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| EXCEED Pilot Project 3 |
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| Improving the Evaluation of Therapist Adherence to
Multisystemic Therapy with Ethnically Diverse, Adolescent Drug Offenders |
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Treatment fidelity is of central importance in efforts to disseminate
empirically-supported treatments to “real-world” settings. Unfortunately,
the limited availability of valid measures of treatment fidelity limits the
ability to evaluate and maintain treatment adherence in community mental
health settings. Since African American youth tend to be over represented
among those with serious mental health problems, the dearth of effective
treatments and valid methods for evaluating fidelity to such treatments
disproportionately effects them.
This study proposes to develop further an
existing measure of treatment fidelity, the Multisystemic Therapy Adherence
Measure, which measures therapist adherence to the Multisystemic Therapy (MST;
Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) treatment protocol.
A recently funded randomized trial funded by NIAAA and NIDA provides an opportunity
to build on existing psychometric work with the MST Adherence Measure to enhance the
potential for transporting MST to community treatment settings.
This study has two primary aims related to the refinement and validation of
the original MST adherence measure.
First, this application proposes to develop an
adherence measure that (1) taps the 9 principles which operationalize MST with
greater specificity than the previous measure, and (2) indexes additional dimensions
that differentiate MST from traditional mental health treatment for substance abuse
problems in youth. The second aim is to examine the utility of treatment adherence
in predicting short- and long-term treatment outcomes in a multi-ethnic sample of
substance-abusing juvenile offenders, and evaluate whether adherence to the MST
treatment protocol is equally predictive of outcomes for African American and Caucasian
youth and families.
Since MST has proven to be an effective treatment for African
American offenders, the development of an inexpensive yet valid measure for facilitating
treatment adherence to MST in “real-world” settings should aid in improving the
quality of mental health care for African American youth.
If the measure is shown to
be a valid index of treatment adherence, a proposal for a randomized trial will be
developed to study the effectiveness of this measure as a time- and cost-efficient
feedback mechanism for MST therapists and clinical supervisors in maintaining adherence
to the MST treatment protocol.
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