Evaluating and Training Substance Abuse Counselors: A Pilot Study Assessing Standardized Patients as Authentic Clients

Abstract

Clinician training and supervision are needed to transfer evidence-based practices to community-based treatment organizations. Standardized patients (SPs) are used for clinician training and evaluating. However, to be effective for substance abuse counselors, SPs must realistically portray substance abuse treatment clients. The current study assessed authenticity of SPs as substance abuse treatment clients. Twenty-one substance abuse counselors interviewed SP(s) with differing profiles. Counselors provided quantitative and qualitative ratings of SP authenticity. Counselor responses to the study procedures were analyzed as well. Quantitative results include high-authenticity ratings for the SPs but counselors’ subjective responses varied. Counselor's rated the experience of participating in the study positively and provided constructive comments for future applications of this methodology. Results support future work on SPs as teaching and evaluation tools in substance abuse counseling. Findings also illustrate the need to refine definitions of authenticity for SPs as substance abuse clients.

Keywords

Evidence-based practice quality of care simulated patients standardized patients substance abuse clients substance abuse treatment

Get full access to this article

View all access options for this article.

References

Crits-Christoph

and Siqueland

1996 Psychosocial treatment for drug abuse: selected review and recommendations for national health care. Arch Gen Psychiatry. 53: 749–756

Finney

J W

and Monahan

S C

1996 The cost-effectiveness of treatment for alcoholism: a second approximation. J Stud Alcohol 57: 229–243

Institute of Medicine 1990 Broadening the Base of Treatment for Alcohol Problems Washington, DC: National Academy Press.

Leshner

A I

1997 Addiction is a brain disease, and it matters. Science 278: 45–47

Leshner

A I

1999 Editorial: Science is revolutionizing our view of addiction and what to do about it. Am J Psychiatry 156: 1–3

McLellan

A T

, Belding

, McKay

J R

, Zanis

and Alterman

A I

1996 “Can the outcomes research literature inform the search for quality indicators in substance abuse treatment?”. In Institute of Medicine. Managing Managed Care: Quality Improvement in Behavioral Health Washington, DC: National Academy Press.

McLellan

A T

, Woody

G E

, Metzger

, McKay

, Durell

, Alterman

A I

and O'Brien

C P

1997 “Evaluating the effectiveness of addiction treatments: reasonable expectations, appropriate comparisons”. In Treating Drug Abusers Effectively Edited by: Egertson

J A

, Fox

D M

and Leshner

A I

Oxford: Blackwell Publishers.

Miller

W R

1992 The effectiveness of treatment for substance abuse: reasons for optimism. J Subst Abuse Treat 9: 93–102

Moos

R H

and Finney

J W

1995 Substance abuse treatment programs and processes: linkages to patients’ needs and outcomes. J Subst Abuse 7: 1–8

10.

O'Brien

C P

and McLellan

A T

1996 Myths about the treatment of addiction. Lancet 347: 237–240

11.

O'Connor

P G

and Schottenfeld

R S

1998 Patients with alcohol problems. N Engl J Med 338: 592–602

12.

Weisner

2001 “Overview”. In Recent Developments in Alcoholism, Volume 15, Services Research in the Era of Managed Care Edited by: Galanter

99–105 New York: Kluwer Academic/Plenum Publishers.

13.

McLellan

A T

, Carise

and Kleber

H D

2003 Can the national addiction treatment infrastructure support the public's demand for quality care?. J Subst Abuse Treat 25: 117–121

14.

McLellan

A T

and Meyers

2004 Contemporary addiction treatment: a review of systems problems for adults and adolescents. Biol Psychiatry 56: 764–770

15.

McGlynn

E A

, Asch

S M

, Adams

, Keesey

, Hicks

, DeCristofaro

and Kerr

E A

2003 The quality of health care delivered to adults in the United States. N Engl J Med 348: 2635–2645

16.

Lamb

, Greenlick

M R

and McCarty

1998 Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment Washington, DC: Institute of Medicine, National Academy Press.

