Benchmarking Treatment Adherence and Therapist Competence in Individual Cognitive-Behavioral Treatment for Youth Anxiety Disorders

Bryce D. McLeod, Michael A. Southam-Gerow, Amanda Doss, Aaron Hogue, Philip C. Kendall, John R. Weisz

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Evidence-based treatments (EBTs) for youth are typically developed and established through studies in research settings designed to ensure treatment integrity, that is, protocol adherence and competence by therapists. An important question for implementation science is how well integrity is maintained when these EBTs are delivered in community settings. The present study investigated whether the integrity achieved by therapists in community settings achieved a benchmark set by therapists in a research setting when they delivered the same EBT—an individual cognitive-behavioral treatment (ICBT) for youth anxiety. Therapists (N = 29; 68.97% White; 13.79% male) provided ICBT to 68 youths (M age = 10.60 years, SD = 2.03; 82.35% White; 52.94% male) diagnosed with a principal anxiety disorder in research or community settings. Training and supervision protocols were the same across settings. Two independent teams of trained coders rated 744 sessions using observational instruments designed to assess ICBT adherence and competence. Both adherence and competence were higher in the research setting. Group differences in competence were consistent across treatment, but differences in adherence were most pronounced when treatment shifted to exposure, widely viewed as the most critical component of ICBT. When using the benchmarks from the research setting, therapists from the community settings fell short for indices of adherence and competence. However, given differences between therapists and clients, as well as the fact that treatment outcomes were similar across settings, our findings raise questions about whether it is appropriate to use treatment integrity benchmarks from research settings for community.

Original languageEnglish (US)
Pages (from-to)1-13
Number of pages13
JournalJournal of Clinical Child and Adolescent Psychology
DOIs
StateAccepted/In press - Oct 22 2017

Fingerprint

Benchmarking
Anxiety Disorders
Mental Competency
Research
Therapeutics
Anxiety

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Clinical Psychology

Cite this

Benchmarking Treatment Adherence and Therapist Competence in Individual Cognitive-Behavioral Treatment for Youth Anxiety Disorders. / McLeod, Bryce D.; Southam-Gerow, Michael A.; Doss, Amanda; Hogue, Aaron; Kendall, Philip C.; Weisz, John R.

In: Journal of Clinical Child and Adolescent Psychology, 22.10.2017, p. 1-13.

Research output: Contribution to journalArticle

@article{a1d5a60e9d0c4d41ae5d3b5c92c623e8,
title = "Benchmarking Treatment Adherence and Therapist Competence in Individual Cognitive-Behavioral Treatment for Youth Anxiety Disorders",
abstract = "Evidence-based treatments (EBTs) for youth are typically developed and established through studies in research settings designed to ensure treatment integrity, that is, protocol adherence and competence by therapists. An important question for implementation science is how well integrity is maintained when these EBTs are delivered in community settings. The present study investigated whether the integrity achieved by therapists in community settings achieved a benchmark set by therapists in a research setting when they delivered the same EBT—an individual cognitive-behavioral treatment (ICBT) for youth anxiety. Therapists (N = 29; 68.97{\%} White; 13.79{\%} male) provided ICBT to 68 youths (M age = 10.60 years, SD = 2.03; 82.35{\%} White; 52.94{\%} male) diagnosed with a principal anxiety disorder in research or community settings. Training and supervision protocols were the same across settings. Two independent teams of trained coders rated 744 sessions using observational instruments designed to assess ICBT adherence and competence. Both adherence and competence were higher in the research setting. Group differences in competence were consistent across treatment, but differences in adherence were most pronounced when treatment shifted to exposure, widely viewed as the most critical component of ICBT. When using the benchmarks from the research setting, therapists from the community settings fell short for indices of adherence and competence. However, given differences between therapists and clients, as well as the fact that treatment outcomes were similar across settings, our findings raise questions about whether it is appropriate to use treatment integrity benchmarks from research settings for community.",
author = "McLeod, {Bryce D.} and Southam-Gerow, {Michael A.} and Amanda Doss and Aaron Hogue and Kendall, {Philip C.} and Weisz, {John R.}",
year = "2017",
month = "10",
day = "22",
doi = "10.1080/15374416.2017.1381914",
language = "English (US)",
pages = "1--13",
journal = "Journal of Clinical Child and Adolescent Psychology",
issn = "1537-4416",
publisher = "Routledge",

