Refining and Piloting the R3 Supervision Strategy in Substance Use Disorder Treatment Programs

PROJECT SUMMARY/ABSTRACT Substance use disorders (SUDs) such as addiction to opioids, methamphetamines and alcohol are a significant burden in the US, affecting almost 50 million individuals annually. Community specialty SUD treatment programs (“SUD programs”) are a key type of SUD providers and while effective treatments for SUD

exist, significant issues in the organization and delivery of SUD programs (e.g., burnout, turnover) undermine the delivery of high-quality services. Clinical supervisors are centrally positioned to support SUD counselors (frontline clinical providers) and ensure high service quality. In order for clinical supervisors to effectively support counselors, they need evidence-based supervision

strategies. Currently, supervisors in community SUD programs receive very little training, support, and direction for supervision, and thus their supervision practices are highly variable, raising concern about the effectiveness of clinical supervision as currently provided in these programs. R3 is an evidence-based

supervision strategy that can help fill the gap. The R3 strategy has been developed for child welfare settings where it improved leadership, climate, and client outcomes. Based on our preliminary formative work with SUD providers in Arkansas, the R3 strategy was deemed acceptable and feasible in SUD programs, and had high

perceived potential to improve supervision quality, counselor well-being and performance, and client outcomes. Participants thought the core components of the R3 strategy were a good fit for SUD settings and would not require adaptation; however, the language, behavioral examples, and associated materials (e.g., training,

manual) would need to be modified for use in SUD settings. The goals of our study are to iteratively modify and refine the R3 supervision strategy for SUD settings (R3-SUD) and pilot it in SUD residential treatment programs using quality improvement and implementation science tools and approaches. Aim 1 involves partnering with SUD providers to modify and refine the R3

strategy and accompanying materials. Using the Evidence-Based Quality Improvement (EBQI) process, we will engage SUD partners in a series of collaborative meetings to review and discuss modification to the R3 strategy and related study materials, and to make key decisions. The output of this work will be a refined R3

strategy for SUD settings (R3-SUD). Aim 2 involves conducting two pilot cycles with 8 supervisors and 35 counselors at 5 SUD residential treatment programs to assess R3-SUD feasibility and acceptability, to examine its impact on key organizational, counselor, and client outcomes, and to document barriers and facilitators for

its implementation and sustained use in routine SUD practice. This study will provide key information to inform planning and design of a future large scale (fully powered) study to assess the effectiveness of the R3-SUD strategy in a large sample of SUD programs.