Therapist Adherence and Organizational Effects on Change in Youth Behavior Problems One Year After Multisystemic Therapy

Abstract

The current study investigated the relations among therapist adherence to an evidence-based treatment for youth with serious antisocial behavior (i.e., Multisystemic Therapy), organizational climate and structure, and improvement in youth behavior problems one-year post treatment. Participants were 1979 youth and families treated by 429 therapists across 45 provider organizations in North America. Hierarchical Linear Modeling (HLM) results showed therapist adherence predicted improvement in youth behavior. Two structure variables and one climate variable predicted changes in youth behavior, and the climate variable also predicted therapist adherence. No statistical support for formal mediation of organizational effects through adherence was found, though examination of changes in parameter estimates suggest a possible interplay of organizational climate with adherence and youth behavior change.

Assessing and Changing Organizational Social Contexts for Effective Mental Health Services

“…The social contexts of organizations that provide mental health and social services are associated with differences in both individual service provider behavior and client outcomes (1,3,4,34,35,37,44,47,82,97,98,110). Moreover, organizational research in many sectors, including medicine, customer service (e.g., banking), and various professional fields (e.g., information technology), explains how organizational social contexts determine whether an organization is innovative, that is, whether it is an early adopter of new ideas, tools, and practices that could improve its effectiveness (15,51,86,88,94).…”

Therapist Training in Empirically Supported Treatments: A Review of Evaluation Methods for Short- and Long-Term Outcomes

“…Caregiver report of therapist adherence was assessed monthly with the expert-consensus-developed MST TherapistAdherence Measure (TAM; Henggeler and Borduin 1992), and later revised (Henggeler et al 2006) using a 2-point scale to yield a score representing the percentage of items on which the therapist was rated as adherent. As therapist adherence was not stable across families served, scores were averaged to yield a mean level of therapist adherence for each family (M = .64, SD = .26) in analyses with the entire MST Transportability Study data set (Schoenwald et al 2008). Similarly, the Contingency Management-Therapist Adherence Measure (CM-TAM; Chapman et al 2008) is a 9-item measure that can be completed by caregivers and youth.…”

“…The TAM has been subject to factor analysis and shown to have a single factor solution with high internal consistency (Schoenwald et al 2003); the TAM-R was revised using a Rasch-based approach to scale development and also has a single factor solution (Schoenwald et al 2008). These measures demonstrate some predictive validity in their association with client outcomes, detailed below.…”

“…Relationship to Client Outcomes Mediational analyses conducted by Schoenwald et al (2008) found that greater therapist adherence was associated with reduction in youth externalizing behavior as measured by the CBCL through one year after treatment completion. Similarly, a smaller initial portion of the data set showed therapist adherence during treatment was associated with lower internalizing and externalizing behavior scores at post-treatment assessment; greater therapist adherence was also associated with client discharge from treatment when treatment goals had been met, rather than for other reasons (Schoenwald et al 2003).…”

“…Similarly, Beidas and Kendall (2010) concluded that training may influence therapist knowledge, attitudes, self-reported behavior, and observerrated behavior, often discussed in terms of therapist adherence to or competence in an EST protocol. Therapist adherence to protocol has been associated with improved client symptoms during the course of treatment (e.g., Feeley et al 1999;Strunk et al 2010) and with improved client outcomes after treatment (e.g., Martino et al 2008;Schoenwald et al 2003Schoenwald et al , 2008Strosahl et al 1998). In addition to variation in therapist training outcomes, multiple methods for evaluating these outcomes also exist.…”