Measurement Training and Feedback System for Adolescent Externalizing Problems

Two widely endorsed approaches are consistently effective for treating adolescent externalizing problems: family therapy and cognitive-behavioral therapy (CBT). Stronger adherence to core evidence-based interventions (EBIs) of these approaches predicts better outcomes in research and community settings. Yet these EBIs are not widely implemented with fidelity.

To help close this quality gap in adolescent services, we are developing an online intervention to strengthen fidelity to these EBIs in routine care, called Measurement Training and Feedback System (MTFS). MTFS will target two essential aspects of EBI fidelity: training components will seek to improve EBI self-monitoring, and a feedback component will seek to increase EBI utilization.

In keeping with NIMH’s Experimental Therapeutics paradigm, this study will examine whether an Intervention (MTFS) has direct impact on its immediate targets (EBI self-monitoring and utilization); if promising, future studies will examine links among intervention, targets, and ultimate outcomes (AEPs).

The MTFS

The MTFS package will be an online quality assurance system completed by therapists and supervisors that can be readily sustained in usual care. Two weekly training components will adapt gold-standard observational fidelity coding procedures to promote improved self-monitoring of the targeted EBIs. A monthly feedback component will adapt a measurement feedback system to promote increased use of these EBIs in everyday practice.

To maximize provider investment, sites will define their own fidelity standards for family therapy and CBT and help design their own feedback report templates. This study will be among the first to (1) test whether training therapists in observational assessment of EBI fidelity increases the accuracy with which they self-monitor use of those EBIs and (2) adapt measurement feedback procedures to track and improve therapist utilization of EBIs. If effective, MTFS could be adapted to promote EBI fidelity for a variety of clinical populations and approaches.

• University of Miami