}

TY - JOUR

T1 - Benchmarking Treatment Adherence and Therapist Competence in Individual Cognitive-Behavioral Treatment for Youth Anxiety Disorders

AU - McLeod, Bryce D.

AU - Southam-Gerow, Michael A.

AU - Doss, Amanda

AU - Hogue, Aaron

AU - Kendall, Philip C.

AU - Weisz, John R.

PY - 2017/10/22

Y1 - 2017/10/22

N2 - Evidence-based treatments (EBTs) for youth are typically developed and established through studies in research settings designed to ensure treatment integrity, that is, protocol adherence and competence by therapists. An important question for implementation science is how well integrity is maintained when these EBTs are delivered in community settings. The present study investigated whether the integrity achieved by therapists in community settings achieved a benchmark set by therapists in a research setting when they delivered the same EBT—an individual cognitive-behavioral treatment (ICBT) for youth anxiety. Therapists (N = 29; 68.97% White; 13.79% male) provided ICBT to 68 youths (M age = 10.60 years, SD = 2.03; 82.35% White; 52.94% male) diagnosed with a principal anxiety disorder in research or community settings. Training and supervision protocols were the same across settings. Two independent teams of trained coders rated 744 sessions using observational instruments designed to assess ICBT adherence and competence. Both adherence and competence were higher in the research setting. Group differences in competence were consistent across treatment, but differences in adherence were most pronounced when treatment shifted to exposure, widely viewed as the most critical component of ICBT. When using the benchmarks from the research setting, therapists from the community settings fell short for indices of adherence and competence. However, given differences between therapists and clients, as well as the fact that treatment outcomes were similar across settings, our findings raise questions about whether it is appropriate to use treatment integrity benchmarks from research settings for community.

AB - Evidence-based treatments (EBTs) for youth are typically developed and established through studies in research settings designed to ensure treatment integrity, that is, protocol adherence and competence by therapists. An important question for implementation science is how well integrity is maintained when these EBTs are delivered in community settings. The present study investigated whether the integrity achieved by therapists in community settings achieved a benchmark set by therapists in a research setting when they delivered the same EBT—an individual cognitive-behavioral treatment (ICBT) for youth anxiety. Therapists (N = 29; 68.97% White; 13.79% male) provided ICBT to 68 youths (M age = 10.60 years, SD = 2.03; 82.35% White; 52.94% male) diagnosed with a principal anxiety disorder in research or community settings. Training and supervision protocols were the same across settings. Two independent teams of trained coders rated 744 sessions using observational instruments designed to assess ICBT adherence and competence. Both adherence and competence were higher in the research setting. Group differences in competence were consistent across treatment, but differences in adherence were most pronounced when treatment shifted to exposure, widely viewed as the most critical component of ICBT. When using the benchmarks from the research setting, therapists from the community settings fell short for indices of adherence and competence. However, given differences between therapists and clients, as well as the fact that treatment outcomes were similar across settings, our findings raise questions about whether it is appropriate to use treatment integrity benchmarks from research settings for community.

UR - http://www.scopus.com/inward/record.url?scp=85031800778&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85031800778&partnerID=8YFLogxK

U2 - 10.1080/15374416.2017.1381914

DO - 10.1080/15374416.2017.1381914

M3 - Article

C2 - 29053382

AN - SCOPUS:85031800778

SP - 1

EP - 13

JO - Journal of Clinical Child and Adolescent Psychology

JF - Journal of Clinical Child and Adolescent Psychology

SN - 1537-4416

ER -