Objective: Understanding the pathways through which treatments work to change symptom and diagnostic outcomes is important to the development and delivery of evidence-based treatments. This study assessed the extent to which adherence (therapist’s delivery of prescribed therapeutic interventions) and differentiation (therapist’s delivery of non-prescribed therapeutic interventions) to Coping Cat, a CBT program, affected client symptom and diagnostic outcomes. Method: The Therapy Process Observational Coding System for Child Psychotherapy – Revised Strategies Scale (McLeod et al., 2015) was used to characterize therapeutic interventions delivered within and outside of the Coping Cat program with youths aged 7-15 receiving treatment in one efficacy (n = 51; 41% female; 84% Caucasian, M age = 10.37) and one effectiveness (n = 17; 56% female, 39% Caucasian, M age = 10.90) trial. Youth- and parent-report symptom checklists and diagnostic interviews were used to assess symptom and diagnostic remission. Multiple hierarchical regression analyses and hierarchical binomial logistic regression were used to investigate the relation between adherence and differentiation and symptom change and remission of principal diagnosis. Results: Neither adherence nor differentiation were significantly related to symptom or diagnostic outcomes. No clear trend emerged, and results were inconsistent across parent and youth report, outcome type, and setting. Conclusion: These results are consistent with past literature. Two interpretations exist: (1) that there is no relation between treatment delivery and outcomes, and (2) that methodological and analytic flaws undercut the ability of the analyses to identify a relation.

The field has developed many evidence-based treatments (EBTs); the integrity of EBTs being delivered, however, has been studied less than rigorously. Because many treatment manuals are developed to be delivered session-by-session, one way to assess treatment adherence, specifically, is across the course of the case: do therapists deliver treatment components in the order prescribed? The goals of this study were to characterize how therapists deviate from prescribed order and how adherence to order relates to child characteristics. Therapy process data were collected from a subsample of children (N = 33, aged 7-15) that received cognitive behavioral therapy (CBT) to address primary symptoms of anxiety. Adherence to CBT was measured by the CBT Adherence Scale for Youth Anxiety (Southam-Gerow & McLeod, 2011). Four methods to assess order were developed. Analyses include descriptive and correlative statistics that characterize the delivery of CBT and the relation between adherence to order and pretreatment characteristics.

The goal of the current study was to develop and test a rigorous measure of therapist adherence to a cognitive-behavioral, manual-based treatment for childhood and adolescent depression. This project employed data from the recently completed UCLAYouth Anxiety and Depression Treatment study. This study aimed to advance the literature by devoting the full focus of the project to the development of a manual-based measure that would demonstrate interrater reliability across multiple raters. This study reported on the psychometric development of the PASCET Manual Adherence Scale (PMAS) (e.g. scoring strategy, item development, reliability), a unique measure of therapist adherence that represents the content of the treatment manual for the "Primary and Secondary Control Enhancement Training" program (PASCET; Weisz et al., 1999). In sum, the P-MAS showed strong interrater reliability for most items of the scale. The items with poorer ICCs may have been influenced by instrumentation problems, small sample size, and range restriction. Some session content showed evidence that more meetings may be required to sufficiently cover the material, particularly for those that involve heavy in-vivo content, require the use of technology, or involve cognitive interventions which may be challenging for children and young teenagers. The results indicated that therapists adhered to slightly more than half of the prescribed manual content overall. The variability in adherence appeared greater for session-specific content than for standard session items, reflecting the variability within that content and the myriad of factors which may have influenced adherence to diverse material. Adherence for session-specific content demonstrated a slightly downward trend over time, with a significant drop off between the first and second phases of treatment and a leveling off between second and third phases. For all but two relevant sessions, therapist adherence to didactic content was significantly higher than adherence to in-vivo content, highlighting the challenges of engaging depressed youth in active learning. As this active involvement is theorized to be an essential component in addressing depressive symptoms, the challenges in implementation of this content may represent the most significant barrier to therapist adherence with this manual.

