Therapist predictors of treatment delivery fidelity in a community-based trial of 12-step facilitation

Abstract

Background and aims Therapist characteristics may be associated with variation in consistency, quality and effectiveness of treatment delivery. We examined associations between treatment fidelity and therapist education, experience, treatment orientation, and perceived skills in a randomized, multi-site trial of Twelve Step Facilitation (TSF). Methods Raters scored audio-recorded, TSF sessions (n = 966; 97% of TSF sessions) from 32 community-based, trained therapists for adherence, competence, empathy, and global session performance. Results Therapists with graduate degrees had significantly higher adherence and global performance fidelity ratings. Therapists reporting more positive attitudes towards 12-Step groups had lower adherence ratings. Being in recovery was associated with lower fidelity in univariate tests, but higher adherence in multivariate analysis. Fidelity was higher for therapists reporting self-efficacy in basic counseling skills and lower for self-efficacy in addiction-specific counseling skills. Fidelity was also superior in group relative to individual TSF sessions. Conclusions Results have implications for therapist selection, training and supervision in community-based, effectiveness trials and community implementation of evidence-based treatments. To obtain high fidelity and improve outcomes, it may be preferable to choose masters level therapists who are open to learning new treatments and have good, general counseling skills.

Factor structure of therapist fidelity to individual resiliency training in the Recovery After an Initial Schizophrenia Episode Early Treatment Program

“…Although the relationship between years of education and the overall quality score was no longer significant when scores were averaged across clients for each clinician, the magnitude of the correlation was virtually the same across the smaller and larger samples. The significant positive relationship between clinician years of education and fidelity ratings is consistent with some previous research in this area (Campbell et al, ). The relational factor involves competence‐related elements that require more responsiveness and skill on the part of the clinician while the technical factor required adherence‐related behaviour that is more explicitly prescribed in the treatment manual (Rollinson et al, ).…”

The relationship of therapeutic alliance and treatment delivery fidelity with treatment retention in a multisite trial of twelve-step facilitation.

“…The availability of comprehensive fidelity ratings for the entire TSF sample provided an opportunity to study relationships of fidelity with other variables, including predictors and outcomes. A prior report (Campbell, Buti, et al, 2013) found that therapists reporting self-efficacy in basic counseling skills had higher adherence, competence, and empathy delivering the TSF intervention and those with graduate degrees had higher adherence. In contrast, therapists with more positive attitudes towards 12-Step groups and self-efficacy in addiction-specific counseling skills had lower adherence ratings.…”

“…In an ancillary study, we assessed the reliability and concurrent validity of the Twelve Step Facilitation Adherence Competence Empathy Scales (TSF ACES), a ratings measure of treatment delivery fidelity based on an expansion of the adherence rating scales used in STAGE-12 (Campbell, Manuel et al, 2013). Trained, independent raters evaluated fidelity of all audio-recorded TSF sessions.…”

A Meta-Evaluation: The Role of Treatment Fidelity within Psychosocial Interventions during the Last Decade

“…The measurement of treatment fidelity would benefit from the inclusion of a treatment manual, therapist certification, fidelity ratings of treatment, supervision [42], adherence scales, competence scales and structured professional development opportunities. This comprehensive tool kit would support the facilitation and delivery of programs locally, regionally and internationally.…”