Pilot evaluation of the CBT tracker : a hybrid measurement feedback system for monitoring treatment integrity and client progress
Year: 2022
Type: dissertation
Abstract: Routine outcomes monitoring (ROM) and the use of evidence-based treatments (EBTs) are two research-supported practices that have potential to improve client outcomes in mental healthcare, including youth psychotherapy, but are largely underutilized in routine practice. The innovative developments of measurement feedback systems (MFSs) and "core components" approaches to cognitive and behavioral therapy (CBT) have each shown potential to overcome important barriers that limit uptake and use of ROM and EBTs, respectively. However, other critical barriers remain yet unaddressed, including clinician perceptions of the net benefits of using MFSs, MFS dependence on client-report measures, and difficulty achieving EBT integrity. Combining MFS technology and core components approaches to CBT may hold unique potential to address these remaining barriers. Purpose: The current study evaluates the potential for implementation of a novel MFS, the CBT Tracker, which integrates measurement and feedback about both client outcomes and treatment integrity to core components of youth CBT. Methods: A convergent parallel mixed methods design was employed to evaluate the CBT Tracker in relation to seven implementation outcomes: acceptability, appropriateness, feasibility, adoption, fidelity, penetration, and sustainability. A diverse sample of 36 community therapists were asked to pilot the CBT Tracker while providing up to six sessions of CBT to a youth client in routine practice. Therapists completed a background questionnaire at enrollment and a semi-structured qualitative interview at conclusion of study participation. Qualitative content analysis of interview transcripts was employed to assess clinicians' perceptions of the CBT Tracker in relation to the target implementation outcomes and identify specific implementation determinants. Quantitative analyses examined adoption, penetration, fidelity, sustainability, and determinants of these outcomes, as indicated by participants' use of the CBT Tracker during the study and associations between use and participant background characteristics. Results: Findings provide proof of concept that EBT integrity feedback can be integrated into an MFS in a way that is acceptable, appropriate, and feasible in diverse, usual care clinical settings. Findings further support the potential of such an MFS to simultaneously support implementation of EBTs and ROM in routine care. However, many barriers to adoption, penetration, fidelity, and sustainability were also identified, and findings indicate that the CBT Tracker may need to be augmented with multiple contextually-responsive implementation strategies in order to achieve widespread implementation.
DOI: 10.32469/10355/95143
Author: Jack H. Andrews
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Award: G1010754820
OpenAlex ID: W4378416883