title: Toward effective quality assurance in evidence-based practice: links between expert consultation, therapist fidelity, and child outcomes.
abstract: This study validated a measure of expert clinical consultation and examined the association between consultation, therapist adherence, and youth outcomes in community-based settings. Consultant adherence to the multisystemic therapy (MST) consultation protocol was assessed through therapist reports, and therapist adherence to MST principles was assessed through caregiver reports in 2 samples of families (N1 = 178, N2 = 274) and therapists (N1 = 87, N2 = 162). Caregiver reports of youth behavior and functioning were obtained in the second sample pre- and posttreatment. Random effects regression models demonstrated associations between consultant behavior, therapist adherence, and posttreatment youth behavior problems and functioning. Instrumental aspects of consultation supported therapist adherence and improved youth outcomes; supportive aspects of consultation were negatively associated with adherence and outcomes. These findings suggest the availability to clinicians of expert consultation can impact clinician fidelity to a treatment model and child outcomes.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA. schoensk@musc.edu
authors.forename: Sonja K
authors.initials: SK
authors.lastname: Schoenwald
authors.forename: Ashli J
authors.initials: AJ
authors.lastname: Sheidow
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Letourneau
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D002648:Child; D003156:Community Mental Health Services; D003479:Curriculum; D019317:Evidence-Based Medicine; D005196:Family Therapy / Q000193:education; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007318:Inservice Training; D008297:Male; D009934:Organization and Administration; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010552:Personality Assessment / Q000706:statistics & numerical data; D010865:Pilot Projects; D011594:Psychometrics; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D012044:Regression Analysis; D013223:Statistics as Topic