Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions
ABSTRACT Assessing treatment fidelity is a core methodological consideration in the study of treatment outcome; it influences both the degree to which changes can be attributed to the intervention and the ability to replicate and disseminate the intervention. Efforts to increase access to evidence-based psychological treatments are receiving unprecedented support; but pressures exist to adapt treatments to service settings, running the risk of compromising fidelity. However, little evidence is available to inform the necessary conditions for the transportation of interventions to service provision settings, and the degree to which fidelity is even evaluated or emphasized in dissemination and implementation programs varies dramatically. Moreover, adaptation is associated with several benefits for dissemination efforts and may address relevant barriers to adoption. A particularly promising strategy for maximizing the benefits of both fidelity and adaptation is the use of transdiagnostic interventions. Such treatments allow for greater flexibility of the pacing and content of treatment, while still providing structure to facilitate testing and replication. Preliminary evidence supports the efficacy of this strategy, which may be particularly conducive to dissemination into service provision settings. At this time, further research is needed to evaluate the relationships among fidelity, adaptation, and outcome, and to determine the potential for transdiagnostic treatments to facilitate dissemination.
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ABSTRACT: Theorists have highlighted the commonalities in cognitive and behavioural processes across multiple disorders i.e. transdiagnostic approach. We report two studies that tested the psychometric properties of a new scale to assess these processes. The Cognitive and Behavioural Processes Questionnaire (CBP-Q) was developed as a 15-item measure. In Study 1, the CBP-Q was administered to a student (n = 172) sample with a range of standardised measures of the processes and symptom measures. Study 2 repeated the evaluation in a mixed clinical group (n = 161) and a community control group (n = 57). An exploratory factor analysis resulted in a 12-item version of the CBP-Q, consisting of a single factor. The measure demonstrated good internal consistency, test–retest stability and satisfactory convergent and divergent validity in both studies. Correlations with symptom-based measures showed increased engagement in these cognitive and behavioural processes to be associated with higher levels of symptomatology. The scale was elevated in the clinical relative to the community group and there were no differences in scores between broad diagnostic groupings (anxiety vs. mood vs. other). The CBP-Q has good psychometric properties. The findings are consistent with the transdiagnostic approach and indicate that a single, as yet unspecified factor may account for the shared variance across cognitive and behavioural maintenance processes.Cognitive Therapy and Research 01/2014; 39(2). DOI:10.1007/s10608-014-9641-9 · 1.70 Impact Factor
Dataset: Schoewald Garland et al. 2011
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ABSTRACT: Background: Intervention fidelity has important implications for the interpretation of intervention outcomes. Reviews on fidelity implementation for psychosocial interventions targeting children and adolescents with comorbid mental health problems are scarce. The purpose of this study was to systematically review reported fidelity of psychosocial interventions for children with comorbid mental health conditions. Method: Fidelity and quality ratings were calculated based on an analysis of articles resulting from a previously reported systematic search of the literature (using PsycINFO, MEDLINE and ERIC databases between 1994 and 2009), using the Intervention Fidelity Assessment Checklist for the fidelity measure and the Cochrane Colla boration�s tool for assessing risk of bias for the quality measure. Results: Overall, few studies were found to have a high level of fidelity adherence. Only 1 of the 10 studies met the �high� intervention fidelity cutoff. Conclusions: Findings suggest that current psychosocial interventions for children and adolescents with comorbid mental health disorders must be interpreted with caution, given many studies either do not measure intervention fidelity or have variable levels of fidelity adherence. Including fidelity components in future studies would aid in determining the effectiveness and generalizability of interventions targeted at children with comorbid disorders.Child and Adolescent Mental Health 09/2012; 17(3):139-145. DOI:10.1111/j.1475-3588.2011.00635.x · 0.95 Impact Factor