Module 1: Introduction to the
TIP 34 Training Program
TIP34 Book
TrainerNotes
TIP 34 References
1.WhatisaTIP?(pp.vii-viii)
2.ExecutiveSummary andRecommendations(pp.xv-xxvi)
3.Chapter1:IntroductiontoBriefInterventions andBriefTherapies
(pp.1-12)
Training Emphasis
1.Rationale forUsingBriefInterventionsandBriefTherapies
2.CharacteristicsofBriefInterventions
3.CharacteristicsofBriefTherapies
4.Overview of TIP 34 Training for Brief Interventions and Brief Therapies
5.QualityAssuranceandImprovement Process
6.StrategyIntegration Process
Learning Objectives
1.Participantswillbeabletoidentifythreereasonsforusingbrief
interventionsandbrieftherapies.
2.Participantswillbeabletoidentifyfivecommon characteristicsof briefinterventions.
3.Participants willbeabletoidentifyfivecommoncharacteristicsof brieftherapies.
4.ParticipantswillbeacquaintedwiththeTIP 34 trainingtopics, objectives,andagendas.
5.Participantswillbeabletoidentifythree waystoassessthe effectivenessofbriefinterventionsandbrieftherapiesto incorporateintotheirclinicalpractice.
6.Participants willbeintroducedtothestrategyintegrationprocessandforms.
31Introductiontothe TIP 34 TrainingProgram
TIP34:BriefInterventionsand BriefTherapies for SubstanceAbuse
Agenda
1.WelcomeandIntroductions(5Minutes)
2.ReasonsforUsingBriefInterventionsandBriefTherapies
(5Minutes)
Common Characteristics of Brief Interventions and Brief Therapies
(5Minutes)
4.TIP34 TrainingOverview(10Minutes)
5.QualityAssuranceandImprovement (5Minutes)
6.StrategyIdentificationExerciseOverview(5Minutes)
7.StrategyIntegration Mind-MapExerciseOverview(5Minutes)
8.Training Follow-upandFeedback(2Minutes)
9.AssignmentsandClosing(3Minutes)
Training Equipment and Supplies
1.Whiteboardanderasablemarkers–OR–newsprintpad,markers,andeasel
2.LCDprojector–OR–overhead transparencyprojector
3.PowerPointslideCD–OR–overheadtransparencies
4.Moveableseating
5.Nametags(optional,reusableordisposable)
6.Attendancerecord
7.Pens andcoloredpencilsorcrayons
8.Continuingeducation certificates(optional)
Definition of Terms
SubstanceAbuse:Throughoutthistraining,theterm“substanceabuse”isused inageneral sense tocoverbothsubstanceabusedisordersandsubstancedependencedisorders(asdefinedbytheDiagnostic andStatisticalManualofMentalDisorders,4thEdition[DSM-IV] [AmericanPsychiatricAssociation,1994]).Becausetheterm“substanceabuse”iscommonlyused bysubstanceabusetreatmentprofessionalstodescribeanyexcessiveuse ofaddictive substances,itisusedtodenotebothsubstancedependenceandsubstanceabuse. Thetermincludestheuseofalcoholaswellasothersubstancesof abuse.
IntroductiontotheTIP34TrainingProgram32
TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
ParticipantMaterials
TimeClock
TrainerNotes
33
ParticipantMaterials
(One for each participant)
1.TIP 34 BriefInterventionsandBriefTherapiesforSubstanceAbuse
2.QuickGuideforCliniciansBasedon TIP 34
3.KAPKeysforCliniciansBasedonTIP 34
4.Module1ParticipantWorkbook:
a.Module1Packet Cover
b.ReasonsforUsingBriefInterventionsandBriefTherapiesc. CommonCharacteristicsofBriefInterventions
d.CommonCharacteristicsofBriefTherapiese. TIP 34 TrainingModules andSchedule
f. GroupRules
g.QualityAssuranceandImprovement
h.Sample StrategyIdentification Exercise
i.Sample StrategyIntegration Mind-Maps(2)
j. e-MailFeedbackForm
5.Homework:HandoutsfornextTIP 34 Training Module
Module 1 - Section 1
Welcome & Introductions
Time: 5 Minutes
Trainer Notes
Thissectioncanbedidacticorinvolvelowtohighgroupinteraction,withallornone oftheparticipantsparticipating withintroductions.
Thismodulebegins with:(1)abriefwelcome,(2)abriefexplanationof theTreatmentImprovement Protocol(TIP) Series,(3)thetrainer’s rational forprovidingthetraining,and(4)thetrainer’spersonalintroduction.
Trainerandparticipant introductionsmaynot be necessary iftheyareallstaffmembersofthesameagency.Ifthetrainerand/orparticipantsarenotacquainted,introductionscanbeconducted.However,introductionsshouldbekeptverybriefduetoshorttimeconstraints(e.g.;includeonly name,department,andtitle).
Whetherornottheparticipantsknowthetrainer, s/heshould provideapersonalintroduction relatinghis/herworkexperiencewithbrief
IntroductiontotheTIP34TrainingProgram
TIP34:BriefInterventionsand BriefTherapies for SubstanceAbuse
interventionsandbrieftherapies,andthereason(s)forprovidingthis
stafftraining.
