In order to continue to improve the effectiveness of psychotherapy, researchers must identify key change processes. Unfortunately, there are disparate views in the field about the relative importance and potency of specific techniques versus relationship factors. Few measures have been developed to examine the relative contribution of these factors, particularly for child-focused treatment. The Common-Factor Therapist Competence Scale for Youth Psychotherapy (COMP-CF) was developed to address this deficit. For this study, 142 video-taped sessions of child CBT for anxiety were observed and rated by independent coders using the COMP-CF. The measure demonstrated good reliability and internal consistency. Significant between-therapist and between-session differences were noted that warrant further exploration. The COMP-CF also demonstrated initial validity when compared to other observer-rater measures of therapeutic processes such as alliance, CBT-specific competence, and adherence. Recommendations for further development and refinement are discussed. Used in conjunction with adherence measures, the competence measure developed here may help improve our understanding of the therapeutic process.

The increasing diversity of the United States creates a pressing public health need to investigate methods to increase the engagement, retention, and efficacy of mental health services for racial/ethnic minority (REM) youth. Evidence from the adult psychotherapy treatment literature suggests that enhancing therapist cultural competence leads to increases in client satisfaction, alliance, and retention (Constantine, 2002; Sodowsky, Kuo-Jackson, Richardson, & Corey, 1998; Worthington, Soth-McNett, & Moreno, 2007). However, this relationship has not been adequately explored in youth mental health services, due in part, to a lack of valid and reliable measurement. This research project included measure development and initial validation of the Youth Therapist Observational Cultural Competence Scale (YTOCCS) with the aim of creating an observer-rated measure of youth therapist cultural competence. The measure was developed from a review of the theoretical and empirical literature and integrated the surveyed opinions of practicing child therapists, caregivers of REM children involved in the mental health system, and experts in therapist cultural competence. The study used an extreme group design based on child-therapist alliance selecting 32 recordings of 8 unique child-therapist dyads. Three coders were trained using a standardized manual and independently double coded early treatment sessions from an effectiveness trial for individual child cognitive-behavioral therapy conducted in community clinics. The measure demonstrated good reliability as measured by intraclass correlation coefficient, adequate internal consistency, and evidence supported initial validity through demonstrated significant between-group differences. Future studies are warranted to refine the measure and to explore the factor structure of the measure.