The virtual requirement that substance abuse programs use evidence-based treatments (EBT) has
prompted the development of dissemination strategies to promote EBT technology transfer.
Implementation research, clinical trial training methods, and clinician training studies
suggest that clinical supervision that involves direct observation, fidelity rating-based
feedback, and coaching of therapeutic skills is a promising dissemination approach. However,
clinical supervision delivered within substance abuse programs by on-site supervisors has
never been directly tested in a randomized controlled trial to determine the impact of
supervision on both clinician EBT skills and client treatment outcomes.
Recent results from two NIDA CTN protocols testing the effectiveness of Motivational
Interviewing (MI) have shown that community program clinicians can learn to deliver MI with
fidelity when receiving MI supervision from their program supervisors after workshop training
and that their implementation of MI early in treatment improves client retention and primary
substance use outcomes. A MI supervision manual called MIA: STEP (Motivational Interviewing
Assessment: Supervisory Tools for Enhancing Proficiency) was developed from these protocols
and has begun to be widely distributed by NIDA in partnership with SAMHSA for community
program use. The effectiveness of the MIA: STEP supervision approach is unknown.
This study will directly test the effectiveness of MIA: STEP supervision on clinician MI
fidelity and on client outcomes by randomly assigning 60 clinicians and 420 substance-using
outpatients from 11 community programs within Connecticut to one of two conditions in which
clinicians in both conditions will deliver a 1-session MI intervention to clients as the
enter treatment. The conditions are: 1) workshop training plus MIA: STEP supervision, and 2)
workshop training alone with supervision-as-usual practices used at each program. This
project will be the first randomized trial to examine the impact of clinical supervision in
an empirically based treatment on both clinician and client outcomes. Moreover, because it
will provide workshop training and supervision completely within the context of community
programs and utilize in-house program supervisors, it will provide a rigorous evaluation of a
feasible model for disseminating EBTs such as MI.