Although evidence-based treatments (EBTs) often perform well in research settings, when EBTs are delivered in practice settings they sometimes fail to outperform usual care (UC). One reason for this could be that therapists in practice settings may not follow the EBT protocol as closely or may deliver more therapeutic interventions that align with other treatment domains. I tested this possibility in the context of cognitive-behavioral treatment (CBT) for youth anxiety by comparing how CBT was delivered in practice (i.e., community-based clinics) and research (i.e., lab) settings. A diverse sample of youth (aged 7-15) received one of two treatments to address primary presenting problems of anxiety: CBT in a lab (N = 51), CBT in clinics (N = 18), or UC in clinics (N = 22). The extensiveness of therapeutic interventions delivered was measured using the Therapy Process Observational Coding System for Child Psychotherapy – Strategies Scale (McLeod & Weisz, 2010). Two coders independently coded the same available sessions. Analyses investigated mean-level differences in interventions session-by-session, over time between the three groups. Results indicated that CBT delivery differed across groups, over time. Future researchers should use this characterization to further implementation and process-outcome research, and eventually either enhance quality control efforts or alter aspects of EBT protocols (Garland, Hulbert, & Hawley, 2006).

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.

Thesis (Ph. D.)--Rutgers University, 2009. / "Graduate Program in Psychology." Includes bibliographical references (p. 51-66).

Background: Despite implementation efforts, most anxious youth do not receive evidence-based treatment. Dissemination initiatives can increase consumer knowledge of evidence-based treatments. Opinion leaders (OLs) have been used in public health campaigns, but this strategy has not been examined for the dissemination of mental health treatments. This study uses the theory of planned behavior to test the dissemination strategies of (1) involving an OL and (2) using an educational presentation to increase caregiver demand for CBT for youth anxiety. Methods: Participants (N=262; 92% Female; 69% White, 82% non-Hispanic) were caregivers who registered for a virtual presentation on youth anxiety and how to seek treatment. Caregivers were cluster-randomized by school (N=25) to the OL condition (presented by a clinical researcher and local caregiver OL) or the researcher-only condition (presented by two clinical researchers). Presentations occurred from May 2021-May 2022. Measures were completed pre- and post-presentation, and at three-month follow-up. Results: One hundred and nine participants attended the presentations. Relative to the researcher co-presenter, participants rated the OL as significantly more relatable, familiar, similar, and understanding of their community, but significantly less credible. Across conditions, there was a significant increase in participants’ (a) knowledge of, (b) subjective norms related to, and (c) intention to seek CBT for youth anxiety, but no change in stigma or attitudes about CBT. Presentation conditions did not differ in change on these measures, or on rates of seeking youth anxiety CBT at three-month follow-up. Conclusion: Although involvement of a caregiver OL did not increase caregiver demand for EBT for youth anxiety, the overall outreach presentation was an effective dissemination strategy. Involving OLs may not be necessary for all consumer audiences, but may be beneficial for individuals with higher levels of stigma or scientific skepticism than participants in this study. / Psychology

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