Capturing fidelity to understand implementation of Trauma-focused Cognitive Behavioral Therapy in juvenile justice correctional facilities

The primary objective of this study examined the relationship between therapist treatment fidelity to Trauma-focused Cognitive- Behavioral Therapy (TF-CBT) and youth self-reported post session symptom severity. TF-CBT was provided to 21 incarcerated youth by 8 therapists employed in 3 juvenile correctional facilities. This study used observational coding measurement of 53 TF-CBT therapy audiotapes to measure therapist fidelity components: adherence to TF-CBT specific strategies, technical competence, nonspecific competence, and patient engagement across three treatment phases (1=psychoeducation phase, 2= skills building phase, and 3= trauma narrative and processing). Results found treatment fidelity did not relate to improved youth self -reported symptom severity across treatment. Higher pretreatment symptom severity was the only positive predictor of TF-CBT effectiveness and it related to a worsening of post-session symptoms. The second aim examined treatment adherence reliability of therapist self-report and observational coder ratings. Therapists and trained observational coders provided adherence ratings on 49 TF-CBT treatment sessions. Correspondence between therapists and observational coders was low, with 8 of 11 of the codes having a Kappa value of .4 or lower. Results indicate therapists overreport treatment adherence in comparison to observational coders. Overall, the study’s findings suggest that therapist treatment fidelity to a protocol may not be the key mechanism related to EBT effectiveness in unique settings with complex populations. Substantial research is still needed to corroborate the relationship between treatment fidelity and outcomes across settings, treatments, and informants. Implications for implementation science and effectiveness research with juvenile justice youth are also discussed.

Author dc:creator

• Heier, Julie E.

Contributors dc:contributor

• Carlson, Cindy I., 1949-
• Lopez, Molly
• Whittaker, Tiffany A
• Stark, Kevin D

• Implementation science
• Fidelity
• Trauma
• Evidence-based treatments
• Juvenile justice

Language dc:language

en

Identifier

http://dx.doi.org/10.26153/tsw/1275

OAI identifier oai:identifier

oai:tdl-ir.tdl.org:2152/74144