Benchmarking Family Therapy for Adolescent Behavior Problems in Usual Care: Fidelity, Outcomes, and Therapist Performance Differences.
Benchmarking Family Therapy for Adolescent Behavior Problems in Usual Care: Fidelity, Outcomes, and Therapist Performance Differences.
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DOI：
10.1007/s10488-016-0769-7
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发表时间：
2017-09
期刊：
影响因子：
--
通讯作者：
Henderson CE
中科院分区：
文献类型：
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作者：
Hogue A;Dauber S;Henderson CE
这项研究评估了在日常护理中为青少年行为问题提供家庭治疗的社区治疗师是否达到了在治疗忠诚度和结果的对照试验中建立的表现基准，并特别关注治疗师表现的个体差异。这项研究包括N=38名青少年(50%男性；平均年龄15岁)，他们自我报告的种族/民族是西班牙裔(74%)、非裔美国人(11%)、多种族(11%)和其他(4%)。客户在一家社区心理健康诊所接受13名治疗师的治疗，该诊所将家庭治疗作为常规护理标准。治疗师提供了遵守核心家庭治疗技术的自我报告数据；这些分数根据与观察者报告的一致性进行了通货膨胀调整。结果显示，社区治疗师在一项对照试验中超过了研究治疗师建立的核心家庭治疗技术的保真度基准。关于六个月随访时病人功能的变化，社区治疗师在内化症状和外化症状和犯罪行为方面相当于基准，而在外化症状和犯罪行为方面更好。社区治疗师也表现出了高度的表现一致性：每一位都接近保真度基准，只有两位在任何客户变化指标上产生了相对较弱的结果。在小样本量的情况下，解释治疗师表现数据的注意事项被描述了。建议制定治疗师报告的保真度措施，并利用统计过程控制方法来诊断治疗师的差异并加强质量保证程序。
This study evaluated whether community therapists delivering family therapy for adolescent behavior problems in usual care achieved performance benchmarks established in controlled trials for treatment fidelity and outcomes, with particular focus on individual differences in therapist performance. The study contained N = 38 adolescents (50% male; mean age 15 years) whose self-reported race/ethnicity was Hispanic (74%), African American (11%), multiracial (11%), and other (4%). Clients were treated by 13 therapists in one community mental health clinic that delivered family therapy as the routine standard of care. Therapists provided self-report data on adherence to core family therapy techniques; these scores were inflation-adjusted based on concordance with observer reports. Results showed that community therapists surpassed the fidelity benchmark for core family therapy techniques established by research therapists during a controlled trial. Regarding change in client functioning at six-month follow-up, community therapists were equivalent to the benchmark for internalizing symptoms and superior for externalizing symptoms and delinquent acts. Community therapists also demonstrated a high degree of performance uniformity: Each one approximated the fidelity benchmark, and only two produced relatively weak outcomes on any of the client change indicators. Caveats for interpreting therapist performance data, given the small sample size, are described. Recommendations are made for developing therapist-report fidelity measures and utilizing statistical process control methods to diagnose therapist differences and enhance quality assurance procedures.