17.

McLellan

A T

2002 Editorial. Technology transfer and the treatment of addiction: what can research offer practice?. J Subst Abuse Treat 22: 169–170

18.

Simpson

D D

2002 A conceptual article for transferring research to practice. J Subst Abuse Treat 22: 171–182

19.

Addiction Technology Transfer Centers 2000 The Change Book: Blueprint for Technology Transfer Kansas City, MO: ATTC National Office.

20.

Substance Abuse and Mental Health Services Administration 2002 Report to Congress on the Prevention and Treatment of Co-occuring Substance Abuse Disorders and Mental Disorders Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.

21.

Rosengren

D B

, Baer

J S

, Hartzler

, Dunn

C W

and Wells

E A

2005 The video assessment of simulated encounters (VASE): Development and validation of a group-administered method for evaluating clinician skills in motivational interviewing. Drug Alcohol Depend 79: 321–330

22.

Baer

J S

, Rosengren

D B

, Dunn

C W

, Wells

E A

, Ogle

R L

and Hartzler

2004 An evaluation of workshop training in motivational interviewing for addiction and mental health clinicians. Drug Alcohol Depend 73: 99–106

23.

Institute of Medicine 2006 Improving the Quality of Health Care for Mental and Substance-Use Conditions Washington, DC: The National Academies Press.

24.

Barrows

H S

1987 Simulated (Standardized) Patients and Other Human Simulations Chapel Hill, NC: Health Sciences Consortium.

25.

Colliver

J A

and Swartz

M H

1997 Assessing clinical performance with standardized patients. JAMA 278: 790–791

26.

Swartz

M H

and Colliver

J A

1996 Using standardized patients for assessing clinical performance: an overview. Mt Sinai J Med 63: 241–249

27.

Bindman

A B

1999 Can physician profiles be trusted?. JAMA 281: 2142–2143

28.

Brownell

, Stillman

and Wang

1994 Growing use of standardized patients in teaching and evaluation in medical education. Teach Learn Med 6: 15–22

29.

Rosenberg

1997 Playing patient. Am Med News : 24–26 June 2nd

30.

Hazelkorn

H M

and Robins

L S

1996 Actors play patients: using surrogate patients to look into private practice. Public Health Rep 111: 129–132

31.

Marchiondo

and Kipp

1987 Establishing a standardized patient education program. Crit Care Nurse 7: 58–66

32.

Madden

J M

, Quick

J D

, Ross-Degnan

and Kafle

K K

1997 Undercover careseekers: simulated clients in the study of health provider behavior in developing countries. Soc Sci Med 45: 1465–1482

33.

Eagles

J M

, Calder

S A

, Nicoll

K S

and Walker

L G

2001 A comparison of real patients, simulated patients and videotaped interview in teaching medical students about alcohol misuse. Med Teach 23: 490–493

34.

Famuyiwa

O O

, Zachariah

M P

and Ilechukwu

S T

1991 The objective structured clinical examination in undergraduate psychiatry. Med Educ 25: 45–50

35.

Hanson

, Hodges

, McNaughton

and Regehr

1998 The integration of child psychiatry into a psychiatry clerkship OSCE. Can J Psychiatry 43: 614–618

36.

Hodges

, Regehr

, Hanson

and McNaughton

1997 An objective structured clinical examination for evaluating psychiatric clinical clerks. Acad Med 72: 715–721

37.

Loschen

1993 Using the objective structured clinical examination in a psychiatric residency. Acad Psychiatry 17: 95–104

38.

Badger

L W

, Gruy

F V

, Hartman

, Plant

M A

, Leeper

Anderson

1994 Patient presentation, interview content, and the detection of depression by primary care physicians. Psychosom Med 56: 128–135

39.

Cloe

, Raju

, Barrett

, Gerrity

and Dietrich

2000 The MacArthur Foundation Depression Education Program for Primary Care Physicians: background and rationale. Gen Hosp Psychiatry 22: 299–358

40.

