ارزیابی وفاداری به شیوه های مبتنی بر شواهد در مراقبت معمول:مثالی از خانواده درمانی برای مشکلات رفتاری نوجوانان

This study describes a multimethod evaluation of treatment fidelity to the family therapy (FT) approach demonstrated by front-line therapists in a community behavioral health clinic that utilized FT as its routine standard of care. Study cases (N = 50) were adolescents with conduct and/or substance use problems randomly assigned to routine family therapy (RFT) or to a treatment-as-usual clinic not aligned with the FT approach (TAU). Observational analyses showed that RFT therapists consistently achieved a level of adherence to core FT techniques comparable to the adherence benchmark established during an efficacy trial of a research-based FT. Analyses of therapist-report measures found that compared to TAU, RFT demonstrated strong adherence to FT and differentiation from three other evidence-based practices: cognitive-behavioral therapy, motivational interviewing, and drug counseling. Implications for rigorous fidelity assessments of evidence-based practices in usual care settings are discussed.

The goal of this study was to determine whether a community clinic that featured family therapy (FT) as its routine standard of care demonstrated fidelity to the FT approach when treating adolescent behavior problems, utilizing assessment methods that appear well-suited for efficient fidelity evaluation in usual care. Treatment fidelity is an index of the degree to which interventions are delivered in accordance with essential theoretical and procedural aspects of a given model (Hogue et al., 1998). Fidelity consists of three related components (Waltz, Addis, Koerner, & Jacobson, 1993): adherence refers to the quantity or extent to which interventions are delivered; competence refers to the quality or skill of delivery; and differentiation refers to the degree to which comparative treatment approaches differ from one another in practice based on guiding theory and prescribed interventions. Whereas the past decade has witnessed noteworthy gains in the knowledge base and technology base of fidelity evaluation in controlled research settings, parallel efforts in usual care settings have been slow in coming ( Schoenwald et al., 2011).