Archive for the ‘Uncategorized’ Category

Measures of Clinicians’ Skills Post-CM-Training Predict Subsequent Client Outcomes

January 9, 2017

counselor client_138711347The implementation of evidence-based behavior therapies for routine use in addiction care settings remains a challenge.  A prominent issue involves fidelity, or clinician capability to skillfully deliver an intervention as intended and thereby offer therapy-exposed clientele an opportunity to approximate the therapeutic outcomes reported in corresponding efficacy trials.  If an evidence-based intervention is not delivered correctly, it may not be as effective for clients as it was in the studies that make up its evidence base in the first place.

One widely studied behavior therapy for substance use disorders is contingency management (CM), which involves the use of tangible reinforcers to encourage clients to demonstrate identified behaviors such as session attendance or medication adherence.

This study examined the links between post-training assessment of clinician skills in delivering CM and outcomes for their CM-exposed clients.

Nineteen direct-care clinicians affiliated with one of the community treatment programs in the Pacific Northwest Node of the NIDA Clinical Trials Network were examined, comparing post-training implementation domains (assessed using standardized patients) to a targeted outcome of subsequently CM-exposed clients.

Clinicians’ skillfulness, a behavioral measure of their capability to skillfully deliver the intended CM intervention, was found to be a robust and specific predictor of their subsequent client outcomes.

Analyses also revealed CM skillfulness to:

  1. fully mediate an association between a general therapeutic effectiveness and client outcome,
  2. partially mediate an association of in-training exposure to CM and client outcomes, and
  3. be composed of six component clinical practice behaviors that each contributed meaningfully to this behavior fidelity index.

Conclusions: Study findings offer preliminary evidence of the predictive validity of post-training CM skillfulness for subsequent client outcomes. This suggests an apparent value in providing skills-focused training in CM, and perhaps other empirically-supported behavior therapies.

Skills-focused training does not necessarily preclude trainer use of didactic and discussion elements in CM training curricula, presumably for purposes of enhancing clinician knowledge of core operant conditions principles and practices, as well as to dispel myths and misconceptions that deter adoption readiness. However, current findings provide preliminary evidence to suggest such passive learning strategies are insufficient if the goal of behavior therapy training is to prepare a workforce to effectively implement a new approach.

Citation: Hartzler B, et al. Predictive Validity of Addiction Treatment Clinicians’ Post-Training Contingency Management Skills for Subsequent Clinical Outcomes. Journal of Substance Abuse Treatment 2017;72:126-133.


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Measuring Implementation Fidelity for Culturally-Adapted HIV Prevention Intervention

August 13, 2013

minoritymalesThis study, co-written by Mary Hatch-Maillette and Don Calsyn of the Pacific Northwest Node, along with colleagues from the CTN, assessed the reliability of the Fidelity Rating and Skill Evaluation (FRASE) instrument, a scale developed for use with the Real Men Are Safe-Culturally Adapted (REMAS-CA) intervention. REMAS-CA is a an adaptation for ethnically diverse men of the original REMAS, an HIV prevention intervention for men in substance abuse treatment, found effective in reducing sexual risk behaviors in National Drug Abuse Treatment Clinical Trials Network protocol CTN-0018.

Results showed that the FRASE was a reliable instrument for measuring the fidelity of REMAS-CA delivery, and therapists achieved adequate adherence and competence after training, demonstrating significant improvement over time. Sessions 4 and 5 of the REMAS-CA were found to contain the most challenging modules for therapists to deliver.

Conclusions: These findings offer some guidelines for increasing counselor competence in implementing REMAS-CA for research or clinical practice. Specifically, more effort should be spent on training counselors to implement the emotionally charged discussion and the specific skill building present in Sessions 4 and 5.

Citation: Hatch-Maillette MA, Burlew AK, Turnbull S, Robinson M, Calsyn DA. Measuring Fidelity to a Culturally Adapted HIV Prevention Intervention for Men in Substance Abuse Treatment. Journal of Substance Abuse Treatment 2013;45(4):363-369.


