Training Community Treatment Providers in Research Interventions for Women with Addictions and PTSD

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Training Community Treatment Providers in
Research Interventions for Women with Addictions
and PTSD

• Gloria M. Miele, Ph.D.
• Training Director, CTN Long Island Node/Columbia
  University
• National Conference on Women, Addiction and
  Recovery News You Can Use
• Anaheim, CA, July 14, 2006

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Training Elements and Issues

• Who was trained?
• What was the training format?
• What were the training topics?
• What follow-up was provided?
• What were the benefits and challenges?

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CTN-0015 Trainers and Lead Node Supervisors

• Seeking Safety
• Womens Health Education

• Lisa Najavits, Ph.D.
• Martha Schmitz, Ph.D.
• Lisa Litt, Ph.D.
• Lisa Cohen, Ph.D.
• Dawn Baird-Taylor, Ph.D.
• Gloria Miele, Ph.D.

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Who Was Trained?

• All female staff
• Agreed to randomization, videotaping and research
  monitoring
• Demonstrated ability to conduct manualized,
  problem-solving session prior to randomization
• Had no prior experience with study interventions

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Counselor and Supervisor Demographics
Counselors n18 Supervisors n18
Age M 38.0 41.8
Race N () White Black/African American Hispanic/Latina 9 (50.0) 5 (27.8) 4 (22.2) 12 (66.7) 5 (27.8) 1 (5.5)
Yrs in Substance Abuse M 4.8 9.0
Years at Program M 3.9 4.8
Highest Degree N () gtBachelors Degree Bachelors Degree Masters Degree/Doctorate 1 (5.5) 7 (38.9) 10 (55.6) 1 (5.5) 2 (11.1) 15 (83.3)
In Recovery N () No Yes Prefer not to answer 13 (72.3) 4 (22.2) 1 (5.5) 15 (83.3) 2 (11.1) 1 (5.5)
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Intervention-SpecificTraining Elements

• 3-day group training
• Explanation, demonstration and role-play
• Post-training certification
• Counselors and supervisors conducted pilot groups
• Supervisors coded counselors sessions and
  compared ratings with lead experts
• Train-the-trainer model
• Used for supervisor training

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Training in Individual Orientation Session

• Conducted by counselor prior to participants
  entry into group
• Revealed randomization condition
• Provided overview of intervention
• Discussed ground rules of groups

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Seeking Safety Topics

• Safety
• PTSD Taking Back Your Power
• Detaching from Emotional Pain
• When Substances Control You
• Taking Good Care of Yourself
• Compassion

• Red and Green Flags
• Honesty
• Integrating the Split Self
• Creating Meaning
• Setting Boundaries in Relationships
• Healing from Anger

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Womens Health Education Topics

• Body Systems
• Female anatomy
• Breast care
• Infections
• HIV
• Contraception

• Pregnancy
• STDs
• Nutrition
• High Blood Pressure
• Diabetes
• Menopause

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Training in Research-to-Practice Challenges

• The Therapeutic Misconception
• Research is not treatment
• Protocol adherence is key
• Avoiding cross-contamination
• Need to keep interventions separate
• Cant share information with other colleagues or
  clients

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Other Training and Implementation Issues

• Ongoing, on-site supervision
• Form completion
• Progress notes
• Adherence forms
• Other documentation

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Ongoing Supervision and Monitoring

• Supervisors attended weekly supervision
  teleconferences with Lead Node experts in the
  respective intervention
• Calls included discussion of specific issues,
  review of session tapes and adherence ratings

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Adherence Monitoring

• Counselors
• Supervisors rated 50 of cases and gave feedback
  based on ratings
• Cut-offs for continued participation in trial and
  guidelines for retraining
• Supervisors
• Lead node experts rated 25 of sessions rated by
  local supervisors and gave feedback on level of
  agreement

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Counselor and SupervisorBenefits

• Expanded skills in delivering and supervising
  interventions
• Became more comfortable using treatment manuals
  and working explicitly with women with
  co-occurring disorders
• Sustainability and interest after conclusion of
  trial

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Counselor and SupervisorChallenges

• Rolling admission groups and no-shows led to
  delays in providing interventions
• TTT model led to counselors feeling less involved
  in the process
• Adherence monitoring
• Counselor issues
• Supervisor issues
• Participant characteristics
• Time commitment

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Summary

• Training, supervision and implementation require
  time and commitment from all levels of staff
• Involve counselors and supervisors in ongoing
  supervision from lead node
• Ensure adequate training in research process,
  procedures and special need of patient population