An essential element of advancing an evidence-based practice in addiction treatment involves ensuring that clinicians acquire the skill to deliver the particular treatment approach faithfully and consistently. But in a period marked by increasing reliance on distance learning for training, how can supervisors guarantee from afar that counselors are equipped to offer these evidence-based treatments effectively?
Two researchers at the University at Buffalo Research Institute on Addictions (RIA) will use a two-year grant of more than $267,000 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to refine an interactive voice recording (IVR) telephone system designed to resemble the experience of face-to-face supervision.
This study and the prior research that informed it focus on training in the processes of behavioral couples therapy for alcohol abuse. But the RIA researchers say that if evaluation of results obtained through the IVR system proves accurate, this system could be used in training of clinicians in any number of evidence-based practices, in instances where standard role play exercises that are designed to mimic the clinical experience are not feasible.
“In the big picture, with the move toward online training, we really need to figure out a way to do clinical skill evaluation that approximates role play,” says Christopher Barrick, PhD, an RIA research scientist who is the NIAAA-funded study’s principal investigator.
Source of partnership
This study originated from earlier research involving behavioral couples therapy, a modality that has been established as effective but is seen as not being used to a great enough degree in community settings.
Barrick says that to create a proxy for the typical role play sessions in which trained clinicians act out the scenarios they will encounter with an actual patient, researchers developed an IVR system in which Barrick would record a scenario and the trainee would leave a verbal response through voicemail. “We aimed for them to give us two ore three sentences for each scenario, or about a minute or two of response,” he says.
However, “We didn’t have a good way to score and rate the responses,” Barrick explains. So he sought out RIA colleague and research scientist Neil McGillicuddy, PhD, who was working with a similar instrument in another subject area.
“I had developed a measure to assess how well parents deal with teen drug and alcohol abuse,” says McGillicuddy. A group of clinical experts came up with a series of scenarios that parents confront when living with a teen who is using, and then a second group of experts came in to evaluate the responses that parents offered in role play sessions.
What resulted from this effort was a scoring system that the two researchers in tandem hope to refine in the latest behavioral couples therapy study, which will collect feedback through IVR.
“Technology is amazing, but the telephone is such a basic tool,” says Barrick. “Every counselor has a phone. You don’t need a camera, or a fast Internet connection.”
While responses delivered by telephone might not exactly duplicate a face-to-face encounter between a clinician and a supervisor, Barrick says, they do offer considerable opportunities for coaching and feedback. This feedback is of course essential to determining, beyond whether a clinician learned a skill, whether the clinician has become adept at applying it to sessions with patients.
“We often look to see, ‘Did the counselor do X, Y and Z?’, but we don’t often go deeper to, ‘Did they do them well?’” McGillicuddy says.
Barrick says this research recognizes where the field is moving with regard to the diverse formats under which clinical training will be taking place.