Integrity of Evidence-Based Practice: Are Providers Modifying Practice Content or Practice Sequencing?

Park, Alayna L.; Chorpita, Bruce F.; Regan, Jennifer; Weisz, John R.

doi:10.1007/s10488-014-0559-z

Cited by 31 publications

(31 citation statements)

References 42 publications

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“…In addition to serving as an indicator of treatment quality, fidelity monitoring serves as useful feedback for implementers, alerting them to areas that require attention (Kutash et al, 2012; Park, Chorpita, Regan, Weisz, & The Research Network on Youth Mental Health 2014; McLeod, Southam-Gerow, Tully, Rodríguez, & Smith, 2013). The call for ongoing fidelity assessment is especially warranted given research showing that fidelity can change over time.…”

mentioning

confidence: 99%

Examining adherence to components of cognitive-behavioral therapy for youth anxiety after training and consultation.

Edmunds

Brodman

Ringle

et al. 2017

Professional Psychology: Research and Practice

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The present study examined 115 service providers’ adherence to components of cognitive-behavioral therapy (CBT) for youth anxiety prior to training, post workshop training, and after three months of weekly consultation. Adherence was measured using a role-play with a trained actor. We examined differences in individual adherence to CBT components across time and the relationship between number of consultation sessions attended and adherence ratings following consultation. Findings indicated that somatic arousal identification and relaxation were the most used treatment components prior to training. Adherence to all components of CBT increased following workshop training, except the usage of problem-solving. Adherence to problem-solving, positive reinforcement, the identification of anxious self-talk, and the creation of coping thoughts increased following consultation but usage of problem-solving remained low compared to other treatment components. Overall adherence remained less than optimal at the final measurement point. Number of consultation sessions attended predicted post-consultation adherence to identification of somatic arousal, identification of anxious self-talk, and positive reinforcement. Implications include tailoring future training based on baseline levels of adherence and spending more time during training and consultation on underutilized CBT components, such as problem-solving. Limitations of the present study, including how adherence was measured, are discussed. This study adds to the implementation science literature by providing more nuanced information on changes in adherence over the course of training and consultation of service providers.

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mentioning

confidence: 99%

Examining adherence to components of cognitive-behavioral therapy for youth anxiety after training and consultation.

Edmunds

Brodman

Ringle

et al. 2017

Professional Psychology: Research and Practice

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“…Of interest, all of these practices were the first skills that providers would have taught to clients, following any engagement and psychoeducation practices, if they were adhering to the default sequences of practices featured in the MATCH-ADTC manual. Such findings are reassuring—not only in that they provide additional support for providers’ frequent use of EBT practices (e.g., Palinkas et al, 2013; Park et al, 2015), but also in that they suggest that providers are adhering to the sequencing prescribed by the modular EBT (as a portion of youths prematurely terminated from treatment [Chorpita et al, 2016] and thus frequency of practice delivery is likely biased toward practices covered in the early stages of treatment).…”

Section: Discussionmentioning

confidence: 81%

“…Despite preliminary evidence suggesting that providers trained in a modular EBT tend to use EBT practices in the vast majority of their treatment sessions and to make relatively few adaptations to EBT protocols during the implementation process (Palinkas et al, 2013; Park, Chorpita, Regan, & Weisz, 2015), skepticism remains as to whether the flexibility allowed by modular design encourages protocol drift—particularly during occasions when interferences to treatment, such as diagnostic comorbidity, arise as they often do (Chorpita et al, 2014). …”

mentioning

confidence: 99%

Community-Based Providers’ Selection of Practices for Children and Adolescents With Comorbid Mental Health Problems

Park

Moskowitz

Chorpita

2016

Journal of Clinical Child & Adolescent Psychology

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The goal of this study is to explore providers’ patterns of implementation by investigating how community mental health providers selected therapy practice modules from a flexible, modular evidence-based treatment working with youths with comorbid mental health problems. Data were obtained from 57 youths, 5–15 years old, presenting with anxiety, depressive, and/or conduct problems and their 27 providers during their participation in an effectiveness trial involving a modular evidence-based treatment. Although all youths evidenced clinically elevated symptomatology in at least two problem areas, providers targeted youths’ comorbid problems with only about half of their study cases. Practice modules indicated for youths’ comorbid problems were typically used less frequently and with less depth relative to practice modules indicated for youths’ principal clinical problem and were often transdiagnostic in nature (i.e., designed to target more than one problem area). To determine whether providers’ decisions to target youths’ comorbid problems were systematic, multilevel, logistic regression analyses were conducted and revealed that youths’ pretreatment characteristics and time in therapy influenced providers’ patterns of module selection. Providers tend to use, but not exploit, the flexibility allowed by modular EBTs and to focus treatment on youths’ principal presenting problem. In addition, providers appear to make these practice choices in a systematic and rational manner, and whether and which choices are associated with improved outcomes is an important area of future study.

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“…This strategic coordination of approaches can be outlined relatively well by examining a partial factoring of some of these approaches. Subsequent investigations have in fact shown that providers in the standard condition often struggled with the constrained flexibility by modifying practice sequencing in ways that were proscribed (Park, Chorpita, Regan, & Weisz, 2015) and that they engaged in a more "modular" pattern of use of the standard protocols after the trial concluded (Palinkas et al, 2013). We confess that the levels of these factors are a gross simplification of their respective dimensions (e.g., there are countless ways to give feedback, varying across countless parameters) and that these dimensions are not the only ones of interest by any means, but the matrix nevertheless serves as a useful starting point to illustrate CSA at the treatment program level.…”

Section: Modular Approach To Therapy For Childrenmentioning

confidence: 99%

“…Further, there was minimal measurement or monitoring of treatment engagement over time, and expert consultation did not involve recruited expertise for treatment engagement strategies. Interestingly, recent findings by Park et al (2015) showed that providers in the MATCH condition in the 2012 trial struggled with MATCH's integral protocol structure with respect to targeting engagement, with 37% of cases deviating from the written MATCH sequence in order to revisit the engagement modules at the beginning of the protocol. Not surprisingly, rates of early treatment termination (a downstream indicator of poor engagement) did not differ significantly across conditions in either trial [the rate of early termination for MATCH was 42%, for standard EBT, 59% and for UC, 57% in the Weisz et al (2012) trial; early termination rates were 52% for MATCH and 57% for the control condition in the Chorpita et al (2017) trial].…”

Section: Modular Approach To Therapy For Childrenmentioning

confidence: 99%

Coordinated strategic action: Aspiring to wisdom in mental health service systems.

Chorpita

Daleiden

2018

Clinical Psychology: Science and Practice

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This paper outlines a model of coordinated strategic action (CSA) for system and treatment design, centering on the concept of wisdom, or knowing “what to do when” based on all available knowledge and a sensitivity to context. Following an overview of the full system context, this paper first illustrates CSA operating across multiple service system layers and then illustrates its use in the design of a single evidence‐based treatment program. CSA is neither a commitment to any single “best” approach nor a “kitchen sink” of all of them, but rather, it involves strategic and synergistic assembly of the most relevant resources and methods in light of a chosen goal and the context in which that goal is to be achieved.

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Integrity of Evidence-Based Practice: Are Providers Modifying Practice Content or Practice Sequencing?

Cited by 31 publications

References 42 publications

Examining adherence to components of cognitive-behavioral therapy for youth anxiety after training and consultation.

Examining adherence to components of cognitive-behavioral therapy for youth anxiety after training and consultation.

Community-Based Providers’ Selection of Practices for Children and Adolescents With Comorbid Mental Health Problems

Coordinated strategic action: Aspiring to wisdom in mental health service systems.

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