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Helping Alliance, Retention, and Outcomes for Women with Trauma Histories

April 6, 2012

In this secondary analysis of data from the protocol CTN-0015 (Women’s Treatment for Trauma and Substance Use Disorders),  researchers examined the association between the therapeutic alliance and treatment outcome among 223 women with PTSD and substance use disorders.  The research team included Mary Hatch-Maillette, PhD, from the PNW Node.

Conclusions: Women who received the study intervention, Seeking Safety, had significantly higher alliance ratings than those in the control group.  Alliance was related to significant decreases in PTSD symptoms and higher retention for both interventions. Alliance was not related to substance use outcomes.

In all, this study demonstrates that this typically challenging group of women can develop a strong therapeutic alliance within a relatively brief treatment episode in a group format, facilitating reductions in PTSD symptoms and leading to treatment retention.

Citation:  Ruglass LM, Miele GM, Hien DA, Campbell ANC, Hu M, Caldeira N, Jian H, Litt L, Killeen T, Hatch-Maillette MA, Najavits LM, Brown C, Robinson JA, Brigham GS, Nunes EV.  Helping Alliance, Retention, and Treatment Outcomes: A Secondary Analysis from the NIDA Clinical Trials Network Women and Trauma Study.  Substance Use & Misuse 2012 (in press).

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Clinical Research Jobs at RCKC

March 7, 2011

In addition to the Research Assistant position already posted, 2 part-time positions are available for the same project at Recovery Centers of King County.

Nurse Practitioner or Physician’s Assistant (.3 FTE)

RCKC is advertising an exciting opportunity for an ARNP or PA to assist in the administration of a large NIDA-funded multi-site study investigating the safety and effectiveness of buprenorphine with naltrexone for the treatment of cocaine dependence.  This person will be responsible for meeting with study participants during the eight week treatment phase to conduct medical exams and complete other tasks relevant to the study protocol.  The Nurse Practitioner or Physician’s Assistant will work in collaboration with the Study Physician, Research Staff, and staff from the Alcohol and Drug Abuse Institute at the University of Washington in implementing the study protocol. (download full description and application instructions)

Study Physician (.12 FTE)

RCKC is advertising an exciting part-time opportunity for a Study Physician to assist in the administration of a large NIDA-funded multi-site study investigating the safety and effectiveness of buprenorphine with naltrexone for the treatment of cocaine dependence.  This person will be responsible for overseeing the clinical care of participants throughout the duration of the study.  The Study Physician will work in collaboration with the Investigators, Nurse Practitioner/Physician’s Assistant, Research Staff, and staff from the Alcohol and Drug Abuse Institute at the University of Washington in implementing the study protocol. (download full description and application instructions)

Research Assistant Position at Recovery Centers of King County

March 2, 2011

Recovery Centers of King County is a community treatment program and part of the National Drug Abuse Treatment Clinical Trials Network. RCKC is seeking a Research Assistant to assist in the administration of a large NIDA-funded multi-site study investigating the safety and effectiveness of buprenorphine with naltrexone for the treatment of cocaine dependence. The primary purpose of the Research Assistant position is to represent the “front line” of this research and to carry out the day-to-day activities of this study. The Research Assistant will work in collaboration with the Research Coordinator, medical staff, and staff from the Alcohol and Drug Abuse Institute at the University of Washington in implementing this study protocol.

* For more about this position (and other addiction research jobs in the Seattle area), please see the Employment page on the ADAI website:  http://adai.washington.edu/jobs.htm

Participants for Study of M.I. Training & Assessment

December 28, 2009

The University of Washington is seeking participants for a study of several measures of counseling skills relevant to Motivational Interviewing (MI).   Study participants will receive up to $100 for completing two assessment protocols.  Assessments are completed online and over the phone. To qualify, you need to work at least half time in a clinical setting dealing with clients with mental health or substance use problems. At this time, we are soliciting participation only from residents of the United States due to difficulties issuing payments, mailing headsets, and providing phone-based technical support internationally.  As all study materials are in English, fluency in English is also required.

If interested, please visit http://caspimi.com or read the flyer: http://depts.washington.edu/adai/caspimi.pdf.

You may also call or email Michelle Ingalsbe at (206) 616-0025 or mhansten@u.washington.edu for more information.  Please remember that we cannot guarantee the confidentiality of any information sent by e-mail.