1. T HE RELATIONSHIP OF COUNSELOR - LEVEL VARIABLES TO INTERVENTION ADOPTION Joseph Guydish, Holly Fussell, Sarah Turcotte Manser, Lynn E. Kunkel, Mable Chan, & Dennis McCarty AHSR 2010 Lexington, Kentucky This work was supported by NIDA R01DA025600 and the Western States Research Node of the NIDA Clinical Trials Network (U10 DA015815 )

2. A DOPTION OF E VIDENCE -B ASED P RACTICES (EBP S ) ● One goal of the CTN is to translate EBPs shown to be effective into clinical practice ● EBPs are tested in multi-site clinical trials ● Clinicians and supervisors trained ● Opportunity to try a new intervention ● What happens to the EBP once the trial ends?

3. S PACESHIP RCT Clinical Trial Resources Adherence Admin Setting Usual Staff Training Intervention Motivations Interests Supervisor

4. Matrix Clinical Trial Interviews (n=42) Intervention Designer1 Clinical Trial Funder2 Steering Committee Member3 Coordinating Center4 Site Principal Investigator7 Site Evaluator5 Clinic Director6 Clinical Staff14 Interviews were completed 2-12 months after treatment phase completion Adoption of Matrix Following Clinical Trial Adoption of Matrix at 8 clinics Qualitative interviews at multiple levels Transcribed and coded

5. No Opportunity No Adoption Counselor Adoption Partial Adoption Adoption Clinics24011 Adoption of Matrix at Clinic Sites Guydish, J., Turcotte Manser, S., Jessup, M., Tajima, B., Sears, C., & Montini, T. (2005) Multi-level assessment protocol (MAP) for adoption in multi-site clinical trials, Journal of Drug Issues. 35, 529- 546.

6. Organizational No Opportunity No Adoption Counselor (Toolbox) Adoption Partial Adoption Adoption Clinics02111 Adoption of MI/MET at Clinic Sites Guydish, J., Jessup, M., Tajima, B., Turcotte Manser, S. (2010) Adoption of Motivational Interviewing and Motivational Enhancement Therapy following clinical trials. Journal of Psychoactive Drugs, 6, 215-226.

7. CTN 0031 STAGE-12: S TIMULANT A BUSER G ROUPS TO E NGAGE IN 12-S TEP ● Twelve Step Facilitation ● 10 sites ● Stimulant Users ● 5 group sessions and 3 individual sessions

8. R ELATIONSHIPS IN T RANSLATIONAL R ESEARCH, A LIGNED WITH S TAGE -12 C LINICAL T RIAL Pre-STAGE 12During STAGE 12 StudyPost STAGE 12 OrganizationalVariablesCounselorFactorsAdoption (Qualitative Measure (Qualitative Measure ) ImplementationFidelityClientOutcomes

9. S UMMARY OF M EASURES Pre-STAGE 12 Staff Survey (119 Counselors) ATSG (General 12 step attitudes) SIGCS (Goal Commitment) During STAGE 12 Implementation Fidelity (29 Counselors) Overall Skill and Fidelity Proscribed Behaviors Empathy During STAGE 12 Client Outcomes: Days stimulant use in past 30 Post-STAGE 12 Adoption: Qualitative Interviews ATSG: Laudet, A.B.; White, W.L. (2005) An exploratory investigation of the association between clinicians' attitudes toward twelve-step groups and referral rates. Alcohol Treatment Quarterly, 23 (1), 31-45. SIGCS: Hollenbeck, J.R., C.R. Williams, & H. Klein (1989). “An empirical examination of the antecedents of commitment to difficult goals.” Journal of Applied Psychology, 74(1): 12-23.

10. STAGE-12 Counselors n=29 Non-STAGE-12 Counselors n=90 P-value Mean (std) Age 52.0 (8.3)47.4 (11.6)0.051 Years of Counseling Experience 12.3 (6.5)10.6 (11.4)0.30 Years of working at agency 6.5 (5.7)6.2 (11.1)0.90 Years of formal education 16.6 (2.1)15.8 (4.6)0.19 General 12 step items scale 9.0 (1.0)8.19 (1.6)0.001 Goal commitment scale 4.2 (0.6)4.0 (0.6)0.032 N(%) Recovery 15 (52%)35 (39%)0.25 GenderFemale 21 (72%)65 (72%)0.82 Race African American 5 (17%)17 (19%) 1.0 Caucasian 21 (72%)63 (70%) Others 2 (7%)7(8%) Descriptive Statistics for STAGE-12 counselors as compared to non-STAGE-12 counselors in survey data (n=119)

11. Simple Regression Models (n=29): Baseline variables predicting fidelity outcomes ProscribedEmpathyOverall Age 0.021 (-0.012, 0.053) 0.20 -0.0039 (-0.053, 0.045) 0.87 -0.020 (-0.060, 0.020) 0.31 Years of counseling experience -0.0042 (-0.047, 0.039) 0.84 0.012 (-0.051, 0.075) 0.69 0.011 (-0.041, 0.063) 0.66 Years of working at agency -0.0027 (-0.052, 0.046) 0.91 0.0071 (-0.065, 0.079) 0.84 0.015 (-0.044, 0.075) 0.60 Years of formal education -0.061 (-0.19, 0.070) 0.35 0.063 (-0.13, 0.26) 0.51 0.098 (-0.059, 0.26) 0.21 Gender 0.64 (-0.013, 1.30) 0.0543 -0.63 (-1.63, 0.37) 0.20 -0.75 (-1.53, 0.025) 0.057 Recovery 0.35 (-0.20, 0.90) 0.21 -0.26 (-1.053, 0.54) 0.51 -0.14 (-0.82, 0.53) 0.66 Caucasian 0.29 (-0.32, 0.89) 0.34 0.45 (-0.44, 1.33) 0.31 0.15 (-0.60, 0.89) 0.69 General 12-step Scale 0.078 (-0.19, 0.35) 0.56 -0.24 (-0.63, 0.15) 0.22 -0.22 (-0.54, 0.10) 0.18 Goal Commitment Scale -0.48 (-0.93, -0.035) 0.0356 0.25 (-0.45, 0.95) 0.47 0.17 (-0.42, 0.75) 0.56

12. Regression Models (n=29): Baseline variables predicting fidelity outcomes ProscribedEmpathyOverall Age 0.0050 (-0.029, 0.039) 0.76 0.023 -0.032, 0.078) 0.39 0.0017 (-0.042, 0.045) 0.94 Gender 0.57 (-0.070, 1.22) 0.0780 -0.53 (-1.59, 0.52) 0.31 -0.62 (-1.45, 0.21) 0.14 General 12-step Scale 0.13 (-0.17, 0.43) 0.37 -0.38 (-0.87, 0.11) 0.12 -0.25 (-0.63, 0.14) 0.20 Goal Commitment Scale -0.60 (-1.077, -0.13) 0.0150* 0.59 (-0.19, 1.36) 0.13 0.43 (-0.18, 1.040) 0.16 *significant at 0.05 level

13. Summary 1.STAGE 12 counselors older, + 12 step attitudes, higher goal commitment 2.For 12 step counselors Women had lower proscribed behaviors and higher overall fidelity implementation 3.In regression predicting implementation: Goal Commitment, gender predict proscribed beh.