Eachparticipant wearsanametagclearlyshowingfirstnameor preferred name inlargeletters.
Trainer Script
Welcome & Topic Introduction
WelcometothisprofessionaltrainingprogramontheTIP34: Brief InterventionsandBriefTherapiesforSubstanceAbuse.TheTreatment Improvement Protocol(TIP) Seriesaremanualsof best practice guidelinesforthetreatmentofsubstanceabusedisorders.Therearecurrentlythirty-fiveTIPs manuals,providedasaserviceoftheCenterforSubstanceAbuseTreatment(CSAT) oftheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA).
Trainer Rationale for Tip 34 Training
Briefintervention andbrieftherapytechniqueshavebecomeanincreasinglyimportant partofthecontinuumofcareinthetreatmentofsubstanceabuse problems. I believethatwecanallbenefitfromadditional traininganddiscussionopportunitiesinthisarea because
.
Trainer Introduction
Myname is ,andmypositionis .
Inmyownclinicalexperience, Ihavehadtheopportunitytolearnanduse thesebriefintervention andbrieftherapyapproachesin
(e.g.,settingsoragencies)with (e.g.typesofclients).
ParticipantIntroductions(Optional)
Thesetrainingmodulesincludelargeandsmallgroupdiscussions. Therefore,weneed tobeacquaintedwithoneanotherbeforewebegin.Sincewehaveonly ashorttimeforthispartofthetraining, please limityourintroductiontoyourname,position, anddepartment.We will gettoknowmoreabout oneanotherinthetrainingprocess.
IntroductiontotheTIP34TrainingProgram34
TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
Module1–Section2
TimeClock
TrainerNotes
TIP 34Book
Participant Workbook
Reasons for Using Brief Interventions and Brief Therapies
Time: 5 Minutes
Trainer Notes
Thissectioncanbedidacticorinvolvemoderategroupinteraction.
Trainercanrelate information onhowbriefinterventionsandbrief therapiesarecurrentlyused orcouldbeused intheagency.
TIP 34 Reference
Chapter1:IntroductiontoBriefInterventions andTherapies(pp.1-12)
ParticipantWorkbook
■ReasonsforUsingBriefInterventionsandBriefTherapies
Trainer Script
Reasons for Using Brief Interventions and Brief Therapies
Theuse ofbriefintervention andbrieftherapytechniquesisgrowingandthere arevery good reasonsforthis:
1.Thereisagrowingbodyofresearchevidencethatconsistent demonstratestheirefficacy.
2.Thereisanincreasingdemandforsubstanceabusetreatment(arisingfromtheidentification ofmoreat-risksubstanceusersthroughEAPs, substance-testingprograms,health screeningefforts, anddrunkdrivingarrests),butalackofresourcestomeet thedemand.
3.Providersfrommanydisciplinesareawarethatearlyinterventionwithlessdysfunctional clients oftenhasgreatersuccessrates,andresultsinthelong-termreductioninsubstanceabuse-relatedmorbidityandassociatedhealthcarecosts.
4.Theprevalenceofharmfulandriskysubstanceuse farexceedsthecurrentcapacity oftrained professionalsandservices.
5.Greater use oftheseapproachesresult inmoreresources,time,andenergyfortreating thosewithmoreseveresubstanceabusedisorders.
6.Thereisalso increasedclientinterestinshort-term treatments.
35IntroductiontotheTIP34TrainingProgram
TIP34:BriefInterventionsand BriefTherapies for SubstanceAbuse
CliniciansBecomeEclecticPractitioners
Inrecent years,thebio-psychosocialapproachtothetreatmentof substanceabusedisordershas stimulatedmorecross-disciplinarycooperation.Inpractice,manytherapistswhohavebeen trainedin specifictheoreticalmodelsborrowtechniquesfromother models whenworkingwiththeirclients.Althoughthemodelsremaindistinct,therapistsoftenbecomeeclecticpractitioners.
Documented Effectiveness Through Carefully
Constructed Research Studies
Thecredibilityofrecommendedtreatmentapproachesmust be documentedthroughcarefullyconductedresearchstudies.Brief interventionsandbrieftherapieshaveresearchthatsupportstheiruse:
- Researchstudieshavebeen conductedinawiderange of
healthcaresettings,fromhospitalsandprimaryhealth care locationstomentalhealth clinics.
2.Briefinterventionshavebeenwidelytestedwithbothgeneralclinicalandsubstance-abusingpopulationsandhaveshowngreat promise inchangingclientbehavior.
3.Brieftherapies,however,havebeen unevenlyresearched.
4.Muchresearchsupportsthetheorythat longertimeintreatmentis associatedwithbetter outcomes.However,researchalso suggeststhat,forsome clients,there isnolossineffectivenesswhenlengthandintensityoftreatmentarereduced.
5.Muchoftheresearchtodate has centeredonclients withalcohol- relatedproblems.However,similarapproachescanbetakenwithusersofother substances.
Opportunity to Increase Positive Outcomes
These short, problem-specific approachesprovide the opportunity for clinicians to increase positive outcomes:
1.Clinicianscanuse thesemodalitiesindependentlyasstand-alone interventionsortreatments,orasadditionstootherformsof substanceabuse andmental health treatment.
