Schoenwald Sonja K, Sheidow Ashli J, Letourneau Elizabeth J
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
J Clin Child Adolesc Psychol. 2004 Mar;33(1):94-104. doi: 10.1207/S15374424JCCP3301_10.
This study validated a measure of expert clinical consultation and examined the association between consultation, therapist adherence, and youth outcomes in community-based settings. Consultant adherence to the multisystemic therapy (MST) consultation protocol was assessed through therapist reports, and therapist adherence to MST principles was assessed through caregiver reports in 2 samples of families (N1 = 178, N2 = 274) and therapists (N1 = 87, N2 = 162). Caregiver reports of youth behavior and functioning were obtained in the second sample pre- and posttreatment. Random effects regression models demonstrated associations between consultant behavior, therapist adherence, and posttreatment youth behavior problems and functioning. Instrumental aspects of consultation supported therapist adherence and improved youth outcomes; supportive aspects of consultation were negatively associated with adherence and outcomes. These findings suggest the availability to clinicians of expert consultation can impact clinician fidelity to a treatment model and child outcomes.
本研究验证了一种专家临床咨询测量方法，并考察了社区环境中咨询、治疗师依从性与青少年治疗结果之间的关联。通过治疗师报告评估咨询师对多系统治疗（MST）咨询方案的依从性，通过照顾者报告评估治疗师对MST原则的依从性，样本包括两个家庭样本（N1 = 178，N2 = 274）和治疗师样本（N1 = 87，N2 = 162）。在第二个样本的治疗前和治疗后获取了照顾者关于青少年行为和功能的报告。随机效应回归模型显示了咨询师行为、治疗师依从性与治疗后青少年行为问题及功能之间的关联。咨询的工具性方面支持治疗师的依从性并改善青少年治疗结果；咨询的支持性方面与依从性和治疗结果呈负相关。这些发现表明，专家咨询对临床医生的可用性会影响临床医生对治疗模式的忠诚度以及儿童治疗结果。
