Initial development of a treatment adherence measure for cognitive–behavioral therapy for child anxiety.

Southam‐Gerow, Michael A.; McLeod, Bryce D.; Arnold, Cassidy C.; Rodríguez, Adriana; Cox, Julia R.; Reise, Steven P.; Bonifay, Wesley E.; Weisz, John R.; Kendall, Philip C.

doi:10.1037/pas0000141

Cited by 34 publications

(44 citation statements)

References 34 publications

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“…A coder considers both thoroughness and frequency while making a rating; extensiveness ratings thus provide dosage information about each intervention. Previous studies have demonstrated that the TPOCS-RS, or variants thereof (i.e., PRAC-TPOCS, Garland et al, 2010; TPOCS-S, McLeod & Weisz, 2010), have demonstrated item inter-rater reliability ranging from .71 to .86 ( M ICC = .81), the item and subscale scores provide evidence of construct validity across research and practice settings (McLeod & Weisz, 2010; McLeod et al, 2015; Southam-Gerow et al, 2016; Wood et al, 2006), subscales scores differentiate between treatment types (McLeod et al, 2015; Southam-Gerow et al, 2010; Weisz et al, 2009; Wood et al, 2006), and subscale scores demonstrated predictive validity (Garland et al, 2014). The current study used the TPOCS-RS Psychodynamic, Family, and Client-centered subscales.…”

Section: Methodsmentioning

confidence: 99%

“…Without consensus on how to score integrity instruments (see McLeod et al, 2015; Southam-Gerow et al, 2016), we considered three approaches: (a) Average of all items on each subscale for each session (Coping Cat M = 2.63, SD = 1.22; Psychodynamic M = 1.19, SD = 0.35; Family M = 1.57, SD = 0.85; Client-Centered M = 2.76, SD = 0.76); (b) Average of all scored items (items scored above a 1) for each session (Coping Cat M = 3.08, SD = 1.22; Psychodynamic M = 1.40, SD = 0.60; Family M = 1.96, SD = 1.14; Client-Centered M = 3.11, SD = 0.79); and (c) Highest item scored for each session (Coping Cat M = 4.56, SD = 2.10; Psychodynamic M = 1.49, SD = 0.81; Family M = 2.52, SD = 1.91; Client-Centered M = 4.28, SD = 1.41). Though scores on the three scoring approaches differed in magnitude, the three scores for each subscale were highly correlated (all r s > .78).…”

Section: Methodsmentioning

confidence: 99%

“…We chose to use the highest score on each subscale so that the scores were easily translated to the 1–7 rating approach used for the measure (cf. Southam-Gerow et al, 2016). …”

Section: Methodsmentioning

confidence: 99%

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Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?

et al. 2017

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Does delivery of the same manual-based individual cognitive-behavioral treatment (ICBT) program for youth anxiety differ across research and practice settings? We examined this question in a sample of eighty-nine youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with a primary anxiety disorder. The youths received (a) ICBT in a research setting, (b) ICBT in practice settings, or (c) non-manual-based usual care (UC) in practice settings. Treatment delivery was assessed using four theory-based subscales (Cognitive-behavioral, Psychodynamic, Client-Centered, Family) from the Therapy Process Observational Coding System for Child Psychotherapy–Revised Strategies scale (TPOCS-RS). Reliable independent coders, using the TPOCS-RS, rated 954 treatment sessions from two randomized controlled trials (1 efficacy and 1 effectiveness trial). In both settings, therapists trained and supervised in ICBT delivered comparable levels of cognitive-behavioral interventions at the beginning of treatment. However, therapists trained in ICBT in the research setting increased their use of cognitive-behavioral interventions as treatment progressed whereas their practice setting counterparts waned over time. Relative to the two ICBT groups, the UC therapists delivered a significantly higher dose of psychodynamic and family interventions and a significantly lower dose of cognitive-behavioral interventions. Overall, results indicate that there were more similarities than differences in manual-based ICBT delivery across research and practice settings. Future research should explore why the delivery of cognitive-behavioral interventions in the ICBT program changed over time and across settings, and whether the answers to these questions could inform implementation of ICBT programs.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?

et al. 2017

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“…First, weincluded items that assesscompetence in delivering interventions common to many CBT approaches (e.g., homework assignment;Stallard et al, 2014). Second, and consistent with most competence instruments (Bjaastad et al, 2015; Forgatch et al, 2005; Gutermann et al, 2014; Hogue et al, 2008a), wedeveloped items that gaugecompetence in delivering the core theory-driven interventions central to ICBTfor youth anxiety (e.g., coping plan, exposure).Third, we developed items that measurecompetence in specific delivery methods (e.g., didactically or via rehearsal; Southam-Gerow et al, 2016), an approach found in a previous competence instrument (Forgatch et al, 2005). …”

