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:
Efforts to recruit RCS counselors to participate in the pilot project were unsuccessful. Of the fourteen SF Bay Area Vet Center counselors who were contacted about participating, only 4 agreed to participate (28%). Counselors who declined indicated that overwhelming clinical and administrative responsibilities precluded their participation. Site visits to each Vet Center, reminder phone calls and emails from project staff, ongoing support from RCS National Leadership, and active involvement of RCS Regional Management did not improve study enrollment. Furthermore, three of the four counselors who began the protocol dropped out of the study before recruiting any client participants or providing any audiotapes of counseling sessions. Aggressive efforts to expand recruitment beyond RCS counselors to include VA Palo Alto mental health and addiction treatment staff and trainees were also largely unsuccessful.

IMPACT:
The study protocol is not feasible for a large scale clinical trial in RCS. Previous research using similar study designs has demonstrated that counselors must be offered substantial monetary incentives in order to provide researchers with audio tapes of counseling sessions. VA regulations explicitly prohibit offering such compensation to VA employees

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External Links for this Project

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PUBLICATIONS:

None at this time.

DRA: Substance Use Disorders
DRE: Treatment - Observational
Keywords: Drug abuse, PTSD, Telemedicine
MeSH Terms: none