Category: ADHD - Child
Better implementation (i.e., greater dosage and/or increased fidelity) is often associated with better client outcomes (see Durlak & DuPre, 2008, for a review). However, the transfer of evidence-based practices from a lab setting to a clinical setting can often lead to compromised dosage and integrity (Durlak, 2015). It is thus important to identify factors that facilitate or impede implementation with integrity because their identification will inform how to extend the reach of evidence-based practices to those who need it. A family-based approach for adolescents with Attention Deficit Hyperactivity Disorder (ADHD), which integrates family therapy techniques with skill development, is currently being evaluated in an effectiveness trial (Changing Academic Support in the Home for Adolescents with ADHD; [CASH-AA]; Hogue, Bobek, & Evans, 2016). In this study, we sought to examine implementation of this family-based protocol as part of the effectiveness trial. Specifically, we examined the extent to which therapists used the CASH protocol and the reasons for their choices. In addition, we examined adolescent and clinician characteristics that may be associated with use.
Therapists at three mental health and one substance use outpatient treatment clinics were trained in CASH procedures, and supervision and support were provided on a monthly basis. Clinicians were told that the treatment procedures in CASH were evidence-based practices for adolescents with ADHD (Schultz et al., 2017) and encouraged their use with adolescents with ADHD and academic impairment. Therapists completed forms after each session indicating the extent to which they used CASH procedures in the session. Previous research has shown that therapist can reliably report on session content of this nature (Hogue, Dauber, Henderson, & Liddle, 2014). We explored how therapists’ allegiance to and self-efficacy for conducting evidence-based therapy influenced implementation, because higher allegiance and/or greater self-efficacy can lead to better client outcomes (Dragioti, Dimoliatis, Fountoulakis, & Evangelou, 2015). We also examined how the degree of academic impairment reported by the adolescent client influenced implementation, as clinicians are more likely to use an intervention that they believe matches the needs of the client instead of those that do not. Additionally, we gathered qualitative data from the clinicians about their reasons for using and not using CASH procedures, as this is an effective way of determining factors that influence implementation (Aarons, Fettes, Sommerfeld, & Palinkas, 2012).
As of submission, therapists conducted a total of 374 sessions with 46 clients. Ninety-seven (25.8%) sessions included CASH-AA; average time of use per session was (M = 12.23 minutes; SD = 11.27; range = 2-60; mode = 5 minutes). Although therapist allegiance to and self-efficacy for conducting evidence-based therapy was not associated with implementation, therapists reported that specific child, family, and contextual factors influenced use (e.g., comorbid symptom presentation and ‘crisis of the week’). Present findings along with analyses of these additional factors will be described in the poster.
W. John Monopoli– graduate student, Ohio University, Athens, Ohio
Steven Evans– Ohio University
Jacqueline Fisher– The National Center on Addiction and Substance Use at Columbia University
Alexis Nager– The National Center on Addiction and Substance Use at Columbia University
Aaron Hogue– The National Center on Addiction and Substance Use at Columbia University
The National Center on Addiction and Substance Use at Columbia University