Intervention training, supervision and fidelity monitoring in NIDA CTN-0047: SMART-ED.
Effective training and ongoing coaching in psychosocial treatment modalities is critical to maintaining fidelity in both research and practice. Maintaining fidelity may be particularly challenging in emergency department settings due to the fast pace and competing urgent and emergent priorities. This presentation describes intervention training, certification, supervision and fidelity monitoring procedures used in the NIDA CTN six-site “Screening Motivational Assessment and Referral to Treatment in Emergency Departments (SMART-ED)” study. Interventionists received a 2-day training in basic motivational interviewing skills, followed 1 month later by a 2-day training in the specific intervention used in this trial. Practice sessions with consenting ED patients were reviewed by expert raters, using the Motivational Interviewing Treatment Integrity scale (MITI, v.3.1.1), to determine if interventionists had reached benchmark scores and were therefore certifiable. Clinical supervision of interventionists was conducted independently of fidelity monitoring; centralized fidelity monitors reviewed 12% (n=96) of interventionists’ sessions and reported MITI scores to clinical supervisors to offer objective feedback regarding their supervisee’s performance. Clinical supervisors conducted bi-weekly phone supervision, discussing MI fidelity and clinical issues. Following completion of the trial, 20% of the interventionist sessions (n=161), of which 30% (n=55) were coded by two independent raters to assess inter-rater reliability, were randomly selected and coded for overall trial fidelity. Participating interventionists were 21 females and 12 males with little experience in addiction counseling (M=1.58 +/- 2.5 years). Fidelity monitoring during the trial successfully prevented drift and identified only one interventionist in need of remedial supervision. Bi-weekly coaching continued throughout the trial and interventionists found these sessions useful in maintaining their skills. Results from fidelity monitoring indicate above average performance on MITI scores.
Conclusions: The two-stage interventionist training, bi-weekly supervision, and ongoing monitoring produced excellent results and prevented drift. This model may bestow an advantage for learning and implementing brief interventions based on an MI approach.
Related protocols: CTN-0047