Lange Aurelie M C, van der Rijken Rachel E A, Busschbach Jan J V, Delsing Marc J M H, Scholte Ron H J
Viersprong Institute for Studies on Personality Disorders, Kooikersweg 203 C, 5223 KE 's Hertogenbosch, The Netherlands.
Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands.
Child Youth Care Forum. 2017;46(4):455-471. doi: 10.1007/s10566-016-9388-4. Epub 2017 Jan 6.
Therapist adherence is a quality indicator in routine clinical care when evaluating the success of the implementation of an intervention. The current study investigated whether therapist adherence mediates the association between therapist, team, and country-wide experience (i.e. number of years since implementation in the country) on the one hand, and treatment outcome on the other hand. We replicated and extended a study by Löfholm et al. (2014).
Data over a 10-year period were obtained from 4290 adolescents (12-17 years) with antisocial or delinquent problem behavior, who were treated with Multisystemic Therapy (MST) by 222 therapists, working in 27 different teams in the Netherlands. Multilevel structural equation modeling was used to assess the associations between experience, therapist adherence, and post-treatment outcomes.
Treatment outcomes were directly predicted by therapist experience, countrywide experience, and therapist adherence, but not by team experience. Moreover, therapist adherence mediated the association between therapist and country-wide experience, and treatment outcomes. The association between therapist experience and therapist adherence was not affected by the number of years of team experience or country-wide experience.
The effect of country-wide experience on outcome may reflect increasing experience of training and supporting the therapists. It suggests that nation-wide quality control may relate to better therapist adherence and treatment outcome for adolescents treated with systemic therapy.
在评估干预措施实施的成功与否时，治疗师的依从性是常规临床护理中的一项质量指标。本研究调查了治疗师的依从性是否一方面介导了治疗师、团队和全国经验（即该疗法在该国实施的年数）与另一方面治疗结果之间的关联。我们重复并扩展了Löfholm等人（2014年）的一项研究。
从4290名有反社会或违法问题行为的青少年（12 - 17岁）中获取了10年期间的数据，这些青少年由荷兰27个不同团队的222名治疗师采用多系统疗法（MST）进行治疗。采用多层次结构方程模型来评估经验、治疗师依从性和治疗后结果之间的关联。
治疗结果直接由治疗师经验、全国经验和治疗师依从性预测，但不由团队经验预测。此外，治疗师依从性介导了治疗师与全国经验以及治疗结果之间的关联。治疗师经验与治疗师依从性之间的关联不受团队经验年数或全国经验年数的影响。
全国经验对结果的影响可能反映了培训和支持治疗师方面经验的增加。这表明全国范围的质量控制可能与接受系统疗法治疗的青少年的治疗师更好的依从性和治疗结果相关。
