Wain R Morgan, Kutner Bryan A, Smith Jennifer L, Carpenter Kenneth M, Hu Mei-Chen, Amrhein Paul C, Nunes Edward V
Division of Substance Abuse, New York State Psychiatric Institute, 1051 Riverside Drive, Room 3732, Box 120, New York, NY, 10032, USA.
Department of Psychiatry, Columbia University, 1051 Riverside Drive, Room 3732, Box 120, New York, NY, 10032, USA.
J Subst Abuse Treat. 2015 Oct;57:96-101. doi: 10.1016/j.jsat.2015.04.006. Epub 2015 Apr 14.
The objective of this study was to investigate the relation between self-report and objective assessment of motivational interviewing (MI) skills following training and supervision. After an MI workshop, 96 clinicians from 26 community programs (age 21-68, 65% female, 40.8% Black, 29.6% Caucasian, 24.5% Hispanic, 2.0% Asian, 3.1% other) were randomized to supervision (tele-conferencing or tape-based), or workshop only. At four time points, trainees completed a self-report of MI skill, using items from the MI understanding questionnaire (MIU), and were objectively assessed by raters using the Motivational Interviewing Treatment Integrity (MITI) system. Correlations were calculated between MIU and MITI scores. A generalized linear mixed model was tested on MIU scores, with MITI scores, supervision condition and time as independent variables. MIU scores increased from pre-workshop (mean = 4.74, SD = 1.79) to post-workshop (mean = 6.31, SD = 1.03) (t = 8.69, p < .0001). With supervision, scores continued to increase, from post-workshop to week 8 (mean = 7.07, SD = 0.91, t = 5.60, p < .0001) and from week 8 to week 20 (mean = 7.28, SD = 0.94, t = 2.43, p = .02). However, MIU scores did not significantly correlate with MITI scores, with or without supervision. Self-reported ability increased with supervision, but self-report was not an indicator of objectively measured skill. This suggests that training does not increase correspondence between self-report and objective assessment, so community treatment programs should not rely on clinician self-report to assess the need for ongoing training and supervision and it may be necessary to train clinicians to accurately assess their own skill.
本研究的目的是调查在培训和督导之后,动机性访谈(MI)技能的自我报告与客观评估之间的关系。在参加MI工作坊之后,来自26个社区项目的96名临床医生(年龄21 - 68岁,65%为女性,40.8%为黑人,29.6%为白人,24.5%为西班牙裔,2.0%为亚洲人,3.1%为其他种族)被随机分配至督导组(电话会议督导或基于录音带的督导)或仅参加工作坊组。在四个时间点,学员使用动机性访谈理解问卷(MIU)中的条目完成MI技能的自我报告,并由评估者使用动机性访谈治疗完整性(MITI)系统进行客观评估。计算MIU与MITI分数之间的相关性。以MITI分数、督导条件和时间作为自变量,对MIU分数进行广义线性混合模型检验。MIU分数从工作坊前(均值 = 4.74,标准差 = 1.79)增加到工作坊后(均值 = 6.31,标准差 = 1.03)(t = 8.69,p <.0001)。在有督导的情况下,分数继续增加,从工作坊后到第8周(均值 = 7.07,标准差 = 0.91,t = 5.60,p <.0001)以及从第8周到第20周(均值 = 7.28,标准差 = 0.94,t = 2.43,p =.02)。然而,无论有无督导,MIU分数与MITI分数均无显著相关性。自我报告的能力在有督导的情况下有所提高,但自我报告并非客观测量技能的指标。这表明培训并未增加自我报告与客观评估之间的一致性,因此社区治疗项目不应依赖临床医生的自我报告来评估持续培训和督导需求,可能有必要培训临床医生准确评估自身技能。