Development and Validation of Child Therapy Integrity Measures

描述(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认知行为疗法(CBT)对青少年焦虑的完整性的指标。尽管CBT治疗儿童焦虑症在对照试验中取得了成功，但该领域的测量差距限制了以下努力：(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，缺乏基于证据的衡量策略来评估为儿童焦虑实施CBT计划的努力的完整性，而且没有一种策略包含诚信的三个维度。这项拟议的研究通过进一步开发和验证一套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化-针对患有焦虑的青少年的CBT来解决这一重大的方法学差距。该项目将实现两个主要目标：(A)建立治疗完整性测量的可靠性(评价者间的可靠性、内部一致性、概括性)和有效性(收敛、判别)；以及(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。评估CBT治疗青少年原发性焦虑症的三个随机临床试验(RCT；疗效试验和两个有效性试验)的记录治疗过程将用于实现这些目标。研究项目分三个阶段进行。在第一阶段，将使用一次疗效试验和一次有效性试验的CBT治疗青少年焦虑的录音疗程来评估治疗完整性措施的心理测量学特性。在第一阶段提供的心理测量数据将用于完善第二阶段的措施。这些措施将在第三阶段用于编码CBT的存档治疗课程，从有效性研究中获得青少年焦虑症。所得数据将被用来调查理论和实践上感兴趣的关键问题，着眼于优化CBT的有效性和效率，包括：(A)探索CBT治疗青年焦虑的依从性、能力、差异性和结果之间的关系；以及(B)确定CBT治疗青年焦虑的完整性的差异来源。这项拟议的研究首次检验了CBT中三个完整性成分(治疗依从性、能力、差异性)与焦虑症儿童CBT临床结果之间的关系。此外，拟议研究产生的衡量标准可以被用作验证父母和治疗师报告的诚信衡量标准的黄金标准。

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.