Toward effective quality assurance in evidence-based practice: Links between expert consultation, therapist fidelity, and child outcomes
Toward effective quality assurance in evidence-based practice: Links between expert consultation, therapist fidelity, and child outcomes
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DOI：
10.1207/s15374424jccp3301_10
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发表时间：
2004-03-01
影响因子：
4.2
通讯作者：
Letourneau, EJ
中科院分区：
文献类型：
--
作者：
Schoenwald, SK;Sheidow, AJ;Letourneau, EJ
这项研究验证了专家临床咨询的衡量标准，并研究了社区环境中咨询、治疗师的依从性和青少年结果之间的关联。通过治疗师报告评估咨询师对多系统治疗(MST)咨询方案的依从性，通过2个样本的家庭(N-1=178，N-2=274)和治疗师(N-1=87，N-2=162)的照顾者报告评估治疗师对MST原则的依从性。在治疗前和治疗后的第二个样本中，获得了关于青少年行为和功能的照顾者报告。随机效应回归模型表明，咨询行为、治疗师的依从性和治疗后的青少年行为问题和功能之间存在关联。咨询的工具性方面支持治疗师的坚持和改善青年结果；咨询的支持性方面与坚持和结果负相关。这些发现表明，临床医生能否获得专家咨询可能会影响临床医生对治疗模式和儿童结局的忠诚度。
This study validated a measure of expert clinical consultation and examined the association between consultation, therapist adherence, and youth outcomes in community-based settings. Consultant adherence to the multisystemic therapy (MST) consultation protocol was assessed through therapist reports, and therapist adherence to MST principles was assessed through caregiver reports in 2 samples of families (N-1 = 178, N-2 = 274) and therapists (N-1 = 87, N-2 = 162). Caregiver reports of youth behavior and functioning were obtained in the second sample pre- and posttreatment. Random effects regression models demonstrated associations between consultant behavior, therapist adherence, and posttreatment youth behavior problems and functioning. Instrumental aspects of consultation supported therapist adherence and improved youth outcomes; supportive aspects of consultation were negatively associated with adherence and outcomes. These findings suggest the availability to clinicians of expert consultation can impact clinician fidelity to a treatment model and child outcomes.