Moving Empirically Supported Practices to Addiction Treatment Programs: Recruiting Supervisors to Help in Technology Transfer

Abstract

Federal and state funding agencies are encouraging or mandating the use of empirically supported treatments in addiction programs, yet many programs have not moved in this direction (Forman, Bovasso, and Woody, ; Roman and Johnson, ; Willenbring et al., ). To improve the skills of counselors in community addiction programs, the authors developed an innovative Web-based course on Cognitive Behavioral Therapy (CBT), a widely accepted empirically-supported practice (ESP) for addiction. Federal funding supports this Web course and a randomized controlled trial to evaluate its effectiveness. Since supervisors often play a pivotal role in helping clinicians transfer learned skills from training courses to the workplace, the authors recruited supervisor-counselor teams, engaging 54 supervisors and 120 counselors. Lessons learned focus on supervisor recruitment and involvement, supervisors’ perceptions of CBT, their own CBT skills and their roles in the study, and implications for technology transfer for the addiction field as a whole. Recruiting supervisors proved difficult because programs lacked clinical supervisors. Recruiting counselors was also difficult because programs were concerned about loss of third-party reimbursement. Across the addiction field, technology transfer will be severely hampered unless such infrastructure problems can be solved. Areas for further investigation are identified.

RÉSUMÉ

Passage des traitements empiriques vers programmes de dépendance: Recrutement de superviseurs afin d’aider le transfert de technologie

Les fondations fédérales et nationales encouragent ou mandatent l’utilisation de traitement empirique dans le cadre des programmes de traitement des dépendances, néanmoins à ce jour de nombreux programmes n’ont pas encore bougé dans cette direction (Forman et al., ; Roman and Johnson, ; Willenbring et al., ). Afin d’améliorer les connaissances des conseillers sur les programmes communautaires contre les dépendances, les auteurs ont développé un cours innovant sur le web concernant la théorie comportementale et cognitive (TCC), un traitement empirique et largement accepté contre les dépendances. La fondation fédérale finance ce cours web et un essai aléatoire contrôle afin d’estimer son efficacité (uniquement la collection des données de recrutement et de base sont complètes; l’essai est encore en cours). Les superviseurs jouant souvent un rôle central en aidant les cliniciens à mettre en pratique les connaissances apprises lors des cours, les auteurs recrutent des équipes de superviseurs-conseillers et embauchent 54 superviseurs ainsi que 120 conseillers. Les leçons étudiées se focalisent sur le recrutement et l’implication des superviseurs, la perception qu’ont ceux-ci sur le TCC, leur connaissance du TCC ainsi que leur rôle dans le transfert de technologie dans le domaine de la dépendance dans sa globalité. Recruter des superviseurs s’est avéré difficile car les programmes manquent de superviseurs cliniques. Le recrutement des conseillers fut également difficile car les programmes s’intéressent à la perte de remboursement par un tiers. Dans le domaine de la dépendance, le transfert de technologie sera sévèrement entravé sauf si les problèmes d’infrastructure peuvent être résolus. D’autres domaines d’investigation ont été identifiés.

RESUMEN

Moviendo tratamiento empírico a programas de adicción: Recrutando supervisores para ayudar en la transferencia de tecnología

Las agencias federales y las que reciben fondos estatales están animando u obligando el uso de tratamientos empíricamente apoyados en programas para el tratamiento de la adicción, sin embargo, muchos programas todavía no han avanzado en esa dirección (Forman et al., ; Roman and Johnson, ; Willenbring et al., ). Para mejorar las habilidades de los consejeros en programas de adicción en la comunidad, los autores desarrollaron un curso innovador basado en el Web sobre la terapia cognitiva-conductual (TCC), una forma de tratamiento apoyado empíricamente y aceptado ampliamente para el tratamiendo de la addicción. Los fondos federales apoyan este curso en el web y un estudio controlado con selección al azar, para evaluar su efectividad (solo el recrutamiento y la colección de datos de base están completados, el estudio todavía está en proceso). Dado que los supervisores a menudo desempeñan un papel fundamental en ayudar a los consejeros clínicos a transferir habilidades aprendidas en cursos para mejorar su trabajo, los autores recrutaron equipos de supervisores y consejeros; participaron 54 supervisores y 120 consejeros. Las lecciones aprendidas se enfocan en el recrutamiento y la participación de los supervisores, las percepciones sobre la terapia cognitiva-conductual (TCC), sus proprias habilidades en la terapia TCC, sus roles en el estudio, y las implicaciones para la transferencia de tecnología en el campo de la adicción. Recrutar supervisores fue difícil porque los programas carecen de supervisores clínicos. El recrutar supervisores también fue difícil porque los programas temían perder el reembolso o pagos de parte terciaria. La transferencia de tecnología en el campo de la adicción será gravemente obstaculizada si estos problemas de infraestructura no pueden ser resueltos. Otras áreas de investigación fueron identificadas.

Keywords :

• addiction agencies
• supervisors
• counselors
• empirically-supported practices (ESPs)
• cognitive-behavioral treatment (CBT)
• innovative Web-based course
• supervisor-counselor teams
• technology transfer
• transfer of training

THE AUTHORS

Maryann Amodeo, M.S.W., Ph.D., is Professor of Clinical Practice and Co-director, Center for Addiction Research and Services, Boston University School of Social Work. Dr. Amodeo's research has focused on effects of parental alcoholism on the adult adjustment of women, treatment paths of addicted clients, Web-based methods to teach evidence-based treatment methods to addiction program staff, and prevention and treatment for refugee and immigrant groups.

Susan A. Storti, PhD, RN, CARN-AP is the Project Director of the National Institute on Drug Abuse Blending Research and Practice contract and is the former Director of the Addiction Technology Transfer Center of New England at Brown University's Center for Alcohol and Addiction Studies. She holds an adjunct faculty positions at Rhode Island College and the University of Nevada, and is a Professor at Roger Williams Hospital Nursing Center for Practice and Education. Since 1993, Dr. Storti has been responsible for facilitating system change through the translation, implementation and adoption of research-based approaches in the treatment of addictive disorders into clinical practice. She has an extensive background working with chemically dependent patients in primary health care settings and in community based substance abuse treatment agencies.

Mary Jo Larson, PhD, MPA has conducted health services research and clinical trials to improve treatment outcomes for over 15 years and specializes in access to and quality of addiction care delivered in primary care and substance abuse service delivery systems. Dr. Larson is the PI of a randomized trial funded by NIDA to develop and evaluate a web-based, multi-module, training program for clinicians in substance abuse agencies. Formerly the Director of the Institute on Health Services Research and Policy at New England Research Institutes, she received small business research awards from NIH to develop innovative web-based continuing education programs for counselors and primary care clinicians on alcohol assessment, treating compulsive hoarding, and treating addictions, and an award from the Department of Defense to implement a training program and randomized trial for mental health clinicians on using cognitive behavioral skills to treat PTSD in veterans.