Development and Validation of Child Therapy Integrity Measures

描述（由申请人提供）：拟议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在对照试验中成功地治疗了儿童焦虑，但该领域的测量差距限制了以下工作：（a）改进和优化CBT的有效性，（B）评估CBT临床医生培训工作的成功。事实上，缺乏基于证据的测量策略来评估实施儿童焦虑CBT计划的努力的完整性，并且没有一个包含完整性的三个维度。拟议的研究解决了这一重大的方法上的差距，通过进一步开发和验证的一套观察措施，旨在评估治疗的完整性的关键组成部分，治疗依从性，治疗师的能力，和治疗的差异，有关CBT的青少年焦虑。该项目将实现两个主要目标：（a）为治疗完整性措施建立可靠性（评价者间可靠性、内部一致性、可推广性）和有效性（收敛性、判别性）;（B）提供证据，将这些措施的数据与（i）儿童结局和（ii）治疗输入变量（例如，客户，治疗师特征）。来自三项随机临床试验（RCT;疗效和2项有效性试验）的治疗记录将用于评估患有原发性焦虑症的青少年的CBT，以实现这些目标。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特性将使用记录的治疗会话CBT焦虑的青少年从一个疗效和一个有效性试验进行评估。在第一阶段提供的心理测量数据将用于在第二阶段完善措施。然后，这些措施将用于第三阶段，从有效性研究中为青少年的焦虑症编码存档的CBT治疗课程。由此产生的数据将被用来调查的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，分化和结果之间的关系在CBT焦虑的青年;和（B）确定的变化来源的完整性CBT焦虑的青年。这项研究是第一个研究三个完整的组成部分（治疗依从性，能力，分化）和CBT焦虑症儿童的临床结果之间的关系。此外，拟议的研究所产生的措施可以作为一个金标准，以验证父母和治疗师的报告措施的完整性。

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.