The effect of therapists’ adherence and competence in delivering the adolescent community reinforcement approach on client outcomes.

Abstract

[Correction Notice: An Erratum for this article was reported in Vol 31(1) of (see record 2016-59284-001). In the article, the disclosed interest for Mark D. Godley in the author note is misrepresented. The accurate representation is that the organization employing Mark D. Godley, Chestnut Health Systems, receives fees for A-CRA training. In addition, the disclosed interest statement for Jane Ellen Smith and Robert J. Meyers should read Jane Ellen Smith and Robert J. Meyers each have private consulting businesses that conduct workshops on CRA or A-CRA; they also receive royalties on the CRA book. All versions of this article have been corrected.] Central to the debate over the implementation of empirically supported treatments is whether therapist skill has a measurable, positive relationship with client outcome. The fidelity and skill with which therapists deliver treatments have been studied under the constructs of adherence and competence. Evidence for a relationship between adherence and competence and client outcomes has been mixed, possibly due to small sample sizes, potentially inadequate measures for rating therapists' skill, and limited statistical methods. The current study used a data set in which 91 therapists provided services to 384 clients from the Assertive Adolescent and Family Treatment project. Therapists trained to deliver the Adolescent Community Reinforcement Approach (A-CRA) submitted audiorecorded sessions to independent raters during their training process. Measures of adherence and competence derived from session ratings were examined in a multilevel model for associations with client substance use outcomes at 3-, 6-, and 12-month follow-ups. Therapist competence was significantly predictive of decreases in clients' days of substance use. Therapist adherence was not predictive of client substance use outcomes in the full sample; however, when only those clients who completed the 12-month follow-up were included, between-therapists adherence was found to be predictive of a decrease in client substance use. This study adds to the evidence that competence in the delivery of treatment is associated with better client treatment outcomes. Adherence may be associated with better treatment outcomes as it was in follow-up completers. Future research should investigate the nature of the relationship between protocol-specific adherence and competence and client outcomes. (PsycINFO Database Record

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014–2017: Outcomes, Treatment Delivery, and Promising Horizons

“…Recent studies on treatment fidelity reaffirmed that adherence to specific intervention techniques prescribed by empirically supported ASU treatments promotes better client outcomes for SU and also co-occurring problems. One study (Campos-Melady et al, 2017) also registered competence-outcome relations for a CBT-I model, an unusual finding that awaits replication for that approach and others. A relative bounty of five MI/MET collectively make a strong case that fidelity to MI/MET prompts increases in youth motivation to reduce SU and in their verbalized plans to reduce, which in turn predict improvements in several treatment outcomes.…”

Community reinforcement and family training and rates of treatment entry: a systematic review

“…Furthermore, the authors make no mention of previous training in CRAFT for either the therapist trainer or the team that adapted the intervention for problem gambling and developed the self‐help materials . Therapist competence and adherence to treatment programme have both been found to be associated with positive patient outcomes in community reinforcement approach (CRA) treatment for patients . None of the five treatment conditions included integrated treatment for the IP.…”

Service providers’ adherence to methadone maintenance treatment protocol in China

“…These results were in line with other studies among addiction physicians in other countries (Guillou Landreat et al, 2015; Wisniewski et al, 2013). We believe that it is essential to improve the level of adherence to guidelines in order to ensure the quality of care and patient outcomes (Campos-Melady et al, 2017; Mazrou, 2013; Trafton et al, 2007). Some patterns of protocol adherence were identified.…”