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BACKGROUND/RATIONALE:
Veterans who access services through the VA Readjustment Counseling Service (RCS or “Vet Centers”) are at elevated risk of developing substance use disorders (SUDs) due to their history of combat exposure and the widespread use of substances to cope with symptoms of Post Traumatic Stress Disorder (PTSD). Randomized controlled trials (RCT) and subsequent meta-analyses have consistently demonstrated that brief motivational interventions (BMI) are among the most effective interventions for substance-using individuals. Preliminary studies have determined that RCS counselors are eager to receive training in how to conduct these brief interventions, and that their existing computer and networking resources are adequate to support the delivery of such training via the Internet.
OBJECTIVE(S):
To determine whether RCS staff who complete an online course designed to deliver training in empirically-supported, brief motivational interventions for substance-using veterans will: (a) show improvement in self ratings of knowledge, self-efficacy, and competence in conducting such interventions, (b) exhibit demonstrable changes in clinical practice that are consistent with the Motivational Interviewing approach, and (c) engender improved client outcomes in the domains of substance use severity, psychiatric symptoms, and motivation to remain abstinent.
METHODS:
This study will recruit counselor participants from four San Francisco Bay Area RCS clinics (located in Redwood City, San Francisco, Oakland, and Concord, CA) to pilot test the study procedures for a larger planned RCT. All counselors will initially be asked to submit an audiotape of a single session with a substance-using client. These tapes will be coded using the Motivational Interviewing Treatment Integrity (MITI) scale to establish a baseline measure of the relevant counseling skills. Counselors who are subsequently assigned to the Web-Based Training (WBT) condition will be asked to complete an accredited Continuing Education independent study course through the Employee Education System (EES) website. See www.vetcentertraining.org/VCTP for detailed information about the WBT course. In addition to the course, participating counselors will also be asked to complete pre- and post-test measures of knowledge about Motivational Interviewing, attitudes towards screening, and assessment and MI, as well as self-efficacy and competence in assessment and treatment of clients with SUDs. Counselors assigned to the comparison condition will also complete the pre- and post-test, but will not access the course itself. Next, each counselor will be asked to recruit two clients who are willing to complete a self-report assessment battery within 30 days of intake. Client self-report assessment data will include situational confidence, PTSD symptoms, motivation for treatment, quantity and frequency of substance use, severity of SUD problems, and a measure of therapeutic alliance. Initial and follow-up sessions will also be audiotaped and coded using the MITI system
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Should this pilot study demonstrate that an online course can provide RCS counselors with the tools and training necessary to effectively screen, assess, and intervene with veterans who are at risk of developing SUDs, it will inform the design of a larger RCT, to be resubmitted for funding as an HSR&D IIR application in December 2006. In the longer term, this intervention could significantly increase the number of RCS counselors who are trained to deliver brief motivational interventions, thereby preventing veterans who are currently consuming alcohol or substances in a risky or harmful manner from developing more severe SUDs. Second, delivering this training content via the web will allow geographically dispersed Vet Center counselors to receive high quality training in a cost-effective fashion. Third, the online course could serve as a central component in subsequent efforts to implement this evidence-based practice throughout RCS and the VA Mental Health treatment system as a whole.
PUBLICATIONS:
None at this time.
DRA:
Substance Abuse, Addictive Disorders
DRE:
Treatment
Keywords:
Drug abuse, PTSD, Telemedicine
MeSH Terms:
none
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