Development and Validation of Child Therapy Integrity Measures

描述（由申请人提供）：本研究的最终目标是进一步开发一套能够评估青少年焦虑认知行为治疗（CBT）完整性的措施。尽管CBT治疗儿童焦虑在对照试验中取得了成功，但该领域的测量差距限制了(a)改进和优化CBT有效性的努力，以及(b)评估CBT临床医生培训工作的成功。事实上，目前缺乏基于证据的测量策略来评估针对儿童焦虑实施CBT项目的努力的完整性，也没有一个包含完整性的三个维度。该研究通过进一步发展和验证一套观察性措施来解决这一重要的方法差距，这些措施旨在评估治疗完整性的关键组成部分-治疗依从性，治疗师能力和治疗差异-与焦虑青少年的CBT有关。该项目将实现两个主要目标：(a)确定处理完整性措施的可靠性（判读器间可靠性、内部一致性、普遍性）和有效性（趋同性、区别性）；(b)提供证据，将这些测量的数据与(i)儿童结果和（ii）治疗输入变量（例如，来访者、治疗师特征）联系起来。从三个随机临床试验（rct；疗效和2个疗效试验）评估CBT治疗青少年原发性焦虑症的记录治疗过程将被用于实现这些目标。研究项目分三个阶段进行。在第一阶段，治疗完整性措施的心理测量学特性将通过一个有效性和一个有效性试验中记录的青少年焦虑的CBT治疗过程来评估。第一阶段提供的心理测量数据将用于完善第二阶段的测量方法。然后，这些措施将用于第三阶段，从有效性研究中编码CBT治疗青少年焦虑的存档疗程。结果数据将用于研究理论和实践兴趣的关键问题，着眼于优化CBT的有效性和效率，包括：(a)探索治疗依从性、能力、分化和CBT治疗青少年焦虑的结果之间的关系；(b)确定CBT治疗青少年焦虑的完整性差异的来源。提出的研究是第一个检查三个完整性组成部分（治疗依从性，能力，区分）与焦虑障碍儿童CBT临床结果之间关系的研究。此外，由提议的研究产生的措施可以作为金标准，用来验证父母和治疗师报告的完整性措施。

DESCRIPTION (provided by applicant): The ultimate objective of the proposed study is to further develop a set of measures capable of assessing the integrity of cognitive-behavioral treatments (CBT) for anxiety in youths. Despite the success of CBT for child anxiety in controlled trials, measurement gaps in the field limit efforts to (a) refine and optimize the effectiveness of CBT, and (b) evaluate the success of CBT clinician training efforts. Indeed, there is a paucity of evidence-based measurement strategies to assess the integrity of efforts to implement CBT programs for child anxiety and none that incorporate the three dimensions of integrity. The proposed study addresses this significant methodological gap through the further development and validation of a set of observational measures designed to assess the key components of treatment integrity-treatment adherence, therapist competence, and treatment differentiation-concerning CBT for youths with anxiety. The project will accomplish two primary aims: (a) Establish reliability (interrater reliability, internal consistency, generalizability) and validity (convergent, discriminant) for the treatment integrity measures; and (b) Provide evidence linking data from these measures to (i) child outcomes, and (ii) therapy input variables (e.g., client, therapist characteristics). Recorded therapy sessions from three randomized clinical trials (RCTs; efficacy and 2 effectiveness trials) evaluating CBT for youth with primary anxiety disorders will be used to accomplish these aims. The research project progresses through three phases. In Phase I, the psychometric properties of the treatment integrity measures will be assessed using recorded therapy sessions of CBT for anxiety in youths from one efficacy and one effectiveness trial. The psychometric data provided in Phase I will be used to refine the measures during Phase II. The measures will then be used in Phase III to code archived therapy sessions of CBT for anxiety in youths from an effectiveness study. The resulting data will be used to investigate key questions of theoretical and practical interest, with an eye toward optimizing the effectiveness and efficiency of CBT, including: (a) Exploring the relations among treatment adherence, competence, differentiation, and outcomes in CBT for anxiety in youth; and (b) Identify sources of variation in the integrity of CBT for anxiety in youth. The proposed study is the first to examine the relation between the three integrity components (treatment adherence, competence, differentiation) and clinical outcomes in CBT for children with anxiety disorders. Moreover, the measures produced by the proposed study may be used as a gold standard against which to validate parent- and therapist report measures of integrity.