title: Treatment adherence and competency ratings among therapists, supervisors, study-related raters and external raters in a clinical trial of a 12-step facilitation for stimulant users.
abstract: This study investigated the correspondence among four groups of raters on adherence to STAGE-12, a manualized 12-step facilitation (TSF) group and individual treatment targeting stimulant abuse. The four rater groups included the study therapists, supervisors, study-related ("TSF expert") raters, and non-project related ("external") raters. Results indicated that external raters rated most critically mean adherence - the mean of all the adherence items - and global performance. External raters also demonstrated the highest degree of reliability with the designated expert. Therapists rated their own adherence lower, on average, than did supervisors and TSF expert raters, but therapist ratings also had the poorest reliability. Findings highlight the challenges in developing practical, but effective methods of fidelity monitoring for evidence based practice in clinical settings. Recommendations based on study findings are provided.
authors.affiliation: University of Washington, Alcohol & Drug Abuse Institute, Seattle, WA 98105; Evergreen Treatment Services, Seattle, WA 98134. Electronic address: peavy@evergreentx.org.
authors.forename: K Michelle
authors.initials: KM
authors.lastname: Peavy
authors.affiliation: University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, CA 94118.
authors.forename: Joseph
authors.initials: J
authors.lastname: Guydish
authors.affiliation: Department of Veterans Affairs, Office of Mental Health.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Manuel
authors.affiliation: Oregon Health & Science University, Department of Public Health & Preventive Medicine, Portland, OR 97239.
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Campbell
authors.affiliation: University of California, San Francisco, Department of Psychiatry, Box 0984-TRC, San Francisco, CA 94143.
authors.forename: Nadra
authors.initials: N
authors.lastname: Lisha
authors.affiliation: University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, CA 94118.
authors.forename: Thao
authors.initials: T
authors.lastname: Le
authors.affiliation: University of California, San Francisco, Department of Psychiatry, Box 0984-TRC, San Francisco, CA 94143.
authors.forename: Kevin
authors.initials: K
authors.lastname: Delucchi
authors.affiliation: University of Washington, Alcohol & Drug Abuse Institute, Seattle, WA 98105.
authors.forename: Sharon
authors.initials: S
authors.lastname: Garrett
mesh_terms: D000328:Adult; D000697:Central Nervous System Stimulants; D002983:Clinical Competence; D003406:Credentialing; D005103:Expert Systems; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010361:Patients; D011584:Psychology / Q000592:standards*; D015203:Reproducibility of Results; D019966:Substance-Related Disorders / Q000534:rehabilitation*
chemical_list: D000697:Central Nervous System Stimulants
keywords: 12-step facilitation; Fidelity; Substance abuse; Treatment adherence