Brief, easy to use, psychometrically strong (i.e., pragmatic) instruments are needed to support implementation research; the current study assessed whether it was possible to develop a pragmatic observational treatment integrity instrument and reduce the amount of time coders spend making treatment integrity ratings (while maintaining score validity) of therapists delivering two protocols of individual cognitive-behavioral treatment (ICBT) for youth anxiety in research and practice settings. The 12-item instrument was derived from four observational treatment integrity instruments with promising score reliability and validity that assess adherence, competence, differentiation, and alliance. A sample of 106 youths (M age = 10.12, SD = 1.81, ages 7-14; 42.50% Female; 69.80% Caucasian) received one of three treatments to address anxiety: standard ICBT in a research setting (n = 51) or standard ICBT (n = 22), modular ICBT (n = 16), or usual care (UC; n = 17) in practice settings. Four coders independently coded five- and 15- minute segments sampled from four sessions from each client (N = 756 sessions). Ten percent of sessions were double-coded for reliability purposes. Reliability, sensitivity to change, construct validity, and predictive validity from the two segments were compared to full session treatment integrity scores independently archived in a study assessing the same clients. Across five- and 15-minute segments, the instrument produced promising score reliability and convergent validity evidence for adherence, competence, and alliance items (items intended for inclusion in ICBT for youth anxiety; M ICCs = .62, SD = .17; M rs = .58, SD = .12) and poor score reliability and validity evidence for differentiation items (items intended for inclusion in other treatment domains; M ICCs = .21, SD = .28; M rs = .27, SD = .25). This study met its primary aim, to develop an instrument that can be coded in less than 20 minutes while maintaining evidence of score validity. Researchers interested in developing such instruments can use this study design as a roadmap. Future research should investigate whether psychometric findings replicate across samples, why certain items (e.g., client-centered interventions) did not evidence score validity, and how this type of instrument can inform EBT training.

This manuscript includes two studies. The research design for study 1 was a single-subject reversal design, while study 2 was a case study with 5 experimental conditions. These studies investigated the effects of a Tier 3 peer-matching self-management intervention on two elementary school students who had previously been less responsive to Tier 1 and Tier 2 interventions. The Tier 3 self-management intervention, which was implemented in the classroom, included daily electronic communication between teachers and the two students' parents. Results indicated that this intervention effectively reduced disruptive behaviors and increased total engagement when implemented with integrity; without integrity, results were variable.

This study examined the effects of a parent-implemented intervention on preschool children's development of letter-naming and phonological awareness skills. Six parent-child dyads with children enrolled in a Head Start Program in West Central Florida were selected to participate in the study. A multiple baseline across participants design was used to evaluate the impact of an intervention package that included activities focusing on: (1) using mnemonics to learn letter names and (2) developing phonological awareness of the onsets of words through parent questioning and feedback. Phonological awareness development was measured using the Dynamic Indicators of Basic Early Literacy Skills First Sound Fluency (DIBELS-FSF) and letter-naming ability was measured using the DIBELS Letter Knowledge (DIBELS-LK) probes. Results showed that five of the six students responded favorably to the intervention, increasing their growth rate on at least one of the two measures. The final child showed little change in trends across the phases. Additionally, data was collected regarding intervention integrity of intervention implementation as well as social validity, or the acceptance and usefulness, of the intervention. Intervention integrity data revealed that the majority of parents completed the intervention with high levels of fidelity, although variability across parents was noted. Social validity data indicated that the parents found the program helpful and effective. Implications for research and practice are discussed.

<p>Known to be one of the most important resources, but also one of the most difficult ones to obtain, the workforce constitutes (consistence) the core of any organization. To find the right person for a particular position is not a trivial task. The recruitment of new staff members is important for any organization in general, but for treating organizations in particular. In order to provide the best service for its clients, it is, for a treating organization, vital to recruit nothing but highly qualified personnel. A well educated workforce can more easily stick to the treatment program and thus maintain treatment integrity. The purpose of this study is to examine how the recruitment process is executed by three treating organizations situated in the municipality of Örebro. Moreover the purpose is to evaluate the process in terms of strengths and weaknesses with the objective of pinpointing parts in the recruitment process in need of improvment. A theoretical framework capturing definitions and theories; treatment conditions, organization theory and the recruitment process. In order to answer the research questions, according to the study’s purpose, a qualitative method was adopted. The data sample ecompassed six personers: two managers and four group officers. The results in brief: The recruitment process of “Ungdoms- och familjeenheten” (the study’s delimit of treating organizations) in the municipality of Örebro has strengths as well as weaknesses. The major strength is the recruiter’s unanimous understanding for the importance of hiring a workforce holding a suitable education fulfilling all requirements. The major weakness is the recruitment process’s lack of a common structure (also read as action plan or policy). This might be due to the fact that recruiters rely on previous experiences.</p>

