Kraan Anneleen E M, Dijkstra Boukje A G, Markus Wiebren
IrisZorg Addiction Treatment, P.O. Box 351, 6800 AJ Arnhem, The Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), P.O. Box 6909, 6503 GK Nijmegen, The Netherlands.
Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), P.O. Box 6909, 6503 GK Nijmegen, The Netherlands.
Eval Program Plann. 2018 Oct;70:61-66. doi: 10.1016/j.evalprogplan.2018.05.004. Epub 2018 Jun 4.
Treatment model adherence is an important predictor of treatment outcome. In clinical practice evidence-based treatments are delivered in widely varying degrees. This study examines which Community Reinforcement Approach (CRA) procedures are delivered by addiction care therapists and how this is associated with therapist characteristics.
The study integrated two observational designs. Firstly, using a prospective design, 24 therapists registered every CRA procedure delivered during every patient contact over a six month period. Secondly, using a cross-sectional design, personal characteristics of 69 therapists were assessed including their self-reported delivery of CRA procedures and their perceptions with regard to the meaningfulness and complexity of these procedures.
The number of CRA procedures delivered varied substantially among therapists both at session and patient level. More experienced therapists and those that had received advanced training previously, delivered more CRA procedures. Finally, the delivery of CRA procedures was positively associated with experienced meaningfulness and negatively associated with difficulty.
The results confirm the relation between treatment delivery and experienced meaningfulness and difficulty of CRA procedures and provides support for advanced training to enhance the delivery of a wider range of CRA procedures.
治疗模式的依从性是治疗结果的重要预测指标。在临床实践中，循证治疗的实施程度差异很大。本研究考察了成瘾护理治疗师实施哪些社区强化法（CRA）程序，以及这与治疗师特征有何关联。
该研究整合了两种观察性设计。首先，采用前瞻性设计，24名治疗师记录了在为期六个月的时间里每次与患者接触时所实施的每一项CRA程序。其次，采用横断面设计，评估了69名治疗师的个人特征，包括他们自我报告的CRA程序实施情况以及他们对这些程序的意义和复杂性的看法。
在治疗师之间，无论是在疗程还是患者层面，所实施的CRA程序数量差异很大。经验更丰富的治疗师以及那些之前接受过高级培训的治疗师，实施的CRA程序更多。最后，CRA程序的实施与感知到的意义呈正相关，与难度呈负相关。
研究结果证实了治疗实施与CRA程序感知到的意义和难度之间的关系，并为通过高级培训来加强更广泛的CRA程序的实施提供了支持。