2.Clinicianscanuse differentlevelsandtypes ofinterventionswithclients based ontheiridentified needs andcharacteristics(e.g.,severityandtypeofsubstance abuse, culturalorenvironmentalinfluences,gender, age,education,social stability).
3. Treatment ismoreeffectivewhentailored toindividualneedsasdeterminedbyin-depth assessmentsoftheproblemandantecedentstothesubstance abuse disorder.
IntroductiontotheTIP34TrainingProgram36
TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
4.These approachesarewellsuitedforclients whomay not be willingorabletoexpendthesignificantpersonalandfinancialresourcesnecessary to completemoreintensive,longer-termtreatments.
5.Theimplementationofsubstanceabusepreventionandbriefinterventionstrategiesinclinicalpractice requiresthedevelopmentofsystematizedprotocols thatcanprovideeasierservicedelivery.
Usedfor aVarietyofProblems
Theseapproachesareusedwithavarietyofsubstanceabuseproblems
fromat-riskuse todependence.
UsedinaVarietyofSettings
These approachesarealsoused inavarietyofsettings–including opportunisticsettings(e.g.,primarycare,homehealth care)and specializedsubstanceabusetreatmentsettings(e.g.,inpatientand outpatient,individualandgroup).
Module 1 – Section 3
TimeClock
TrainerNotes
TIP 34 Book
Participant Workbook
Common Characteristics of
Brief Interventions and Brief Therapies
Time: 5 Minutes
Trainer Notes
Thissectioncanbedidacticorinvolvemoderategroupinteraction.
Trainercanincludeinformationonhowbriefinterventionsandbrief therapiesarecurrentlyused orcouldbeused intheagency.
TIP 34 Reference
Chapter1:IntroductiontoBriefInterventions andTherapies(pp.1-12)
Participant Workbook
■CommonCharacteristicsofBriefInterventionsandBriefTherapies
Trainer Script
Introduction
Today,wewillreviewsomecommoncharacteristicsofbriefinterventions andbrieftherapies,andreasonstousetheseapproachesin yourpractice. Infuturetrainingsessions,wewill exploretheseapproachesinmoredetail.
37IntroductiontotheTIP34TrainingProgram
TIP34:BriefInterventionsand BriefTherapies for SubstanceAbuse
Common Characteristics of Brief Interventions
Commoncharacteristicsofbriefinterventionsincludethefollowing:
1.Investigatesapotentialsubstanceabuseproblem.
2.Generallyinvolvesscreeningforsubstanceabuseproblems,butnot extensiveassessment.
3.Motivates aclienttoperformaparticular action(e.g.,toenter treatment, change abehavior,thinkdifferentlyabout asituation).
4.Generallyinvolvesatherapistgivingadvicetotheclient.
5.Generallyshorterinlengthoftimeornumber ofsessions.
6.Canbeconductedinawidevarietyofnon-traditionaltreatment settings,such associal serviceorprimarycaresettings.
7.Canalso beconductedintraditional substanceabusetreatment settings.
8.Canbedelivered byawiderange ofhealth care andsocial service professionalsinaddition toprofessionalsworkinginthesubstance abuse field.
9.Canuse certainmedia andmaterialssuch aswrittenbookletsor computerprograms.
Common Characteristics of Brief Therapies
Commoncharacteristicsofbrieftherapiesincludethefollowing:
1.Involvesaseriesofsteps takentotreatasubstanceabuseproblem.
2.Usedto addresslargerconcernssuch asalteringpersonality, maintainingabstinence,oraddressinglong-standing problemsthatexacerbatesubstance abuse.
3.Involvesmovement(oranattemptatmovement)towardchange.
4.Concentratesoninvestigatingaprobleminordertodevelopa solution inconsultationwiththeclient.
5.Generallylongerinlengthoftimeornumber ofsessions.
6.Includes extensiveclientassessment.
7.Traditionallytiedtosubstanceabusetreatmentsettings.
8.Requiresprofessionaltraininginspecifictherapeuticmodalities.
9.Basedontheindividual needsofeach clientandtheappropriate servicesoftheagency.
IntroductiontotheTIP34TrainingProgram38
TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
Module 1 – Section 4
TimeClock
TrainerNotes
Participant Workbook
TrainingOverview
Time: 10 Minutes
Trainer Notes
Thissectionisdidactic,withthegroupinteractionlimitedtoclarifying questionsregardingthetrainingoverview.
TrainerdistributesandreviewsTIP34:BriefInterventions andBrief
TherapiesforSubstanceAbuseTreatment.Trainer reviewsTIP 34 TrainingModules. TrainerreviewsTIP 34 TrainingAgenda.
TrainerreviewstheTIP 34 TrainingScheduleandintroducesstaff whowillpresentothermodules.
TrainerdiscussesAttendanceRecordsandContinuing Education Credits. Attendancedocumentationisparticularlyimportant ifCEUsaregivenforthetraining.
TrainerreviewstheGroupRulesforgroupdiscussionsandexercises.
