Schoenwald S K, Henggeler S W, Brondino M J, Rowland M D
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425, USA.
Fam Process. 2000 Spring;39(1):83-103. doi: 10.1111/j.1545-5300.2000.39109.x.
The challenges of specifying a complex and individualized treatment model and measuring fidelity thereto are described, using multisystemic therapy (MST) as an example. Relations between therapist adherence to MST principles and instrumental and ultimate outcome variables are examined, as are relations between clinical supervision and therapist adherence. The findings provide modest support for the associations between MST adherence measures and instrumental and ultimate outcomes. Results also show that adherence can be altered when clinical supervision and adherence monitoring procedures are fortified. The modest associations between adherence measures and youth outcomes argue for further refinement and validation of the MST adherence measure, especially in light of the well-established effectiveness of MST with challenging clinical populations and the increasing dissemination of MST programs.
本文以多系统疗法（MST）为例，阐述了确定复杂且个体化的治疗模式以及衡量其保真度所面临的挑战。研究考察了治疗师对MST原则的遵循与工具性和最终结果变量之间的关系，以及临床督导与治疗师遵循之间的关系。研究结果为MST遵循度测量与工具性和最终结果之间的关联提供了一定支持。结果还表明，当加强临床督导和遵循度监测程序时，遵循度可以得到改变。遵循度测量与青少年结果之间的适度关联表明，需要进一步完善和验证MST遵循度测量，特别是考虑到MST在具有挑战性的临床人群中已确立的有效性以及MST项目的日益普及。
