title: Assessing fidelity of treatment delivery in group and individual 12-step facilitation.
abstract: Twelve step facilitation (TSF) is an emerging, empirically supported treatment, the study of which will be strengthened by rigorous fidelity assessment. This report describes the development, reliability and concurrent validity of the Twelve Step Facilitation Adherence Competence Empathy Scale (TSF ACES), a comprehensive fidelity rating scale for group and individual TSF treatment developed for the National Drug Abuse Treatment Clinical Trials Network study, Stimulant Abuser Groups to Engage in 12-Step. Independent raters used TSF ACES to rate treatment delivery fidelity of 966 (97% of total) TSF group and individual sessions. TSF ACES summary measures assessed therapist treatment adherence, competence, proscribed behaviors, empathy and overall session performance. TSF ACES showed fair to good overall reliability; weighted kappa coefficients for 59 co-rated sessions ranged from .31 to 1.00, with a mean of .69. Reliability ratings for session summary measures were good to excellent (.69-.91). Internal consistency for the instrument was variable (.47-.71). Relationships of the TSF ACES summary measures with each other, as well as relationships of the summary measures with a measure of therapeutic alliance provided support for concurrent and convergent validity. Implications and future directions for the use of TSF ACES in clinical trials and community treatment implementation are discussed.
authors.affiliation: Oregon Health and Science University, Department of Public Health and Preventive Medicine, Portland, OR 97239, USA. drbarbaracampbell@earthlink.net
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Campbell
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Manuel
authors.forename: Sarah Turcotte
authors.initials: ST
authors.lastname: Manser
authors.forename: K Michelle
authors.initials: KM
authors.lastname: Peavy
authors.forename: Julija
authors.initials: J
authors.lastname: Stelmokas
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Guydish
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003695:Delivery of Health Care / Q000592:standards; D004645:Empathy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011615:Psychotherapy, Group / Q000379:methods*; D015203:Reproducibility of Results; D012657:Self-Help Groups; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000534:rehabilitation*