Participant Workbook
■ TIP34: BriefInterventionsandBriefTherapiesforSubstanceAbuse
Treatment
■ TIP34 TrainingModules andSchedule
■ GroupRules
Trainer Script
TIP 34: Brief Interventions and Brief Therapies for Substance Abuse Treatment
The TIPSeriesare bestpractice guidelinesforthetreatmentof substanceabusedisorders.Thistrainingprogramisbased uponTIP34: BriefInterventionsandBriefTherapiesforSubstanceAbuse. Thegoalof thisTIPistoincrease awarenessofthecurrentresearchandevidence-basedstrategies of brief interventionsandbrieftherapies. Pleasebringthismanualtoeach ofourTIP34training sessions.
TIP 34 Training Program
Thetrainingprovides up-to-dateinformationontheusefulnessof thesenewerandshorterformsoftreatmentforawiderange ofsubstanceabuseproblems.Eachofthetrainingsessionsincludes lecture,group
39IntroductiontotheTIP34TrainingProgram
TIP34:BriefInterventionsand BriefTherapies for SubstanceAbuse
discussionandastrategy integrationprocess.During thetraining,wewilluse case studies fromouragency.
TIP 34 Training Modules
Therearetwelvemodulesincludedinthistraining:
1. IntroductiontoBriefInterventionsandBriefTherapies TrainingProgram
2. BriefInterventionsinSubstanceAbuseTreatment
3. BriefTherapiesinSubstanceAbuseTreatment
4. BriefBehavioralTherapyBasedonClassicalConditioningModels
5. BriefBehavioralTherapyBasedonOperantLearningModels
6. BriefCognitiveTherapy
7. BriefCognitive–BehavioralTherapy
8. BriefStrategic/InteractionalTherapies
9. BriefHumanistic andExistential Therapies
10. BriefPsychodynamic Therapy
11. BriefFamilyTherapy
12. Time-LimitedGroupTherapy
TIP 34 Training Agenda
Exceptforthisfirst introductorysession,each trainingmoduleincludes: (1)atopicoverviewanddiscussionbasedonaSummary Grid,(2)astrategyidentificationexercise,and(3)anindividualstrategyintegration plan.
Eachofthemodulesforbriefinterventions and brief therapies is basedonaSummary Grid.Thegridsare based solelyuponinformationinTIP
34. Theysummarizetheessentialpointsforbriefinterventionsandeachofthebrieftherapies.Eachbriefintervention andbrieftherapySummaryGridcontainssectionsabout:
1.KeyConcepts
2.BasicConceptualModels
3.ResearchResults
4.AppropriateSettingsandClients
5.SubstanceAbuseTreatmentApplications
6.DurationofTherapy
7.EffectivenessEvaluation
IntroductiontotheTIP34TrainingProgram40
TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
Thestrategyidentificationandintegrationprocesswillhelpyoutoplantheuseofabriefintervention orbrieftherapystrategywithanactualclient.We willreviewthisprocesslaterinthistrainingsession.
Reading and Homework
Yourfamiliaritywiththematerial willallowustousemoretimefordiscussioninthesetrainingsessions. Tofacilitatethis,I willdistributethehandoutsforthenexttraining(includingthesummary gridsandstrategies)attheendofeach session.Pleaseread theSummary GridandcompletetheStrategyIdentificationExercisebefore thescheduledtraining. Ialso recommendreadingtherelated chapterorpagesinTIP
34. Therelevant pagesinTIP 34 areincluded inthehandouts.
GroupRules
TIP 34 Training Schedule
Yourattendanceateachmoduleisimportant.Ifyouareabsent,youwillnotonly miss thecontentmatter,butalso lose thecontinuityofthegroupinteractionandcase studydiscussions.For these reasons,thescheduleoffutureTIP 34 training sessionshasbeen prepared.Pleaseputthese datesinyourcalendarassoon aspossible.
Continuing Education Credits (Optional)
Continuingeducation creditsfor (e.g.,license or certification) areprovidedforthistraining.Pleasebesure tosigntheattendancesheettoreceiveyourcredithours.
Group Rules
Asthetrainer,Ihavetheresponsibility tokeep discussionsfocusedonthetopic,tokeepthetrainings ontime,andtocreateatrainingenvironmentthatencouragescreativityandparticipation.
Safetyisthekeyingredient forgroupparticipation.Groupmembersmustfeelsafetoexpresstheirideashonestly andfrankly.Inordertoenhancethesafetywithinthistrainingprogram,certaingroundruleswillgovernthediscussionsofthegroup.
These group rulesareinyourhandoutpacket. Although youhaveprobablyusedthese rulesinothergroups ortrainings,thereisvalueinmakingthem explicitwithinthecontext ofourowngroup.
Thebasicrules ofthegroupare:
1.Protect Confidentiality
Confidentialityistheheartofsafety foralltherapeuticgroups. If personalinformationissharedwithinthetraining,itisnottobesharedoutsidethetraining.For example,ifagroupmember reveals thats/heis“inrecovery,”thisinformation willnotbediscussedoutsidethetrainingsessionwithouttheexpresspermissionofthatgroupmember.
41IntroductiontotheTIP34TrainingProgram
TIP34:BriefInterventionsand BriefTherapies for SubstanceAbuse
2.MaintainyourSenseofHumor
Youmay,however,expressunbridledenthusiasmforthistrainingprogramtoeveryoneyoumeet.I was testing your sense of humor.Laughter alwayshelps thelearningprocess.
