Training counselors on an HIV risk reduction intervention: How much practice is enough?
The “Real Men Are Safe-Culturally Adapted” (REMAS-CA) study was an outgrowth of the National Drug Abuse Treatment Clinical Trials Network protocol CTN-0018, which developed and evaluated Real Men Are Safe (REMAS), a safer sex skills training intervention for men in substance abuse treatment. The study aimed to develop an adherence scale for REMAS-CA, a modified version of the original REMAS intervention tailored for African Americans and Hispanics, measure improvement in counselors’ intervention delivery skills over time, and identify which modules of the new adapted intervention were hardest to deliver. REMAS-CA was piloted in four addiction treatment programs, with two counselors per site running 3 or 4 rounds of REMAS-CA groups over about 9 months. Group recordings were reviewed by a team of four (lead- and co-investigator plus two undergraduates) for 1) manual adherence, 2) avoidance of proscribed behaviors, 3) global empathy and co-therapy. Inter-rater reliability was calculated for all raters, and adherence and skill scores were compared for counselors’ first and last cohorts using paired t-tests.
Results found that counselors did not improve delivery of REMAS-CA over time, except in global empathy, which showed significant improvement from first cohort to last. Discussions of current and past relationships, and role plays of communication skills with partners, were most difficult for counselors.
Conclusions: A highly reliable system for rating counselor skill and adherence to REMAS-CA was developed for this study. Counselors’ lack of significant improvement in skill, co-therapy, global empathy, and avoidance of proscribed behaviors may have been because they scored relatively high even in their first round of intervention delivery. Results suggest that the 2-day training and subsequent certification process, manual structure, and early supervision may have solidified counselors’ skills, leaving little “room for improvement.”
Related protocols: CTN-0018