SBIR-STTR Award

Our recent series of innovative randomized trials evaluating the efficacy of various strategies for training clinicians to use evidence based therapies in alcohol and drug abuse has indicated that while both in-person workshop and computer-assisted training can impart the skills necessary to deliver Cognitive Behavioral Therapy (CBT) they are by no means sufficient in establishing competence. Rather, they are an essential first step in providing therapists with initial exposure to basic skills and strategies. To assure that clinicians implement this and other evidence based therapies consistently, effectively, and with adequate fidelity to manual guidelines, ongoing supervision and feedback via monitoring of clinicians' implementation of CBT are essential. However, there are no existing tools available for use by clinical supervisors to guide performance monitoring and feedback in clinicians' implementation of CBT. The overall aim of this Phase I SBIR is to develop a prototype CBT Supervisor's Toolkit and to conduct a pilot feasibility study to evaluate the effectiveness of the Toolkit on the ability of clinical supervisors in community-based addiction treatment settings to accurately evaluate clinicians' fidelity (e.g., adherence and competence) in delivering CBT. If successful, Phase I would provide preliminary evidence that the CBT Supervision Toolkit is feasible and effective in training clinical supervisors to accurately assess clinicians' fidelity and skill in CBT. Specific aims are as follows: 1. Develop a prototype of the CBT Supervisors Toolkit and supervisor workshop. If the Phase I project is successful, these materials will become the basis of a more comprehensive, interactive web-based version of the Toolkit for a Phase II application, which would be evaluated in a randomized trial of the impact of ongoing structured supervision on the ability of clinicians to conduct CBT effectively. 2. Conduct a randomized pilot trial evaluating the impact of the prototype CBT Supervision Toolkit and workshop on clinical supervisors' ability to evaluate clinicians' fidelity in delivering CBT. We will randomize 30 clinical supervisors recruited from community based clinics in New England to two groups: one group will receive the prototype CBT Supervision Toolkit and training via a workshop;the other will receive no formal training. The primary outcome measure will be condition by time differences in the supervisors' accuracy in completing the adherence/competence ratings (in comparison to a master set of expert ratings). We hypothesize that those assigned to the prototype Toolkit and workshop will have greater increases in the accuracy of their adherence and competence ratings compared to those who receive no training.

Public Health Relevance:
The overall aim of this Phase I SBIR is to develop a prototype Cognitive Behavioral Therapy (CBT) Supervisor's Toolkit and to conduct a pilot feasibility study to evaluate the effectiveness of the Toolkit on the ability of clinical supervisors in community-based addiction treatment settings to accurately evaluate clinicians' fidelity (e.g., adherence and competence) in delivering CBT. Supervision and feedback via monitoring of clinicians' application of CBT is essential to assure that clinicians implement CBT (and other evidenced based therapies) consistently, effectively and with sufficient fidelity to manual guidelines. If successful, Phase I would provide preliminary evidence that the CBT Supervision Toolkit is feasible and effective in training clinical supervisors to accurately assess clinicians' fidelity and skill in CBT.

Thesaurus Terms:
Aod Use;Address;Adherence;Adherence (Attribute);Alcohol Abuse;Alcohol Or Other Drugs Use;Behavior Conditioning Therapy;Behavior Modification;Behavior Therapy;Behavior Therapy, Cognitive;Behavior Treatment;Behavior Or Life Style Modifications;Behavioral;Behavioral Conditioning Therapy;Behavioral Modification;Behavioral Therapy;Behavioral Treatment;Clinic;Clinical;Cognitive;Cognitive Therapy;Communities;Competence;Computer Assisted;Computers;Conditioning Therapy;Drug Abuse;Educational Process Of Instructing;Educational Workshop;Effectiveness;Exposure To;Feasibility Studies;Feedback;Guidelines;Individual;Life Style Modification;Manuals;Measures;Medical;Modeling;Monitor;Multimedia;Multimedium;Niaaa;National Institute On Alcohol Abuse And Alcoholism;New England;Northeastern United States;On-Line Systems;Online Systems;Outcome;Outcome Measure;Performance;Persons;Phase;Play;Population;Psychotherapy, Cognitive;Qualifying;Rfp;Randomized;Randomized Clinical Trials;Reading;Recruitment Activity;Request For Proposals;Role;Sbir;Sbirs (R43/44);Sampling;Self Assessment;Self Assessment (Psychology);Series;Small Business Innovation Research;Small Business Innovation Research Grant;Structure;Supervision;System;System, Loinc Axis 4;Teaching;Therapy, Cognition;Time;Training;Training Programs;Videotape;Workshop;Abuse Of Drugs;Abuses Drugs;Addiction;Alcohol Problem;Alcohol Use Disorder;Base;Behavior Intervention;Behavioral Intervention;Clinical Practice;Cognitive Behavior Intervention;Cognitive Behavior Modification;Cognitive Behavior Therapy;Cognitive Behavioral Intervention;Cognitive Behavioral Modification;Cognitive Behavioral Therapy;Community;Comparative Efficacy;Computer Aided;Computerized;Ethanol Abuse;Ethanol Use Disorder;Evidence Base;Hazardous Alcohol Use;Innovate;Innovation;Innovative;Model;Motivational Enhancement Therapy;Motivational Interview;Online Computer;Pilot Trial;Primary Outcome;Problem Drinking;Prototype;Randomisation;Randomization;Randomized Trial;Randomly Assigned;Recruit;Response;Skills;Social Role;Substance Use;Therapy Adherence;Tool;Trial Comparing;Web Based