3.RespectOtherParticipants
Thistrainingmaybringoutstrong opinionsandfeelings.Certain approachesarecontroversialwithrespecttotheireffectivenesswithsubstanceabusingclients.Youhavearighttoyouropinions, andeveryoneinthegrouphas therighttohavetheir ownopinions.Respectoneanother’srighttothinkforthemselves. Pleaseuse“I”statementswhenexpressingyouropinions orfeelings aboutanapproachorstrategy.
4.Share Honestly
Protecting confidentialityandshowingrespectcreatesasafe group environment. Honestywillhappenifyoufeelsafetodosowithinthegroup.Yourcourage toshareyourexperienceswith theseapproachesandstrategieswillalso encourageotherstoparticipate.
5.Participate
Your activeparticipationwillenhancethequalityofthistraining.Activelistening andinvolvementwillbegreatlyappreciatedbyeveryoneinthegroup.Ideally,thediscussionswill stiryourthoughts,andeach ofyoushouldtaketheopportunitytoparticipateinthediscussions.Pleasedosowiththewholegroupandnotonly withyourseatingneighbors
6.RequestInformation/AskQuestions
Theonly badquestionisthe one that isnotasked. Youhavethepersonalrightandtheprofessionalresponsibility tolearnfromthistrainingexperienceandtoask relevant questions.
7.Focusonthe Topic
Pleasekeep yourcommentsfocusedonthetopic.Unfortunately,our session has only 45 minutestocoveragreatdealofmaterial.
Module 1 – Section 5
Quality Assurance and Improvement
Time: 5 Minutes
Trainer Notes
Thissectioncanbedidacticorinvolvemoderategroupinteraction.
Thetrainer discussestheimportanceofincludingqualityassuranceandimprovementmeasuresinthetrainingprocess.
TIP 34 Reference
Chapter1:IntroductiontoBriefInterventions andTherapies(pp.11-12)
IntroductiontotheTIP34TrainingProgram42
TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
ParticipantWorkbook
■ QualityAssuranceandImprovement
Trainer Script
Time Clock
TrainerNotes
Quality Assurance and Improvement
Brief Interventionsandbrieftherapiescanimprovetreatmentoutcomes.Thistrainingprogramencouragesyoutointegratenewstrategiesintoyourpersonalrepertoire ofclientservices.Italso encouragesyoutoevaluatetheeffectivenessofthestrategiesthat you use.
Theuse ofqualityassuranceandimprovement componentscanhelpyoudetermineiftheuse ofnewbriefinterventionsorbrieftherapystrategiesareactuallyimprovingtreatment.Effectivenessevaluationsdonothavetobetime-consumingorcomplicated.Theycanbeconductedinperson,byphone, throughtheInternet, orbymail.
Thestrategyintegrationprocessincludes aqualityassuranceand improvement assessment sixmonthsfromtheinitiationofthebrief interventionorbrieftherapywithyourclient.
Treatmenteffectivenesscanbeassessedinavarietyofways:
1.Aftercarefollow-uprates
2.Aftercarecompliancerates
3.Alumniparticipationrates
4.Dischargeagainstmedical advice rates
5.Counselors’ratings ofclientinvolvementinsubstance abusefollowingtreatment
6.Thenumberofcomplaintsrelatedtothebriefintervention ortherapy
7.Clientsatisfactionsurveys
8.Follow-upphone calls
9.Counselor-rating questionsaddedtotheclinicalchart
Module 1 – Section 6
Strategy Identification Exercise Overview
Time: 5 Minutes
Trainer Notes
Trainerpreparesparticipantsforstrategyidentificationandintegration process.
43IntroductiontotheTIP34TrainingProgram
TIP34:BriefInterventionsand BriefTherapies for SubstanceAbuse
Thetrainer acquaintsparticipantswiththeproceduresforcompletingtheStrategyIdentification Exercise.
Participant Workbook
■ Sample StrategyIdentificationExercise
Participant Workbook
TimeClock
TrainerNotes
Trainer Script
Strategy Identification Exercise
Eachofthetrainingmodulesincludesastrategyintegration component toencourageyoutotrynewbriefintervention andbrieftherapystrategies withyourclients.
Following thereviewoftheSummary Grid,wewill discusstheStrategy IdentificationExercise.Thishandoutpresentsavarietyofstrategiesrelatedtothemodule topic,usuallyorganizedaccording tothebasic conceptualmodels presentedintheSummary Grid.Youshould reviewandcompletethishandoutbeforethetraining.
Asampleofthishandoutisinyourpacket.Itshows justafewofthe strategiesused inBriefCognitiveBehavioralTherapy.
Thehandoutdirectsyoutoplaceacheck (√)nexttostrategiesyou haveusedsuccessfullyinyourclinical practice,andtoplaceastar (*)nexttonewstrategiesyouwouldliketoincludeinyourclinicalpractice.Youwillselectonenewstrategy fromthelisttouse withacurrent client.
Thisexercise includes awhole-groupdiscussion. Iwillaskforvolunteers tosharewhichstrategiestheyhavesuccessfullyused withourclients.Pleasepayclose attentiontotheexpertiseofourstaff that isrevealedinthisexercise. You maywishtorecruitastaff member tohelpyou withyour new strategy.
