? ? Research and focus groups with program managers, clinicians and funding representatives indicate that the costs associated with training and supervising clinicians to deliver behavioral therapies with adequate adherence and competence is beyond the means of most treatment programs. For empirically supported behavioral therapies to be adopted by community-based providers the training and supervision burden must be reduced substantially without compromising the fidelity of the intervention. To do this, the investigators propose to adapt a strategy that has been successfully employed by educators for decades: the use of standardized, highly scripted, empirically based lesson plans. These lesson plans, or """"""""Toolkits,"""""""" will contain instructional media designed for use by clinicians in a prescribed sequence, in a single group therapy session, on a single evidence-based topic. In the proposed study the investigators will: a) develop a prototype of the Toolkit employing instructional design principles and practices; b) test whether clinicians find it acceptable and feasible to conduct a Toolkit facilitated group after only a brief orientation; c) test whether patients find the Toolkit facilitated groups acceptable; and d) test whether this specific Toolkit prototype - Decisional Balance - is effective in increasing patient readiness to change. Addiction researchers have produced a wealth of information, interventions and assessments that could be re-packaged for use in group therapy settings using the Toolkit format. The Toolkit concept is proposed as a strategy for simplifying the transfer of evidence-based behavioral interventions so that clinicians can readily employ them in a standardized manner after only a brief orientation. Ultimately, a full clinical curriculum is envisioned, made up of dozens of evidence-based Toolkits. Like a modem educational curriculum, this clinical curriculum would address the core patient skills and knowledge that addiction experts agree constitutes an adequate """"""""course"""""""" of treatment. ? ?
