title: Therapist predictors of treatment delivery fidelity in a community-based trial of 12-step facilitation.
abstract: OBJECTIVE
  Therapist characteristics may be associated with variation in consistency, quality and effectiveness of treatment delivery. We examined associations between treatment fidelity and therapist education, experience, treatment orientation and perceived skills in a randomized, multi-site trial of Twelve Step Facilitation (TSF).
  
  
  METHODS
  Raters scored audio-recorded, TSF sessions (n = 966; 97% of TSF sessions) from 32 community-based, trained therapists for adherence, competence, empathy and global session performance.
  
  
  RESULTS
  Therapists with graduate degrees had significantly higher adherence and global performance fidelity ratings. Therapists reporting more positive attitudes toward 12-Step groups had lower adherence ratings. Being in recovery was associated with lower fidelity in univariate tests, but higher adherence in multivariate analysis. Fidelity was higher for therapists reporting self-efficacy in basic counseling skills and lower for self-efficacy in addiction-specific counseling skills. Fidelity was also superior in group relative to individual TSF sessions.
  
  
  CONCLUSIONS
  Results have implications for therapist selection, training and supervision in community-based, effectiveness trials and community implementation of evidence-based treatments. To obtain high fidelity and improve outcomes, it may be preferable to choose masters level therapists who are open to learning new treatments and have good, general counseling skills.
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health & Science University, OR, USA. drbarbaracampbell@earthlink.net
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Campbell
authors.forename: Allison
authors.initials: A
authors.lastname: Buti
authors.forename: Holly E
authors.initials: HE
authors.lastname: Fussell
authors.forename: Priya
authors.initials: P
authors.lastname: Srikanth
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Guydish
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003156:Community Mental Health Services / Q000458:organization & administration*; D003376:Counseling / Q000193:education / Q000458:organization & administration* / Q000592:standards; D055317:Evidence-Based Practice / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011369:Professional-Patient Relations; D012657:Self-Help Groups; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000534:rehabilitation*