The Effect of Therapists' Adherence and Competence in Delivering the Adolescent Community Reinforcement Approach on Client Outcomes
The Effect of Therapists' Adherence and Competence in Delivering the Adolescent Community Reinforcement Approach on Client Outcomes
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DOI：
10.1037/adb0000216
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发表时间：
2017-02-01
影响因子：
3.4
通讯作者：
Godley, Mark D.
中科院分区：
文献类型：
--
作者：
Campos-Melady, Marita;Smith, Jane Ellen;Godley, Mark D.
关于实施经验支持的治疗的争论的核心是治疗师的技能是否与客户的结果具有可衡量的积极关系。在依从性和能力的结构下研究了治疗师提供治疗的保真度和技巧。关于依从性、能力和客户结果之间关系的证据一直是混杂的，可能是由于样本量小，评估治疗师技能的措施可能不充分，以及统计方法有限。目前的研究使用了一组数据，其中91名治疗师为来自自信青少年和家庭治疗项目的384名客户提供服务。接受过青少年社区强化方法（A-CRA）培训的治疗师在培训过程中向独立评分者提交了录音。在3个月、6个月和12个月的随访中，采用多层次模型检查依从性和能力指标与来访者物质使用结果的关系。治疗师的能力可以显著预测来访者药物使用天数的减少。在整个样本中，治疗师的依从性不能预测来访者物质使用的结果；然而，当只包括那些完成12个月随访的客户时，发现治疗师之间的依从性可以预测客户物质使用的减少。本研究进一步证明，提供治疗的能力与更好的客户治疗结果相关。依从性可能与更好的治疗结果相关，因为在随访完成者中也是如此。未来的研究应该调查协议特定依从性、能力和客户结果之间关系的本质。
Central to the debate over the implementation of empirically supported treatments is whether therapist skill has a measurable, positive relationship with client outcome. The fidelity and skill with which therapists deliver treatments have been studied under the constructs of adherence and competence. Evidence for a relationship between adherence and competence and client outcomes has been mixed, possibly due to small sample sizes, potentially inadequate measures for rating therapists' skill, and limited statistical methods. The current study used a data set in which 91 therapists provided services to 384 clients from the Assertive Adolescent and Family Treatment project. Therapists trained to deliver the Adolescent Community Reinforcement Approach ( A-CRA) submitted audiorecorded sessions to independent raters during their training process. Measures of adherence and competence derived from session ratings were examined in a multilevel model for associations with client substance use outcomes at 3-, 6-, and 12-month follow-ups. Therapist competence was significantly predictive of decreases in clients' days of substance use. Therapist adherence was not predictive of client substance use outcomes in the full sample; however, when only those clients who completed the 12-month follow-up were included, between-therapists adherence was found to be predictive of a decrease in client substance use. This study adds to the evidence that competence in the delivery of treatment is associated with better client treatment outcomes. Adherence may be associated with better treatment outcomes as it was in follow-up completers. Future research should investigate the nature of the relationship between protocol-specific adherence and competence and client outcomes.