You willdevelopaplanofactionforutilizingyournewstrategy andevaluatingitseffectiveness.TheStrategyIntegrationMind-Map Exerciseisused forthispurpose.
Module 1 – Section 7
Strategy Integration Mind-Map Exercise Overview
Time: 5 Minutes
Trainer Notes
Trainerpreparesparticipantsforusingatargetedstrategy withaclient.
Thetrainer acquaintsparticipantswiththeproceduresforcompletingtheStrategyIntegrationMind-Map.
IntroductiontotheTIP34TrainingProgram44
TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
Participant Workbook
Participant Workbook
■ Sample StrategyIntegration Mind-Map
■ IllustratedStrategyIntegration Mind-Map
Trainer Script
Strategy Integration Mind-Map
Followingyourstrategyselection,you willcreatea“mind-map”toplanhowtoutilizeyourselectedstrategy withyourclient.
Mind-mapping–also known asNode-Link Mapping –isanexcellent, evidence-basedtoolforclarifyingthought processesandenhancingthe learningprocess.Mind-mappingallowsyoutoconceptualizeyourplanfortheintegrationofanewstrategy ononepage.
Thisformatismoreeasilyrememberedthan other formsofwriting,suchasoutlinesorlists. Ituses brainstormingtoencouragethegenerationofnewideas,andallowsyoutoorganizeyourthinkingbyfittingideastogetherintoaconceptual“map.”
Althoughmind-mappingcanuselists, themapisnotcreatedthroughlinearthinking,andallideasarerelatedtothethemeinthecenter.Bypersonalizingthemapwithsymbolsanddesigns,youcandevelopastrategy mind-mapthatcanbemoreeasilyrememberedandthenutilizedwithyourtargetedclient.
Mind-mapsarefunandeasy tocreate.Letmeillustrateamind-mapabouthowtocreateamind-map.
First, youwritetheselected newstrategyinthecenter ofthemind-map. Thisoneisabout“LearningtoMind-Map.” Thefocusofamind-map
isusuallyplaced inthecenter ofthepage.
Then–usingpens, coloredpencils,orcrayons–youplace related ideasinboxes, circles, lists, ordrawingsthat radiate fromthecenter.
Thismind-mapillustratestheuse ofbrainstorming,pictures,lists, and arrows.The ideasareconnectedtothecentralthemeortooneanother withlinesorarrowstoindicate theirrelationship.
Thismind-mapexerciseshould helpyoutofocusonthe issues oftheclientthatmakehim/heragoodcandidateforthistypeofstrategy. Keytopicsaresuggestedontheborderoftheexerciseform.You canbrainstormideasforanyofthesuggestedplanningareas.Youcanwriteordrawyourthoughtsas you addressbarriers,outcomesandresourcesforthisstrategyintegration.
Youmaywanttoincludesome salientandrelevantpointsaboutthe strategythat canbediscussedwiththeclienttoenlist hisorhersupport ofthisapproach.
45IntroductiontotheTIP34TrainingProgram
TIP34:BriefInterventionsand BriefTherapies for SubstanceAbuse
However, youmustincludeanoutcomeevaluation methodforyourstrategy.
Youmaywishtouse other experiencedstaff asasounding boardforideasabouthowtointegratethestrategyintoyourpractice. Followingthisplanning,I willinvitevolunteerstoshareyourmind-mapandplanwiththegroup.
Pleasedonotputthe name ofyourclientonthisform.However,you may want to include thisnewstrategy intheclient’sfile ortreatmentplan.
Thenextimportant stepoccursafterthistraining,whenyouputyourplanintoaction withyourclient.
Module 1 – Section 8
TimeClock
TrainerNotes
ParticipantWorkbook
Training Follow-up and Feedback
Time: 2 Minutes
Trainer Notes
Trainerdiscussesproceduresfortrainingfollow-upandfeedbackfollowingthecompletion oftheStrategyIntegrationMind-Map.
Trainerreviewsthee-Mail Feedback Form.
Trainerdiscussesopportunitytoparticipateinane-Mail Discussion Forum
related totheTIP 34 training.
Participant Workbook
■e-mailFeedbackForm
Trainer Script
e-mail Feedback Form
Sixmonthsafterthecompletionofthistrainingmodule, you willbesentane-MailFeedbackForm.Thisformshouldbereturnedafteryou havecompletedthequalityassuranceandimprovement strategy thatyouselectedonyourStrategyIntegrationMind-Map. You willbeasked togiveinformation aboutyourselectedstrategy, andyourassessment oftheeffectivenessofthebriefintervention and/orbrieftherapywithyourtargetedclient.You willalso beasked togivefeedbackabouttheusefulnessofthetrainingmodule.Thisisanimbeddedqualityassuranceandimprovement strategy fortheTIP 34trainingprogram.
IntroductiontotheTIP34TrainingProgram46
TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
Module 1 – Section9
Assignments and Closing
Time: 3 Minutes
Time Clock
Trainer Notes
Trainergivesabriefpreviewofnexttrainingtopicanddistributesthe handoutpacket.
TrainergivesTIP 34reading referencesforthistraining.
Trainer discusses date, time,andplace ofnexttrainingsession.
Trainerdistributeshandoutpacket fornexttraining.
