Leveraging routine clinical materials and mobile technology to assess CBT fidelity: the Innovative Methods to Assess Psychotherapy Practices (imAPP) study

Implementation Science

Luana Marques¹  Cassidy A. Gutner²  Dawne Vogt²  Shannon Wiltsey Stirman³  Eric Kuhn³  Jason Owen³  Heidi La Bash⁴  Matthew Beristianos⁴  Clara Johnson⁴  Kera Mallard⁴  Sonja Schoenwald⁵  Paul G. Barnett⁶  Robert DeRubeis⁷  Booil Jo⁸  Michael Suvak⁹  Torrey A. Creed^1,10 

[1] Harvard Medical School and Massachusetts General Hospital;National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine;National Center for PTSD, VA Palo Alto HCS and Stanford University Department of Psychiatry and Behavioral Sciences;National Center for PTSD;Oregon Social Learning Center;Palo Alto Veterans Institute for Research;School of Arts and Sciences, University of Pennsylvania;Stanford University;Suffolk University;University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania;

关键词: Fidelity;    Measurement;    Behavioral health;   

DOI  :  10.1186/s13012-018-0756-3

来源: DOAJ

【 摘 要 】

Abstract Background Identifying scalable strategies for assessing fidelity is a key challenge in implementation science. However, for psychosocial interventions, the existing, reliable ways to test treatment fidelity quality are often labor intensive, and less burdensome strategies may not reflect actual clinical practice. Cognitive behavioral therapies (CBTs) provide clinicians with a set of effective core elements to help treat a multitude of disorders, which, evidence suggests, need to be delivered with fidelity to maximize potential client impact. The current “gold standard” for rating CBTs is rating recordings of therapy sessions, which is extremely time-consuming and requires a substantial amount of initial training. Although CBTs can vary based on the target disorder, one common element employed in most CBTs is the use of worksheets to identify specific behaviors and thoughts that affect a client’s ability to recover. The present study will develop and evaluate an innovative new approach to rate CBT fidelity, by developing a universal CBT scoring system based on worksheets completed in therapy sessions. Methods To develop a scoring system for CBT worksheets, we will compile common CBT elements from a variety of CBT worksheets for a range of psychiatric disorders and create adherence and competence measures. We will collect archival worksheets from past studies to test the scoring system and assess test-retest reliability. To evaluate whether CBT worksheet scoring accurately reflects clinician fidelity, we will recruit clinicians who are engaged in a CBT for depression, anxiety, and/or posttraumatic stress disorder. Clinicians and clients will transmit routine therapy materials produced in session (e.g., worksheets, clinical notes, session recordings) to the study team after each session. We will compare observer-rated fidelity, clinical notes, and fidelity-rated worksheets to identify the most effective and efficient method to assess clinician fidelity. Clients will also be randomly assigned to either complete the CBT worksheets on paper forms or on a mobile application (app) to learn if worksheet format influences clinician and client experience or differs in terms of reflecting fidelity. Discussion Scoring fidelity using CBT worksheets may allow clinics to test fidelity in a short and effective manner, enhancing continuous quality improvement in the workplace. Clinicians and clinics can use such data to improve clinician fidelity in real time, leading to improved patient outcomes. Trial registration ClinicalTrials.gov NCT03479398. Retrospectively registered March 20, 2018.

【 授权许可】

Unknown