Despite the large body of research demonstrating the efficacy of evidence-based practices (EBPs) for the most common youth mental health problems, EBPs are rarely used in usual care (UC). When EBPs are implemented in UC settings, there is a drop in adherence, and sometimes a drop in outcomes. Feasible and practical adherence monitoring tools may support high quality EBP delivery in UC. The current study examined the psychometric properties of the Cognitive-Behavioral Therapy Adherence Measure (CBTAM), a suite of therapist-, parent-, and youth-reported measures of adherence to the core components of cognitive-behavioral therapy (CBT) for youth anxiety, depression, and behavior problems. Therapists, parents, and youths completed the CBTAM after every session throughout a six-session treatment. Coders coded a subset of treatment sessions using the CBTAM and other established observational coding systems for CBT adherence and alliance. Therapists were consistent with coders on their ratings of individual CBTAM items. Therapist, parent, and youth CBTAM item ratings were correlated with similar items on established observational measures of CBT adherence and alliance, and these correlations were higher than correlations between CBTAM items and dissimilar items on observational measures. CBTAM adherence scores predicted faster symptom improvement on some therapist- and parent-rated outcomes. Therapist and parent end-of-treatment ratings were consistent with observational coding measures of adherence and alliance. Findings demonstrate the promise of the CBTAM as a feasible adherence monitoring tool for routine care.
Description and Demonstration of Cognitive Behavioral Therapy to Enhance Antiretroviral Therapy Adherence and Treat Depression in HIV-Infected Adults