ABR's recent series of innovative randomized trials evaluating the efficacy of various strategies for training clinicians to use evidence based therapies in alcohol and drug abuse has indicated that while both in-person workshop and computer-assisted training can impart the skills necessary to deliver Cognitive Behavioral Therapy (CBT), they are not sufficient in establishing competence. Workshop training is an essential first step in providing therapists with initial exposure to basic skills and strategies, ut to assure that clinicians implement CBT and other evidence based therapies consistently, effectively, and with adequate fidelity, ongoing supervision and feedback via monitoring of clinicians' implementation of CBT are essential. However, there are no existing tools available for use by clinical supervisors to guide performance monitoring and feedback in clinicians' implementation of CBT. The aim of this Phase II SBIR is to develop a supervision toolkit for CBT and to conduct a randomized training trial to evaluate the effectiveness of the CBT Supervisor's Toolkit on the ability of clinical supervisors in community-based settings to accurately evaluate clinicians' fidelity (e.g., adherence and competence) in delivering CBT. We have successfully completed Phase I and have demonstrated the feasibility and promise of a prototype version of the CBT Toolkit in training clinical supervisors to accurately monitor and provide effective feedback on clinicians' fidelity and skill in CBT. Specific aims for Phase II include the following 1. Complete a full web-based multimedia training program for the CBT Supervisors Toolkit. The program would be modeled on the highly successful supervisor's toolkit for Motivational Interviewing developed by Dr. Carroll and colleagues for Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP, ://www.nida.nih.gov/blending). Accuracy in using the supervisor rating form and independent ratings of skill in providing CBT supervision, and submission of a taped example of a supervisory session that demonstrates adequate skill (clarity, completeness, support) would serve as basic criteria for certifying qualified individuals as CBT supervisors. 2. Conduct a randomized trial in which 105 clinical supervisors would be randomized to (1) the CBT Supervisor's Toolkit website, (2) a two day didactic training or (3) reading the CBT manual alone. Outcomes will include independent ratings of the supervisors' ability to conduct an effective feedback/ supervision session, the ability of the supervisors to accurately assess clinicians' adherence and competence in delivering CBT, satisfaction with training, and relative costs of the three approaches. The development and systematic evaluation of the Toolkit represents the next major step broadening the availability of high quality training and supervision in CBT and thus addresses a major gap in the ability of clinical programs to implement this and other evidence based practices (EBP) effectively.

Public Health Relevance Statement:


Public Health Relevance:
The development and systematic evaluation of the CBT Toolkit represents the next major step broadening the availability of high quality training and supervision in CBT and thus addresses a major gap in the ability of clinical programs to implement this and other evidence based practices (EBP) effectively.

NIH Spending Category:
Alcoholism; Clinical Research; Clinical Trials; Substance Abuse

Project Terms:
addiction; Address; Adherence (attribute); Alcohol abuse; base; Clinical; clinical practice; Cognitive Therapy; Communities; Competence; Computer Assisted; cost; Development; Drug abuse; Educational process of instructing; Educational workshop; Effectiveness; Evaluation; evidence base; Evidence based practice; Exposure to; Feedback; Guidelines; Individual; innovation; Life; Manuals; Modeling; Monitor; motivational enhancement therapy; Multimedia; Online Systems; Outcome; Participant; Performance; Persons; Phase; Play; Population; programs; prototype; public health relevance; Qualifying; Randomized; Randomized Clinical Trials; randomized trial; Reading; Relative (related person); Role; Sampling; satisfaction; Self Assessment (Psychology); Series; skills; Small Business Innovation Research Grant; Supervision; tool; Training; Training Programs; Videotape; web site