Skewes Monica C, Gonzalez Vivian M, Stix Amy
Department of Psychology, Montana State University, United States of America.
Department of Psychology, University of Alaska Anchorage, United States of America.
J Subst Use Addict Treat. 2025 Jan;168:209541. doi: 10.1016/j.josat.2024.209541. Epub 2024 Oct 21.
Although American Indian and Alaska Native (AI/AN) people have high rates of abstinence from alcohol and other drugs, there also is evidence of greater rates of substance use disorders (SUDs) in Native communities. Health disparities associated with substance use are compounded by inadequate access to evidence-based treatments (EBTs). Lack of mental health providers is one notable barrier to EBT implementation in rural AI reservation communities. Our Indigenous Recovery Planning (IRP) intervention merges cultural lessons and culturally adapted relapse prevention strategies to facilitate SUD recovery in the reservation environment. One key implementation strategy is training non-specialist community-based facilitators to deliver IRP, thereby increasing its acceptability and sustainability. This manuscript reports the facilitator training, supervision, and fidelity monitoring procedures used in our ongoing clinical trial of IRP.
The study recruited four AI non-specialist providers from the community to serve as IRP facilitators. Initial training involved an introductory motivational interviewing workshop followed by a 2-day workshop in the IRP curriculum. Then we conducted an open trial of the 6-week intervention with weekly supervision meetings as part of the facilitator training process. During the open trial we also assessed participant and facilitator receptivity to the IRP intervention and pilot tested our fidelity monitoring protocol.
The initial training workshops provided facilitators with information they needed to understand the rationale behind IRP and determine whether the facilitator role was a good fit; however, additional training and supervision during the open trial was needed to ensure proper treatment delivery. Although participant and facilitator feedback ratings were positive, the open trial helped us identify revisions needed to improve our approach to facilitator training, supervision, and fidelity monitoring. We revised these procedures, and also developed a protocol to train new facilitators who join the study midstream.
The open trial was an important aspect of the facilitator training process and helped our team identify several areas of improvement. Our approach to training, supervising, and monitoring community member facilitators may serve as an example of how to overcome one barrier to implementing evidence-based SUD treatments in rural reservation communities with few mental health professionals.
尽管美国印第安人和阿拉斯加原住民（AI/AN）人群戒酒及避免使用其他药物的比例很高，但也有证据表明原住民社区物质使用障碍（SUDs）的发生率更高。与物质使用相关的健康差距因难以获得循证治疗（EBTs）而更加复杂。心理健康服务提供者的短缺是在农村AI保留地社区实施EBT的一个显著障碍。我们的原住民康复计划（IRP）干预措施融合了文化课程和文化适应性复发预防策略，以促进保留地环境中的SUD康复。一个关键的实施策略是培训非专业的社区促进者来实施IRP，从而提高其可接受性和可持续性。本手稿报告了我们正在进行的IRP临床试验中使用的促进者培训、监督和保真度监测程序。
该研究从社区招募了四名AI非专业提供者作为IRP促进者。初始培训包括一个介绍性的动机访谈工作坊，随后是为期两天的IRP课程工作坊。然后我们进行了为期6周干预的开放试验，每周举行监督会议作为促进者培训过程的一部分。在开放试验期间，我们还评估了参与者和促进者对IRP干预的接受度，并对我们的保真度监测方案进行了试点测试。
初始培训工作坊为促进者提供了他们理解IRP背后的原理并确定促进者角色是否合适所需的信息；然而，在开放试验期间需要额外的培训和监督，以确保正确提供治疗。尽管参与者和促进者的反馈评分是积极的，但开放试验帮助我们确定了改进促进者培训、监督和保真度监测方法所需的修订。我们修订了这些程序，并制定了一个协议来培训中途加入该研究的新促进者。
开放试验是促进者培训过程的一个重要方面，并帮助我们的团队确定了几个需要改进的领域。我们培训、监督和监测社区成员促进者的方法可以作为一个范例，说明如何克服在心理健康专业人员稀缺的农村保留地社区实施循证SUD治疗的一个障碍。
