Baer John S, Ball Samuel A, Campbell Barbara K, Miele Gloria M, Schoener Eugene P, Tracy Kathlene
University of Washington, Department of Psychology, Alcohol and Drug Abuse Institute, Seattle, Washington 98105-4631, USA.
Drug Alcohol Depend. 2007 Mar 16;87(2-3):107-18. doi: 10.1016/j.drugalcdep.2006.08.028. Epub 2006 Oct 4.
Methods for the training and fidelity monitoring of behavioral interventions in multi-site addictions research are reviewed, including five published studies and seven ongoing studies sponsored by the National Institute on Drug Abuse-funded Clinical Trials Network.
Methods are categorized and reviewed consistent with a technology model of treatment delivery. Topics include: therapist selection, training, certification, and supervision; selection, training, and certification of supervisors; scales and processes used for monitoring of the quality of treatment; and processes followed to provide new training for replacement staff once trials have begun.
The review reveals both a wide array of procedures and emerging standards for multi-site trials. Methodological weakness was observed with respect to limited empirical support for many adherence scales, little or no evaluation of supervisory processes, and no evaluation of re-training practices.
Methods used in multi-site trials are important not only to ensure validity of those trials, but also to inform the wider dissemination of empirically based treatment into community agencies. Studies examining noted weaknesses are needed. Training and fidelity models that delegate responsibility to participating sites appear most relevant for establishing best practices for dissemination of behavioral interventions. The effectiveness of these distributed training and supervision models should be subjected to empirical study at a level of rigor comparable to the evaluation of their corresponding treatments.
回顾多地点成瘾研究中行为干预的培训和保真度监测方法，包括五项已发表研究和由美国国立药物滥用研究所资助的临床试验网络赞助的七项正在进行的研究。
根据治疗提供的技术模型对方法进行分类和回顾。主题包括：治疗师的选择、培训、认证和监督；监督员的选择、培训和认证；用于监测治疗质量的量表和流程；以及试验开始后为替代人员提供新培训所遵循的流程。
该综述揭示了多地点试验的一系列程序和新兴标准。在许多依从性量表的实证支持有限、对监督过程几乎没有或没有评估以及对再培训实践没有评估方面观察到方法学上的弱点。
多地点试验中使用的方法不仅对于确保这些试验的有效性很重要，而且对于将基于实证的治疗更广泛地传播到社区机构也很重要。需要对已指出的弱点进行研究。将责任委托给参与站点的培训和保真度模型似乎与建立行为干预传播的最佳实践最相关。这些分布式培训和监督模型的有效性应在与评估其相应治疗相当的严谨程度上进行实证研究。