Gerrity

M S

, Cole

S A

, Dietrich

A J

and Barrett

J E

1999 Improving the recognition and management of depression: is there a role for physician education?. J Fam Pract 48: 949–957

41.

Christison

G W

and Haviland

M G

2003 Requiring a one-week addiction treatment experience in a six-week psychiatry clerkship: effects on attitudes toward substance-abusing patients. Teach Learn Med 15: 93–97

42.

Matthews

, Kadish

, Barrett

S V

, Mazor

, Field

and Jonassen

2002 The impact of a brief interclerkship about substance abuse on medical students’ skills. Acad Med 77: 419–428

43.

Roche

A M

, Stubbs

J M

, Sanson-Fisher

R W

and Saunders

J B

1997 A controlled trial of educational strategies to teach medical students brief intervention skills for alcohol problems. Prev Med 26: 78–85

44.

Wagner

P J

, Lentz

and Heslop

S D

2002 Teaching communication skills: a skills-based approach. Acad Med 77: 1164

45.

Walsh

R A

, Sanson-Fisher

R W

, Low

and Roche

A M

1999 Teaching medical students alcohol intervention skills: results of a controlled trial. Med Educ 33: 559–565

46.

Walsh

R A

, Roche

A M

, Sanson-Fisher

R W

and Saunders

J B

2001 Interactional skills of students from traditional and non-traditional medical schools before and after alcohol education. Med Educ 35: 211–216

47.

Murphy

S A

, Scott

C S

and Mandel

L S

1995 Evaluating students’ substance abuse assessment skills. J Subst Abuse 7: 357–364

48.

Stimmel

, Cohen

, Colliver

and Swartz

M D

2000 An assessment of house staff's knowledge of alcohol and substance abuse utilizing standardized patients. Subst Abuse 21: 1–7

49.

Baez

, Eckert-Norton

and Morrison

2004 Interdisciplinary collaboration on substance abuse skill OSCEs. Subst Abuse 25: 29–31

50.

Saitz

, Sullivan

L M

and Samet

J H

2000 Training community-based clinicians in screening and brief intervention for substance abuse problems: translating evidence into practice. Subst Abuse 21: 21–31

51.

Krahn

, Sutor

and Bostwick

J M

2001 Conveying emotional realism: a challenge to using standardized patients. Acad Med 76: 216–217

52.

Mechanic

, McAlpine

D D

and Rosenthal

2001 Are patients’ office visits with physicians getting shorter?. N Engl J Med 344: 198–204

53.

McCarty

and Goldman

H H

2005 “Treatment for alcohol and drug dependence: history, workforce, organization, financing and emerging policies”. In Substance Abuse: A Comprehensive Textbook, 4th ed., Edited by: Lowinson

J H

, Ruiz

, Millman

R B

and Langrod

J G

1346–1360 Philadelphia: Lippincott, Williams, & Wilkins.

54.

Ambert

, Adler

and Detzner

1995 Understanding and evaluating qualitative research. J Marriage Fam 57: 879–893

55.

Fine

G A

and Elsbach

2000 Ethnography and experiment in social psychological theory building: tactics for integrating field data with quantitative lab data. J Exp Soc Psychol 36: 51–76

56.

Forman

R F

, Bovasso

and Woody

2001 Staff beliefs about addictions treatment. J Subst Abuse Treat 21: 1–9

57.

Humphreys

, Greenbaum

M A

, Noke

J M

and Finney

J W

1996 Reliability, validity, and normative data for a short version of the understanding of alcoholism scale. Psychol Addict Behav 10: 38–44

58.

Grella

C E

2003 Contrasting the views of substance misuse and mental health treatment providers on treating the dually diagnosed. Subst Use Misuse 38: 1433–1446

59.

Wind

L A

, VanDalen

, Muijtjens

A MM

and Rethans

J J

2004 Assessing simulated patients in an educational setting: The MaSP (Maastricht Assessment of Simulated Patients). Med Educ 38: 39–44