Intensive Quality Assurance of Therapist Adherence to Behavioral Interventions for Adolescent Substance Use Problems

Abstract

This study was a cross-cultural replication of a study that investigated therapist adherence to behavioral interventions as a result of an intensive quality assurance system which was integrated into Multisystemic Therapy (MST). Thirty-three therapists and eight supervisors were block randomized to either an Intensive Quality Assurance or a Workshop Only condition. Twenty-one of these therapists treated 41 cannabis-abusing adolescents and their families. Therapist adherence and youth drug screens were collected during a 5-month baseline period prior to the workshop on contingency management and during 12 months post workshop. The results replicated the previous finding that intensive quality assurance enhanced therapist adherence over workshop, to cognitive-behavioral techniques, but not to contingency management. While the clinical impact of such quality assurance remains to be demonstrated, cannabis abstinence increased as a function of time in therapy, and was more likely with stronger adherence to contingency management, but did not differ across quality assurance interventions.

KEYWORDS:

• adolescent substance abuse
• cognitive-behavioral techniques
• contingency management
• cross-cultural replication
• effective implementation
• quality assurance

Acknowledgments

We sincerely thank the clinical and research staffs for their participation and collaboration.

This manuscript was supported by grants K23DA015658 and R01DA015844 (International Supplement) from the National Institute on Drug Abuse, NIH.

Notes

***p < 0.01. **p < 0.05.

^a Estimates express odds of cannabis abstinence per unit increase in therapist adherence, before and after adjustment for putative confounders.

^b Sex of youth, sex of therapist, treatment history, number of sessions, therapist experience, therapist education, and month of therapy were entered as confounders.