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confidence: 99%

Development and Initial Psychometrics for a Therapist Competence Instrument for CBT for Youth Anxiety

McLeod

Southam‐Gerow

Rodríguez

et al. 2016

Journal of Clinical Child & Adolescent Psychology

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Objective: Therapistcompetence is an important component of treatment integrity. This paper reports on the development and initial psychometric assessment of the Cognitive-Behavioral Treatment for Anxiety in Youth Competence Scale (CBAY-C), an observational instrumentdesigned to capture therapist limited-domain competence (i.e., competence in the delivery of core interventions and delivery methods found in a specific psychosocialtreatment program) in the delivery of the core practice elements in individual cognitive-behavioral treatment (ICBT) for youth anxiety. Method: Treatment sessions (N = 744) from 68 youth participants (M age = 10.60 years, SD = 2.03; 82.3% Caucasian; 52.9% male) of the same ICBT program for youth anxiety from (a) an efficacy study and (b) an effectiveness study were independently scored by four coders using observational instruments designed to assess therapist competence, treatment adherence, treatment differentiation, alliance, and client involvement. Results: Inter-rater reliability (intraclass correlation coefficients, ICC(2,2)) for the item scores averaged 0.69 (SD = 0.11). The CBAY-C item, scale, and subscale (Skills, Exposure) scores showed evidence of validity via associations with observational instruments of treatment adherence to ICBT for youth anxiety, theory-based domains (CBT, psychodynamic, family, client-centered), alliance, and client involvement. Importantly, although the CBAY-Cscale, subscale, and item scores did overlap with a corresponding observational treatment adherence instrument independently rated by coders,the degree of overlap was moderate, indicating that theCBAY-C assessesa distinct component of treatment integrity. Conclusions: Applications of the instrument and future research directions discussed include the measurement of treatment integrity and testing integrity-outcome relations.

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“…Indeed, an active therapist can implement one or two interventions very thoroughly during a given session yet still receive a below-midpoint mean adherence score that has been averaged across multiple scale items. Another metric for judging the density of EBT delivery in usual care might be tabulating the proportion of sessions in which one (or a few) discrete techniques are scored at or above the midpoint value, indicating the presence of considerable/extensive EBT activity (e.g., Southam-Gerow et al, 2016); though beyond the scope of the current study, analyses of this kind would further enrich our understanding of UC treatment processes (Hurlburt et al, 2010). …”

Section: Discussionmentioning

confidence: 99%

Benchmarking Family Therapy for Adolescent Behavior Problems in Usual Care: Fidelity, Outcomes, and Therapist Performance Differences

Hogue

Dauber

Henderson

2016

Adm Policy Ment Health

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This study evaluated whether community therapists delivering family therapy for adolescent behavior problems in usual care achieved performance benchmarks established in controlled trials for treatment fidelity and outcomes, with particular focus on individual differences in therapist performance. The study contained N = 38 adolescents (50% male; mean age 15 years) whose self-reported race/ethnicity was Hispanic (74%), African American (11%), multiracial (11%), and other (4%). Clients were treated by 13 therapists in one community mental health clinic that delivered family therapy as the routine standard of care. Therapists provided self-report data on adherence to core family therapy techniques; these scores were inflation-adjusted based on concordance with observer reports. Results showed that community therapists surpassed the fidelity benchmark for core family therapy techniques established by research therapists during a controlled trial. Regarding change in client functioning at six-month follow-up, community therapists were equivalent to the benchmark for internalizing symptoms and superior for externalizing symptoms and delinquent acts. Community therapists also demonstrated a high degree of performance uniformity: Each one approximated the fidelity benchmark, and only two produced relatively weak outcomes on any of the client change indicators. Caveats for interpreting therapist performance data, given the small sample size, are described. Recommendations are made for developing therapist-report fidelity measures and utilizing statistical process control methods to diagnose therapist differences and enhance quality assurance procedures.

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Initial development of a treatment adherence measure for cognitive–behavioral therapy for child anxiety.

Cited by 34 publications

References 34 publications

Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?

Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?

Development and Initial Psychometrics for a Therapist Competence Instrument for CBT for Youth Anxiety

Benchmarking Family Therapy for Adolescent Behavior Problems in Usual Care: Fidelity, Outcomes, and Therapist Performance Differences

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