title: The Effectiveness and Cost of Clinical Supervision for Motivational Interviewing: A Randomized Controlled Trial.
abstract: The effectiveness of a competency-based supervision approach called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) was compared to supervision-as-usual (SAU) for increasing clinicians' motivational interviewing (MI) adherence and competence and client retention and primary substance abstinence in a multisite hybrid type 2 effectiveness-implementation randomized controlled trial. Participants were 66 clinicians and 450 clients within one of eleven outpatient substance abuse programs. An independent evaluation of audio recorded supervision sessions indicated that MIA: STEP and SAU were highly and comparably discriminable across sites. While clinicians in both supervision conditions improved their MI performance, clinician supervised with MIA: STEP, compared to those in SAU, showed significantly greater increases in the competency in which they used fundamental and advanced MI strategies when using MI across seven intakes through a 16-week follow-up. There were no retention or substance use differences among the clients seen by clinicians in MIA: STEP or SAU. MIA: STEP was substantially more expensive to deliver than SAU. Innovative alternatives to resource-intensive competency-based supervision approaches such as MIA: STEP are needed to promote the implementation of evidence-based practices.
authors.affiliation: VA Connecticut Healthcare System, Psychology Service, 950 Campbell Avenue, West Haven, CT, 06516, USA; Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA. Electronic address: steve.martino@yale.edu.
authors.forename: Steve
authors.initials: S
authors.lastname: Martino
authors.affiliation: Yale University School of Medicine, The Hispanic Clinic, 25 Park Street, New Haven, CT, 06511, USA. Electronic address: manuel.paris@yale.edu.
authors.forename: Manuel
authors.initials: M
authors.lastname: Paris
authors.affiliation: Yale University School of Medicine, The Hispanic Clinic, 25 Park Street, New Haven, CT, 06511, USA. Electronic address: luis.aneznava@yale.edu.
authors.forename: Luis
authors.initials: L
authors.lastname: Añez
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA. Electronic address: charla.nich@yale.edu.
authors.forename: Charla
authors.initials: C
authors.lastname: Nich
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA. Electronic address: monica.canning-ball@yale.edu.
authors.forename: Monica
authors.initials: M
authors.lastname: Canning-Ball
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA. Electronic address: karen.hunkele@yale.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Hunkele
authors.affiliation: The University of Texas at Austin, Lyndon B. Johnson School of Public Affairs, 2300 Red River Street, Austin, TX, 78713, USA; Seton/UT Clinical Research Institute, 1400 North IH 35, Austin, TX, 78701, USA. Electronic address: tolmstead@austin.utexas.edu.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Olmstead
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA. Electronic address: kathleen.carroll@yale.edu.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000379:methods; D002983:Clinical Competence; D003365:Costs and Cost Analysis; D055317:Evidence-Based Practice; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000191:economics / Q000379:methods*; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D055815:Young Adult
keywords: Clinical supervision; Cost estimation; Implementation strategies; Motivational interviewing; Substance abuse treatment