This study evaluated the influence of academic, behavioral, and sociocultural variables on the implementation of Schoolwide Positive Behavior Support (SWPBS), a system intended to improve discipline in school buildings. The number of schools that are implementing SWPBS has been increasing dramatically over the years as school violence continues to rise and solutions are needed to improve school climate. This study examined the relationship between three categories of variables and the level of implementation of SWPBS in three multiple regression analyses. The categories were school demographic variables (i.e., ethnicity, socio-economic status, teacher: student ratio, percentage of teachers who are out-of-field), severity of need for change (suspensions, office referrals, percentage of students below grade level in reading), and team process variables (coaching, team functioning, administrative support). Of these variables, team functioning was the only one found to be sign ificantly related to implementation. A second component of the study involved collecting data relating to factors that were enablers or barriers to the implementation of SWPBS. Two-hundred and thirty-six school personnel completed a survey, Schoolwide Implementation Factor Survey (SWIF). The survey derived three factors through a factor analysis: school, staff, and students; principal; and assistant principal. These factors were all found to have a high Cronbach's alpha for internal consistency. There were significant differences between schools with a high, middle, and low level of implementation on all of these factors, with respondents from high implementing schools scoring the highest on all factors,and respondents from low implementing schools scoring the lowest. The item on the survey rated as the most helpful in the implementation process was "Expectations and rules that are clearly defined," while the item rated as the most problematic in the implementation process was "Adequat e funding for PBS." Overall, the results highlighted the complexity of implementing a system-wide change.(i.e., ethnicity, socio-economic status, teacher: student ratio, percentage of teachers who are out-of-field), severity of need for change (suspensions, office referrals, percentage of students below grade level in reading), and team process variables (coaching, team functioning, administrative support). Of these variables, team functioning was the only one found to be significantly related to implementation. A second component of the study involved collecting data relating to factors that were enablers or barriers to the implementation of SWPBS. Two-hundred and thirty-six school personnel completed a survey,Schoolwide Implementation Factor Survey (SWIF). The survey derived three factors through a factor analysis: school, staff, and students; principal; and assistant principal. These factors were all found to have a high Cronbach's alpha for internal consistency. There were signific ant differences between schools with a high, middle, and low level of implementation on all of these factors, with respondents from high implementing schools scoring the highest on all factors,and respondents from low implementing schools scoring the lowest. The item on the survey rated as the most helpful in the implementation process was "Expectations and rules that are clearly defined," while the item rated as the most problematic in the implementation process was "Adequate funding for PBS." Overall, the results highlighted the complexity of implementing a system-wide change.

The purpose of this study was to investigate the effects of a supplemental vocabulary intervention on the content area vocabulary word and definition knowledge of DHH student in grades K-2, the integrity with which itinerant teachers implemented the supplemental vocabulary intervention, and the effects and benefits of coaching to support treatment integrity. Mixed methods were employed; a single subject multiple baseline across subjects and content design was used to investigate student word and definition knowledge, while quantitative and qualitative methodologies were used to examine the effects of coaching on teachers' treatment integrity. The supplemental vocabulary intervention included explicit and implicit strategies and was designed to fit the context of itinerant teacher services. Various levels of support were employed to coach teachers as they gained familiarity with the intervention and improved their treatment integrity during implementation. Student word and definition knowledge was examined in relation to teacher treatment integrity to determine if teacher implementation had an effect on student outcomes. Results showed a functional relationship between the supplemental vocabulary intervention and student word and definition knowledge. Teachers' treatment integrity was found to have a greater effect on student definition knowledge than word knowledge. Teachers responded positively to the coaching they received, and their implementation improved over the course of the study. Practical and research implications for using supplemental vocabulary instruction with DHH students, as well as the need to provide support to teachers to improve treatment integrity, are discussed.

Known to be one of the most important resources, but also one of the most difficult ones to obtain, the workforce constitutes (consistence) the core of any organization. To find the right person for a particular position is not a trivial task. The recruitment of new staff members is important for any organization in general, but for treating organizations in particular. In order to provide the best service for its clients, it is, for a treating organization, vital to recruit nothing but highly qualified personnel. A well educated workforce can more easily stick to the treatment program and thus maintain treatment integrity. The purpose of this study is to examine how the recruitment process is executed by three treating organizations situated in the municipality of Örebro. Moreover the purpose is to evaluate the process in terms of strengths and weaknesses with the objective of pinpointing parts in the recruitment process in need of improvment. A theoretical framework capturing definitions and theories; treatment conditions, organization theory and the recruitment process. In order to answer the research questions, according to the study’s purpose, a qualitative method was adopted. The data sample ecompassed six personers: two managers and four group officers. The results in brief: The recruitment process of “Ungdoms- och familjeenheten” (the study’s delimit of treating organizations) in the municipality of Örebro has strengths as well as weaknesses. The major strength is the recruiter’s unanimous understanding for the importance of hiring a workforce holding a suitable education fulfilling all requirements. The major weakness is the recruitment process’s lack of a common structure (also read as action plan or policy). This might be due to the fact that recruiters rely on previous experiences.