The relationship of counselor-level variables to intervention adoption

1. The relationship of counselor-level variables to intervention adoption Joseph Guydish, Holly Fussell, Sarah Turcotte Manser, Lynn E. Kunkel, Mable Chan, & Dennis McCarty AHSR 2010 Lexington, Kentucky This work was supported by NIDA R01DA025600 and the Western States Research Node of the NIDA Clinical Trials Network (U10 DA015815)

2. Adoption of Evidence-Based Practices (EBPs) • One goal of the CTN is to translate EBPs shown to be effective into clinical practice • EBPs are tested in multi-site clinical trials • Clinicians and supervisors trained • Opportunity to try a new intervention • What happens to the EBP once the trial ends?

3. Spaceship RCT Clinical Trial Adherence Resources Intervention Training Setting Motivations Interests Admin Usual Staff Supervisor

4. Adoption of Matrix Following Clinical Trial • Adoption of Matrix at 8 clinics • Qualitative interviews at multiple levels • Transcribed and coded Matrix Clinical Trial Interviews (n=42) Interviews were completed 2-12 months after treatment phase completion

5. Adoption of Matrix at Clinic Sites Guydish, J.,Turcotte Manser, S., Jessup, M., Tajima, B., Sears, C., & Montini, T.  (2005) Multi-level assessment protocol (MAP) for adoption in multi-site clinical trials, Journal of Drug Issues. 35, 529-546.

6. Adoption of MI/MET at Clinic Sites Guydish, J., Jessup, M., Tajima, B., Turcotte Manser, S. (2010) Adoption of Motivational Interviewing and Motivational Enhancement Therapy following clinical trials. Journal of Psychoactive Drugs, 6, 215-226.

7. CTN 0031 STAGE-12:Stimulant Abuser Groups to Engage in 12-Step • Twelve Step Facilitation • 10 sites • Stimulant Users • 5 group sessions and 3 individual sessions

8. Relationships in Translational Research, Aligned with Stage -12 Clinical Trial Pre-STAGE 12 During STAGE 12 Study Post STAGE 12 Organizational Variables Counselor Factors Adoption (Qualitative Measure) Implementation Fidelity Client Outcomes

9. Summary of Measures Pre-STAGE 12 Staff Survey (119 Counselors) • ATSG (General 12 step attitudes) • SIGCS (Goal Commitment) During STAGE 12 Implementation Fidelity (29 Counselors) • Overall Skill and Fidelity • Proscribed Behaviors • Empathy During STAGE 12 Client Outcomes: Days stimulant use in past 30 Post-STAGE 12 Adoption: Qualitative Interviews • ATSG: Laudet, A.B.; White, W.L. (2005) An exploratory investigation of the association between clinicians' attitudes toward twelve-step groups and referral rates. Alcohol Treatment Quarterly, 23 (1), 31-45. • SIGCS: Hollenbeck, J.R., C.R. Williams, & H. Klein (1989). “An empirical examination of the antecedents of commitment to difficult goals.” Journal of Applied Psychology,74(1): 12-23.

10. Descriptive Statistics for STAGE-12 counselors as compared to non-STAGE-12 counselors in survey data (n=119)

11. Simple Regression Models (n=29): Baseline variables predicting fidelity outcomes

12. Regression Models (n=29): Baseline variables predicting fidelity outcomes *significant at 0.05 level

13. Summary 54% STAGE 12 counselors older, + 12 step attitudes, higher goal commitment For 12 step counselors Women had lower proscribed behaviors and higher overall fidelity implementation In regression predicting implementation: Goal Commitment, gender predict proscribed beh. Progress towards completion