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Benchmarking Family Therapy for Adolescent Behavior Problems in Usual Care: Fidelity, Outcomes, and Therapist Performance Differences

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Abstract

This study evaluated whether community therapists delivering family therapy for adolescent behavior problems in usual care achieved performance benchmarks established in controlled trials for treatment fidelity and outcomes, with particular focus on individual differences in therapist performance. The study contained N = 38 adolescents (50 % male; mean age 15 years) whose self-reported race/ethnicity was Hispanic (74 %), African American (11 %), multiracial (11 %), and other (4 %). Clients were treated by 13 therapists in one community mental health clinic that delivered family therapy as the routine standard of care. Therapists provided self-report data on adherence to core family therapy techniques; these scores were inflation-adjusted based on concordance with observer reports. Results showed that community therapists surpassed the fidelity benchmark for core family therapy techniques established by research therapists during a controlled trial. Regarding change in client functioning at 6-month follow-up, community therapists were equivalent to the benchmark for internalizing symptoms and superior for externalizing symptoms and delinquent acts. Community therapists also demonstrated a high degree of performance uniformity: Each one approximated the fidelity benchmark, and only two produced relatively weak outcomes on any of the client change indicators. Caveats for interpreting therapist performance data, given the small sample size, are described. Recommendations are made for developing therapist-report fidelity measures and utilizing statistical process control methods to diagnose therapist differences and enhance quality assurance procedures.

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Acknowledgments

Preparation of this article was supported by Grant R01DA023945 from the National Institute on Drug Abuse. The authors are extremely grateful to Takuya Minami for providing technical assistance in completing benchmarking analyses. We acknowledge the dedicated contributions of Molly Bobek, Jaqueline Horan Fisher, Candace Johnson, and Emily Lichvar in supporting this work. We also thank the therapists working at the Roberto Clemente Center who generously agreed to submit regular self-reports of therapeutic interventions in the hopes of advancing the clinical science in their field.

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  1. The National Center on Addiction and Substance Abuse, 633 Third Avenue, 19th floor, New York, NY, 10017, USA

    Aaron Hogue & Sarah Dauber

  2. Department of Psychology, Sam Houston State University, Huntsville, USA

    Craig E. Henderson

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  1. Aaron Hogue
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Correspondence to Aaron Hogue.

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Dr. Hogue declares that he has no conflict of interest. Dr. Dauber declares that she has no conflict of interest. Dr. Henderson declares that he has no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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This article does not contain any studies with animals performed by any of the authors.

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Hogue, A., Dauber, S. & Henderson, C.E. Benchmarking Family Therapy for Adolescent Behavior Problems in Usual Care: Fidelity, Outcomes, and Therapist Performance Differences. Adm Policy Ment Health 44, 626–641 (2017). https://doi.org/10.1007/s10488-016-0769-7

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