Gillespie Marie L, Huey Stanley J, Cunningham Phillippe B
Department of Psychology, University of Southern California, 3620 McClintock Avenue, SGM 501, Los Angeles, CA 90089, United States.
Department of Psychology, University of Southern California, 3620 McClintock Avenue, SGM 501, Los Angeles, CA 90089, United States; Department of American Studies and Ethnicity, University of Southern California, 3620 South Vermont Avenue, KAP 462, Los Angeles, CA 90089, United States.
J Subst Abuse Treat. 2017 May;76:1-10. doi: 10.1016/j.jsat.2017.01.001. Epub 2017 Jan 13.
Multisystemic therapy (MST) is perhaps the best validated treatment for youth who engage in serious and chronic antisocial behavior (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009). Despite evidence suggesting that high treatment adherence is needed to achieve optimal MST outcomes, this research is limited because past studies have relied on adherence reports derived solely from treatment participants (i.e., caregivers, youth, and therapists). To address this gap in the literature, the present study assessed the reliability and predictive validity of an observational protocol for rating adherence to MST.
The sample was drawn from a randomized clinical trial of juvenile drug offenders (77.5% male, 65% African American) referred to one of four treatment conditions (Henggeler et al., 2006). Audiotaped sessions of youth and their families were selected from the first month of MST and trained undergraduate students independently rated therapist adherence to the nine MST treatment principles. We assessed the validity of MST adherence in predicting outcomes at post-recruitment and 12-month follow-up.
Good interrater reliability (ICC=0.642) was found across all raters for our composite index of adherence. High adherence to MST during the first month of therapy predicted decreases in externalizing behavior at post-recruitment and decreases in youth alcohol consumption at 12-month follow-up.
These results provide independent support for the link between treatment fidelity and behavioral outcomes in the context of MST. Further, this study demonstrates the feasibility of using novice, undergraduate judges to reliably code therapist adherence.
多系统治疗（MST）可能是针对有严重且慢性反社会行为的青少年最有效的已验证治疗方法（Henggeler、Schoenwald、Borduin、Rowland和Cunningham，2009年）。尽管有证据表明需要高治疗依从性才能实现最佳的MST治疗效果，但该研究存在局限性，因为过去的研究仅依赖于治疗参与者（即照顾者、青少年和治疗师）提供的依从性报告。为了填补这一文献空白，本研究评估了一种用于评定MST治疗依从性的观察方案的信度和预测效度。
样本取自一项针对青少年药物犯罪者的随机临床试验（77.5%为男性，65%为非裔美国人），这些青少年被分配到四种治疗条件之一（Henggeler等人，2006年）。从MST治疗的第一个月中选取青少年及其家庭的录音治疗 sessions，并由经过培训的本科生独立评定治疗师对九条MST治疗原则的依从性。我们评估了MST依从性在预测招募后和12个月随访结果方面的效度。
对于我们的综合依从性指数，所有评定者之间的评分者信度良好（ICC = 0.642）。治疗第一个月对MST的高依从性预测了招募后外化行为的减少以及12个月随访时青少年酒精消费量的减少。
这些结果为MST背景下治疗保真度与行为结果之间的联系提供了独立支持。此外，本研究证明了使用新手本科生评定者可靠地编码治疗师依从性的可行性。
