on counselor behavior but strengthen an individual’s belief that they are proficient in the use of an intervention strategy.

Enhancement Strategies Sustained development of new counseling skills is more likely to be accomplished with: – Practice opportunities in a context that best approximates actual clinical encounters. – Post-instruction supervision. – The provision of direct feedback and coaching.

Study Aims Develop and test the efficacy of a post- instruction supervisory method that includes: – Training in a clinician’s clinical context – The provision of real time feedback and coaching – The use of standard communication technology (Telephone).

Participants Recruited from 26 community treatment programs 100 Counselors (94 completed training: MMTP n=50; Drug free outpatient n=32; Residential n=12). The focus of the training was on developing Motivational Interviewing counseling skills

Design Training FU1 FU2 Workshop 5 Tele-Conference Sessions 5 Taped-Based Sessions No Supervision Week 1-2Weeks 3 to 7Week 8Week 20 Pre- WksPost- Wks PatientsActorsPatients

Target Behaviors MI Spirit MI Empathy Percentage of Open Questions Percentage of Complex Reflections Reflection to Question Ratio MI Non-adherent behaviors

*TCS demonstrated better performance

Conclusion TCS demonstrated better performance on measures of: – MI Spirit – MI Empathy – Lower MI non-adherent behavior (compared to workshop only). – Tape supervision demonstrated a trend for better performance on complex reflections.