Relationships between clinician-level attributes and fidelity-consistent and fidelity-inconsistent modifications to an evidence-based psychotherapy.
BACKGROUND
Clinicians often modify evidence-based psychotherapies (EBPs) when delivering them in routine care settings. There has been little study of factors associated with or implications of modifications to EBP protocols. This paper differentiates between fidelity-consistent and fidelity-inconsistent modifications and it examines the potential influence of two clinician characteristics, training outcomes, and attitudes toward EBPs on fidelity-consistent and fidelity-inconsistent modifications of cognitive behavioral therapy in a sample of clinicians who had been trained to deliver these treatments for children or adults.


METHODS
Survey and coded interview data collected 2 years after completion of training programs in cognitive behavioral therapy were used to examine associations between successful or unsuccessful completion of training, clinician attitudes, and modifications. Modifications endorsed by clinicians were categorized as fidelity-consistent or fidelity-inconsistent and entered as outcomes into separate regression models, with training success and attitudes entered as independent variables.


RESULTS
Successful completion of a training program was associated with subsequent fidelity-inconsistent modifications but not fidelity-consistent modifications. Therapists who reported greater openness to using EBPs prior to training reported more fidelity-consistent modifications at follow-up, and those who reported greater willingness to adopt EBPs if they found them appealing were more likely to make fidelity-inconsistent modifications.


CONCLUSIONS
Implications of these findings for training, implementation, EBP sustainment, and future studies are discussed. Research on contextual and protocol-related factors that may impact decisions to modify EBPs will be an important future direction of study to complement to this research.
National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine, Department of Psychiatry, 150 S. Huntington Ave (116B3), Boston, MA, 02130, USA. Shannon.Wiltsey-Stirman@VA.gov.
Shannon
S
Wiltsey Stirman
National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine, Department of Psychiatry, 150 S. Huntington Ave (116B3), Boston, MA, 02130, USA. cgutner@bu.edu.
Cassidy A
CA
Gutner
Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, Philadelphia, USA. crits@mail.med.upenn.edu.
Paul
P
Crits-Christoph
Department of Psychiatry, Harvard University Medical School, Boston, MA, USA. jedmunds@post.harvard.edu.
Julie
J
Edmunds
Philadelphia Department of Behavioral Health and Developmental disAbility Services, 3535 Market Street, Philadelphia, USA. Arthur.C.Evans@phila.gov.
Arthur C
AC
Evans
Center for Mental Health Policy and Services Research, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, USA. rbeidas@upenn.edu.
Rinad S
RS
Beidas
D000328:Adult; D002648:Child; D002983:Clinical Competence / Q000592:standards; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000193:education / Q000379:methods / Q000592:standards; D019317:Evidence-Based Medicine; D006801:Humans; D011613:Psychotherapy / Q000379:methods / Q000592:standards*