SBIR-STTR Award

Bridging the gap between science and practice has been identified as an area of major emphasis for NIDA and NIAAA. Manualized individual Twelve-Step Facilitation has been demonstrated to be effective in well-controlled, randomized clinical trials, but still not widely practiced outside of clinical research settings. Recent evidence suggests that comprehensive face-to-face training, geared to the needs of 'real world' clinicians, significantly improves clinician's knowledge and ability to implement TSF effectively relative to exposure to manuals alone. However, these training methods are time consuming, expensive, and may not be feasible to train large numbers of clinicians and alternatives are needed to provide a broader menu of training options for training large numbers of 'real world' clinicians to use scientifically validated treatments such as TSF. Computer-based training is a promising alternative for training clinicians in TSF. The overall aim of this Phase I SBIR is to develop a prototype computer based package for training clinicians to use TSF techniques and to conduct a pilot feasibility study to evaluate the impact of this training protocol on the ability of substance abuse counselors to deliver TSF competently in comparison to clinicians who read the manual only. Phase I, if successful, would provide preliminary evidence that computer-based training in TSF is feasible and effective for real-world clinicians. Specific aims for Phase I include the following: 1. Develop a single-session prototype of the Computer-Based Training for Twelve Step Faciliation Therapy ('CBT for TSF") training package. If the project is successful, these materials will be the building blocks of a more comprehensive package covering the full TSF manual to be developed in Phase II. 2. Evaluate the impact of the prototype "CBT for TSF" training compared to exposure to the TSF manual alone. We will randomize 30 substance abuse clinicians to two groups. One group will receive only the TSF manual. The second group will complete a single prototype session of the "CBT for TSF" in addition to the manual. Outcome measures will be collected before and after training and include a multiple choice test of the clinicians' knowledge of TSF principles, as well as the clinicians' effectiveness and competence in deliverin 9 TSF as assessed by a role play task.

Thesaurus Terms:
alcoholism /alcohol abuse therapy, computer assisted instruction, education evaluation /planning, educational resource design /development, medical education, physician, training clinical research, human subject

Bridging the gap between science and practice continues as a major problem in the effective delivery of treatments for alcohol abuse and dependence. Twelve Step Facilitation, an empirically supported therapy, is well positioned to bridge this gap. That is, although TSF is a highly structured manual driven approach, its basic tenets are familiar to many counselors and hence can be an effective 'bridge' to other empirically-supported, manualized approaches. In a randomized training study, we have demonstrated that intensive didactic training by ABR staff (Dr. Kathleen Carroll and Stu Baker, two of the original writers of the NIAAA Project MATCH TSF manual) dramatically increases 'real world1 substance abuse counselors' ability to implement TSF effectively, compared to simply reading the manual. However, standard training models, regardless of their effectiveness, are not feasible to train large numbers of clinicians. Computer-assisted training models, which offer greater flexibility in the location and timing of training, as well as a high level of interaction, the opportunity to view effective implementation of the treatment, and numerous other advantages, have not been explored as a strategy to train practitioners and their ability to implement empirically validated therapies. In Phase I of the proposed project, we developed a single introductory module of computer-based training program in TSF ("CBT for TSF") and then conducted a randomized pilot study evaluating its effectiveness compared with reading the manual among 25 substance abuse counselors. Even in this comparatively small sample, the prototype 'CBT for TSF1 program was associated with statistically significant differences in the counselors' ability to implement TSF, as measured by independent ratings of adherence and skill, as well as their knowledge of TSF, with large effect sizes (d=1.0). Thus, having met the a priori criteria for determining success for Phase I, we are now proposing a Phase II project in which we will complete the full "CBT for TSF" program and conduct a randomized training trial with 90 counselors. Counselors will be randomly assigned to one of three training conditions: Manual Only, the "CBT for TSF" program, or three days of face-to-face didactic training in TSF. The primary outcome will be pre-training/post-training independent ratings of the counselors' level of adherence and competence in delivering TSF, as measured by a standardized videotaped role play exercise.

Thesaurus Terms:
Computer Assisted Instruction, Counseling, Drug Abuse, Drug Abuse Therapy, Education Evaluation /Planning, Educational Resource Design /Development, Health Care Personnel Education, Self Help Organization, Training Computer Human Interaction, Handbook Clinical Research, Human Subject, Questionnaire, Videotape /Videodisc