Assessing fidelity in individual and family therapy for adolescent substance abuse

Abstract

This study introduces an observational measure of fidelity in evidence-based practices for adolescent substance abuse treatment. The Therapist Behavior Rating Scale-Competence (TBRS-C) measures adherence and competence in individual cognitive-behavioral therapy and multidimensional family therapy for adolescent substance abuse. The TBRS-C assesses fidelity to the core therapeutic goals of each approach and also contains global ratings of therapist competence. Study participants were 136 clinically referred adolescents and their families observed in 437 treatment sessions. The TBRS-C demonstrated strong interrater reliability for goal-specific ratings of treatment adherence, and modest reliability for goal-specific and global ratings of therapist competence, evidence of construct validity, and discriminant validity with an observational measure of therapeutic alliance. The utility of the TBRS-C for evaluating treatment fidelity in field settings is discussed.

Validity of Therapist Self-Report Ratings of Fidelity to Evidence-Based Practices for Adolescent Behavior Problems: Correspondence between Therapists and Observers

“…The TBRS has shown strong psychometric properties in studies of treatment adherence (Diamond et al 2007; Hogue et al 1998, 2008a), therapist competence (Hogue et al 2008a), and fidelity-outcome links (Hogue et al 2006, 2008b) with samples including drug-using, conduct-disordered, and depressed teens. ITT-ABP items representing the MI and DC approaches were drawn from the Motivational Enhancement Therapy and Twelve Step Facilitation sub-scales of the Yale Adherence and Competence Scale (YACS; Carroll et al 2000).…”

Development and Reliability of a Measure of Clinician Competence in Providing Illness Management and Recovery

“…Moreover, treatment integrity measures that assess actual use of knowledge and skills are crucial and are an advancement over assessment techniques that rely on self-report or chart review. Various evidence-based psychotherapy models, such as cognitivebehavioral therapy for psychosis (37,38), multisystemic therapy (39), and adolescent substance abuse treatment (40), often assess treatment integrity at the clinical interaction level. Integrity at this level has been linked to positive outcomes for consumers (41).…”

Improving Interactions Between Teachers and Young Children with Problem Behavior: A Strengths-Based Approach

“…Thus, assessing both the quality of teacher responses as well as the adherence (i.e., frequency of responses) becomes paramount as researchers attempt to measure treatment fidelity. The literature on treatment fidelity, especially research on the implementation of therapies for drug and alcohol dependence, provides important guidance on measurement issues related to the quality and adherence to treatment protocols (e.g., Carroll et al, 2000;Hogue et al, 2008).…”

“…Thus it is critical that researchers not only measure treatment fidelity but also are thoughtful in the development of fidelity measures in order to capture those characteristics that are most related to treatment effectiveness. To illustrate, research on the treatment of drug and alcohol dependence suggests that quality and adherence, while both associated with treatment outcomes, are not necessarily related to each other but are independent constructs (Hogue et al, 2008). From an educational perspective, adherence to a treatment protocol (e.g., base rates of target behavior) and quality (e.g., purposeful use of target behavior) might have differential effects on children's disruptive behavior.…”