Trainer Notes
Participant Workbook
■Handout Packet forNextTIP34 Training
Trainer Script
ReadingandHomework
Thankyouforparticipatinginthisintroduction totheTIP 34 Training Program.
Ournexttrainingmodule will explore [Training Topic].
Pleaseread theSummary Gridandcompletethe Strategy Identification Exercisebefore thetraining.The TIP 34 referencesforthistrainingare______[relevant TIP 34 pagesorchapter].
Thistrainingmoduleisscheduledfor [date, time,andplace].
47IntroductiontotheTIP34TrainingProgram
TIP34:BriefInterventionsand BriefTherapies for SubstanceAbuse
Participant
Workbook
Module 1:
Introduction totheTIP 34 Training Program
IntroductiontotheTIP34TrainingProgram48
TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
Reasons for Using Brief Interventions and
Brief Therapies
■Theuse ofbriefintervention andbrieftherapytechniquesisgrowing andthere areverygoodreasonsforthis:
1.Thereisagrowingbodyofresearchevidencethat consistentlydemonstratestheirefficacy.
2.Thereisanincreasingdemandforsubstanceabusetreatment(arisingfromtheidentification of moreat-risksubstanceusersthroughEAPs,substance-testingprograms,health screeningefforts, anddrunkdrivingarrests),butalackofresourcestomeet thedemand.
3.Providersfrommanydisciplinesareaware that earlyintervention with lessdysfunctional clients oftenproducesgreatersuccess rates,andresultsinthelong-termreductioninsubstance abuse-related morbidityandassociatedhealth care costs.
4.Theprevalenceofharmfulandriskysubstanceuse farexceedsthecurrent capacity oftrained professionalsandservices.
5.Greater useoftheseapproachesresultinmoreresources,time,andenergyfortreating thosewithmoreseveresubstanceabusedisorders.
6.Thereisalsoincreasedclientinterestinshort-term treatments.
■Inrecentyears,thebio-psychosocialapproachtothetreatmentofsubstanceabusedisordershas stimulatedmorecross-disciplinary cooperation.
■Inpractice,manytherapistswhohavebeen trained inspecifictheoreticalmodels borrowtechniquesfromothermodelswhenworkingwiththeirclients.Althoughthemodelsremain distinct, therapistsoftenbecomeeclecticpractitioners.
■Briefinterventionsandbrieftherapieshaveresearchthat supportstheir use:
1.Researchstudieshavebeenconductedinawiderange ofhealthcare settings,fromhospitalsandprimaryhealth care locationstomentalhealthclinics.
2.Briefinterventionshavebeenwidelytested withbothgeneral clinicalandsubstance-abusing populationsandhaveshowngreatpromiseinchangingclientbehavior.
3.Brieftherapies,however,havebeen unevenlyresearched.
4.Muchresearchsupportsthetheorythat longertimeintreatmentisassociatedwithimproved outcomes. However,researchalsosuggests that,forsomeclients,there isno loss ineffectiveness whenlengthandintensity oftreatmentarereduced.
5.Muchoftheresearchtodatehascenteredonclientswithalcohol-relatedproblems. However,similarapproachescanbetaken withusersofothersubstances.
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■These short,problem-specific approachesprovidetheopportunityforclinicians toincreasepositive outcomes:
1.Clinicianscanusethesemodalitiesindependentlyasstand-aloneinterventionsortreatments,orasadditionstoother formsofsubstanceabuseandmental health treatment.
2.Clinicianscanusedifferentlevelsandtypes ofinterventionswithclients basedontheiridentifiedneeds andcharacteristics(e.g.,severityandtypeofsubstance abuse,culturalorenvironmentalinfluences,gender, age,education,social stability).
3.Treatmentismoreeffectivewhentailoredtoindividualneedsasdeterminedbyin-depth assessmentsoftheproblemandantecedentstothesubstanceabusedisorder.
4.These approachesarewellsuitedforclients whomaynotbewillingorabletoexpend thesignificantpersonalandfinancialresourcesnecessaryto completemoreintensive,longer-termtreatments.
5.Theimplementationofsubstance abuseprevention andbriefintervention strategiesinclinicalpracticerequiresthedevelopmentofsystematized protocolsthatcanprovideeasierservicedelivery.
■Thesetwoapproachesareused withavarietyofsubstance abuseproblems fromatriskusetodependence.
■Bothapproachesarealso usedinavarietyofsettings,including opportunisticsettings(e.g.,primarycare,homehealth care)andspecializedsubstanceabusetreatmentsettings(inpatient andoutpatient).
