School of Social Work, Columbia University, 1255 Amsterdam Ave., New York, NY 10027, USA.
Am J Orthopsychiatry. 2012 Jan;82(1):146-55. doi: 10.1111/j.1939-0025.2011.01133.x.
Poor adherence of children and adolescents to evidence-based psychosocial interventions remains a fundamental impediment to treatment effectiveness. To maintain client adherence, researchers and clinicians have employed a number of adherence-promoting strategies, from telephone calls and letters to providing transportation costs and child care to motivational enhancement therapies. However, the influence of adherence promoters on intervention outcomes has not been reported. This study examined the moderating effect of adherence-promoting strategies in a survey and meta-analysis of randomized clinical trials of cognitive behavioral treatments, interpersonal therapy, and psycho-education for children and adolescents with mental health problems (k = 33). Results indicated the type and intensity of adherence promoters' moderated study effect sizes according to client characteristics (age, gender, diagnosis). Preliminary findings suggest that males had higher effect sizes when more intensive adherence-promoting efforts were employed. Adherence-promoting efforts were associated with lower effect sizes for youths who were diagnosed with externalizing disorders. Results of this study suggest directions for future research to clarify clinical guidelines to maximize retention in evidence-based psychotherapy.
儿童和青少年对循证心理社会干预措施的依从性差仍然是治疗效果的一个基本障碍。为了保持客户的依从性，研究人员和临床医生采用了许多促进依从性的策略，从电话和信件到提供交通费用和儿童保育，再到动机增强疗法。然而，关于促进依从性的策略对干预结果的影响尚未有报道。本研究通过对儿童和青少年心理健康问题的认知行为治疗、人际治疗和心理教育的随机临床试验的调查和荟萃分析，考察了促进依从性的策略的调节作用（k=33）。结果表明，根据客户特征（年龄、性别、诊断），促进依从性的策略的类型和强度调节了研究效果大小。初步研究结果表明，当采用更强化的促进依从性的措施时，男性的效果大小更高。对于被诊断为外化障碍的青少年，促进依从性的努力与较低的效果大小有关。这项研究的结果为未来的研究指明了方向，以澄清临床指南，最大限度地提高循证心理治疗的保留率。
