1. Training Community Treatment Providers in Research Interventions for Women with Addictions and PTSD Gloria M. Miele, Ph.D. Training Director, CTN Long Island Node/Columbia University National Conference on Women, Addiction and Recovery: News You Can Use Anaheim, CA, July 14, 2006

2. Training Elements and Issues Who was trained? What was the training format? What were the training topics? What follow-up was provided? What were the benefits and challenges?

3. CTN-0015 Trainers and Lead Node Supervisors Seeking Safety Women’s Health Education Lisa Najavits, Ph.D. Martha Schmitz, Ph.D. Lisa Litt, Ph.D. Lisa Cohen, Ph.D. Dawn Baird-Taylor, Ph.D. Gloria Miele, Ph.D.

4. Who Was Trained? All female staff Agreed to randomization, videotaping and research monitoring Demonstrated ability to conduct manualized, problem-solving session prior to randomization Had no prior experience with study interventions

5. Counselor and Supervisor Demographics Counselors n=18 Supervisors n=18 Age: M38.041.8 Race: N (%) White Black/African American Hispanic/Latina 9 (50.0) 5 (27.8) 4 (22.2) 12 (66.7) 5 (27.8) 1 (5.5) Yrs in Substance Abuse: M4.89.0 Years at Program: M3.94.8 Highest Degree: N (%) >Bachelors Degree Bachelors Degree Master ’ s Degree/Doctorate 1 (5.5) 7 (38.9) 10 (55.6) 1 (5.5) 2 (11.1) 15 (83.3) In Recovery: N (%) No Yes Prefer not to answer 13 (72.3) 4 (22.2) 1 (5.5) 15 (83.3) 2 (11.1) 1 (5.5)

6. Intervention-Specific Training Elements 3-day group training Explanation, demonstration and role-play Post-training certification Counselors and supervisors conducted pilot groups Supervisors coded counselors’ sessions and compared ratings with lead experts Train-the-trainer model Used for supervisor training

7. Training in Individual Orientation Session Conducted by counselor prior to participant’s entry into group Revealed randomization condition Provided overview of intervention Discussed ground rules of groups

8. Seeking Safety Topics Safety PTSD: Taking Back Your Power Detaching from Emotional Pain When Substances Control You Taking Good Care of Yourself Compassion Red and Green Flags Honesty Integrating the Split Self Creating Meaning Setting Boundaries in Relationships Healing from Anger

9. Women’s Health Education Topics Body Systems Female anatomy Breast care Infections HIV Contraception Pregnancy STDs Nutrition High Blood Pressure Diabetes Menopause

10. Training in Research-to-Practice Challenges The Therapeutic Misconception Research is not treatment Protocol adherence is key Avoiding cross-contamination Need to keep interventions separate Can’t share information with other colleagues or clients

11. Other Training and Implementation Issues Ongoing, on-site supervision Form completion Progress notes Adherence forms Other documentation

12. Ongoing Supervision and Monitoring Supervisors attended weekly supervision teleconferences with Lead Node experts in the respective intervention Calls included discussion of specific issues, review of session tapes and adherence ratings

13. Adherence Monitoring Counselors Supervisors rated 50% of cases and gave feedback based on ratings Cut-offs for continued participation in trial and guidelines for retraining Supervisors Lead node experts rated 25% of sessions rated by local supervisors and gave feedback on level of agreement

14. Counselor and Supervisor Benefits Expanded skills in delivering and supervising interventions Became more comfortable using treatment manuals and working explicitly with women with co-occurring disorders Sustainability and interest after conclusion of trial

15. Counselor and Supervisor Challenges Rolling admission groups and no-shows led to delays in providing interventions TTT model led to counselors feeling less involved in the process Adherence monitoring Counselor issues Supervisor issues Participant characteristics Time commitment

16. Summary Training, supervision and implementation require time and commitment from all levels of staff Involve counselors and supervisors in ongoing supervision from “lead node” Ensure adequate training in research process, procedures and special need of patient population