Provider fidelity and modifications to cognitive processing therapy in a diverse community health clinic: Associations with clinical change
| Autor: | Soo Jeong Youn, Derri L. Shtasel, Shannon Wiltsey-Stirman, Sarah E. Valentine, Naomi M. Simon, Louise E. Dixon De Silva, Debra Kaysen, Emily M. Ahles, Margaret-Anne Mackintosh, Luana Marques |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male 050103 clinical psychology Evidence-based practice media_common.quotation_subject MEDLINE Fidelity PsycINFO Article Stress Disorders Post-Traumatic Community health center Humans 0501 psychology and cognitive sciences Competence (human resources) media_common Cognitive Behavioral Therapy 05 social sciences Middle Aged Community Mental Health Services Psychiatry and Mental health Clinical Psychology Treatment Outcome Community health Cognitive processing therapy Female Clinical Competence Guideline Adherence Psychology Clinical psychology |
| Zdroj: | Journal of Consulting and Clinical Psychology. 87:357-369 |
| ISSN: | 1939-2117 0022-006X |
| DOI: | 10.1037/ccp0000384 |
| Popis: | Objective The purpose of this study is to examine associations between therapist adherence, competence, and modifications of an evidence-based protocol (EBP) delivered in routine clinical care and client outcomes. Method Data were derived from a NIMH-funded implementation-effectiveness hybrid study of Cognitive Processing Therapy (CPT) for PTSD in a diverse community health center. Providers (n = 19) treated clients (n = 58) as part of their routine clinical care. Clients completed the PCL-S and PHQ-9 at baseline, after each CPT session, and posttreatment. CPT sessions were rated for treatment fidelity and therapist modifications. Results Overall, therapist adherence was high, although it decreased across sessions suggesting potential drift. Therapist competence ratings varied widely. Therapists made on average 1.6 fidelity-consistent and 0.4 fidelity-inconsistent modifications per session. Results show that higher numbers of fidelity-consistent modifications were associated with larger reductions in posttraumatic stress and depressive symptoms. High adherence ratings were associated with greater reductions in depressive symptoms, whereas higher competence ratings were associated with greater reduction in posttraumatic stress symptoms. Conclusions The results highlight the importance of differentially assessing therapist adherence, competence, and modifications to EBP in usual care settings. The findings also suggest that effective EBP delivery in routine care may require minor adaptations to meet client needs, consistent with previous studies. Greater attention to fidelity and adaptation can enhance training so providers can tailor while retaining core components of the intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved). |
| Databáze: | OpenAIRE |
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