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TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
Common Characteristics of Brief Interventions
Commoncharacteristicsofbriefinterventionsincludethefollowing:
1.Investigatesapotentialsubstanceabuseproblem
2.Generallyinvolvesscreeningforsubstanceabuseproblems,butnotextensiveassessment
3.Motivates aclienttoperformaparticular action (e.g.,toenter treatment,change abehavior,thinkdifferentlyaboutasituation)
4.Generallyinvolvesatherapistgivingadvicetotheclient
5.Generallyshorterinlengthoftimeornumber of sessions
6.Canbeconductedinawidevarietyofnon-traditional treatmentsettings,such associal serviceorprimarycaresettings
7.Canalso beconductedintraditional substanceabusetreatmentsettings
8.Canbedelivered byawiderangeofhealthcareandsocialserviceprofessionalsinadditionto professionalsworking inthesubstanceabusefield
9.Canuse certainmedia andmaterialssuch aswrittenbookletsorcomputerprograms
Common Characteristics ofBrief Therapies
Commoncharacteristicsofbrieftherapiesincludethefollowing:
1. Involve aseries of stepstaken totreatasubstanceabuseproblem
2.Usedtoaddresslargerconcernssuchasalteringpersonality,maintaining abstinence,oraddressing long-standing problemsthat exacerbate substance abuse
3.Involvemovement (oranattemptatmovement)towardchange
4.Concentrateoninvestigatingaprobleminordertodevelopasolutioninconsultationwiththeclient
5.Generallylongerinlengthoftimeor number of sessions
6.Includeextensiveclientassessment
7.Traditionallytiedtosubstanceabusetreatmentsettings
8.Requireprofessionaltraininginspecifictherapeuticmodalities
9.Basedontheindividualneedsofeachclientandtheappropriateservicesoftheagency
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Tip 34 Training Modules and Schedule
1. Introduction to Brief Interventions and Brief Therapies Training Program
[DATETIME]
2. Brief Interventions in Substance Abuse Treatment
[DATETIME]
3. Brief Therapies in Substance Abuse Treatment
[DATETIME]
4. Brief Behavioral Therapy Based on Classical Conditioning Models
[DATETIME]
5. BriefBehavioralTherapyBasedonOperantLearningModels
[DATETIME]
6. Brief Cognitive Therapy
[DATETIME]
7. Brief Cognitive–Behavioral Therapy
[DATETIME]
8. BriefStrategic/InteractionalTherapies
[DATETIME]
9. BriefHumanistic andExistential Therapies
[DATETIME]
10. Brief Psychodynamic Therapy
[DATETIME]
11. Brief Family Therapy
[DATETIME]
12. Time-Limited Group Therapy
[DATETIME]
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Group Rules
■ProtectConfidentiality—Ifpersonalinformationissharedinthetraining,itisnottobesharedoutsidethetraining.
■Maintain YourSenseofHumor—Anappropriatesenseofhumoriswelcomeatthistrainingandveryhelpfulwhendiscussingcontroversialtopics.
■RespectOtherParticipants— Youhavearighttoyouropinions, justaseveryoneinthegrouphastherighttohavehis/herownopinion.Respectoneanother’srighttothinkforthemselves.
■Share Honestly—Honesty will happenifyoufeelsafe todosowithinthegroup.Yourcourage tosharehonestlywiththegroup will encourageotherstoparticipate.
■Participate—Your activeparticipationenhancesthequalityofthetraining.Activelistening and involvementwill begreatlyappreciatedbyeveryoneinthegroup.
■RequestInformation/AskQuestions—Theonly badquestionistheonethat wasnot asked.
Youhavethepersonalrightandtheprofessionalresponsibility tolearnandask questions.
■Stay FocusedonTheTopic—Pleasekeep yourcommentsandquestionsfocusedonthetopic.
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Quality Assurance and Improvement
Brief Interventions andbrieftherapiescanimprovetreatmentoutcomesinspecificareas.Theuse of qualityassuranceandimprovement componentscanhelpdetermineiftheuse ofbriefinterventionsorbrieftherapiesinspecifictreatmentsituationsisactuallyimprovingtreatment.
Effectivenessevaluationsdonothavetobetime-consumingorcomplicated.Theycanbeconductedin person,byphone,throughtheInternet,orbymail.
Treatmenteffectivenesscanbe assessedinavarietyofways:
1.Aftercarefollow-uprates
2.Aftercarecompliancerates
3.Alumniparticipationrates
4.Discharge againstmedical advice rates
5.Counselors’ratings ofclientinvolvementinsubstanceabusefollowingtreatment
6.Thenumber ofcomplaintsrelated tothebriefintervention or therapy
7.Clientsatisfactionsurveys
8.Follow-upphone calls
9.Counselor-rating questionsaddedtotheclinicalchart
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TIP34:BriefInterventionsandBriefTherapiesforSubstanceAbuse
Sample Strategy Identification Exercise
■ Place a check (√) next to strategies that you have used successfully in your clinical practice.
■ Place a star (*) next to new strategies that you want to include in your clinical practice.
Behavioral Coping Strategies:
●Basicavoidanceofsituationsthathavebeenpreviouslyassociatedwithsubstance abuse
●Seek social supportwhenconfrontedwiththetemptationtodrinkorusedrugs
●Anticipateandplanhowtodealwithupcoming situations(Anticipatory:“Whatcan I doif…”)
●Copewithdifficult,in-the-moment,substance-relatedsituations(“Whatcan I donow…”)
●Copewitharelapsesituation(Restorative:“Whatcan I donowthat I’ve…”).Theseplayarolein determining whether aninitialuseofdrugswill escalateintoafullrelapse
Cognitive Coping Strategies:
●Examinetheclient’scognitive processesrelatedtosubstance abuse
●Identifynegative thinking
●Identifynegative consequencesthat haveresultedfromsubstance abuseandinstilladesiretoexperiencethesenomore
●Identifypositivethinking
● Identifyallthebenefitsthatareaccruedbybeingclean andsober andinstilladesireto experiencethesemore
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