The measurement of treatment adherence (i.e., the frequency and thoroughness with which a therapist delivers a treatment as designed) is critical to the field of implementation science, as adherence is often considered an indicator of successful implementation. Most existing instruments of treatment adherence are treatment protocol specific; however, this approach is costly, inefficient, and disallows cross-treatment and cross-study comparisons. Thus, there is a need for adherence instruments that can be used across treatment protocols. It has been suggested that an instrument that captures adherence at the practice element level would meet this need, as it would have utility across protocols that share practice elements. The current study examines the extent to which an observational adherence instrument designed to assess the core common practice elements found in individual cognitive-behavioral therapy (ICBT) for youth anxiety (the Cognitive-Behavioral Therapy Adherence Scale for Youth Anxiety; CBAY-A) can produce scores that can be reliably and validly interpreted across two separate ICBT protocols: Coping Cat (a standard manualized treatment; SMT) and MATCH (a modular manualized treatment; MMT). This study provides initial psychometric data for scores on an SMT subscale (comprised of CBAY-A items found in the SMT protocol) and an MMT subscale (comprised of CBAY-A items found in the MMT protocol) of the CBAY-A. Treatment sessions (n = 359 SMT; n = 243 MMT) from 38 youth participants (n = 22 SMT; n = 16 MMT; M age = 9.84 years, SD = 1.65; 52.6% male, 60.5% Caucasian) in an effectiveness study were independently coded by two coders using the CBAY-A. Inter-rater reliability intraclass correlation coefficients (2,2) for the item scores averaged 0.83 (SD = 0.07) for the SMT group and 0.80 (SD = 0.09) for the MMT group. CBAY-A SMT and CBAY-A MMT subscale scores demonstrated evidence of convergent and discriminant validity via associations with observational instruments of therapist adherence designed specifically for the SMT and MMT protocols, and observational instruments of competence and alliance. Results provide preliminary evidence that the CBAY-A can be effectively used in place of two separate protocol-specific adherence instruments, indicating that it may be a flexible, efficient, and useful tool for capturing adherence to ICBT protocols for youth anxiety in a way that allows for comparisons across treatment protocols and research studies.

The purpose of this dissertation is to analyze the ways in which distinguished American composer James RayWintle (1942-2013) addresses the problem of formal unity and incorporates previous musical styles in his post-tonal compositions. Because post-tonal music lacks many of the pillars that create tonal structure, it can be difficult for a composer to maintain a sense of form when writing in this style. Wintle attempts to circumvent this issue by incorporating common-practice elements, such as formal sections, familiar stylistic gestures, and referential-pitch organization into his works. For this analysis, the author has selected three of Wintle’s piano compositions that best represent his compositional approach and diverse techniques: Album Leaves - A Set of Five Character Pieces for Piano (2001), Scherzino (Street Scenes of Ovada) for Solo Piano (2010), and Four Miniatures for Piano Four Hands (2003). Wintle’s artistic style borrows extensively from Western classical music, encompassing various historical periods and quoting several major composers. Additionally, he incorporates a variety of musical styles into his chamber works and those for solo piano. These range from the dance suites of the French Baroque and Brahmsian-character pieces to American ragtime. This research also describes Wintle’s compositional style and his borrowing of 18th- and 19th-century techniques, forms, and titles, all set in a post-tonal language. The interviews conducted with the composer and his own program notes serve as primary sources, lending an invaluable insight into his works.