Choices in Treatment Integrity:Considering the Protocol and Consultant Recommendations in Child and Adolescent Therapy

Abstract

Codifying a complex treatment intervention into a manual necessarily involves simplifying procedures, possibly resulting in developer and expert adaptations that align with but are not fully consistent with the manualized content. This study evaluated the integrity of an evidence-based treatment to two information sources (i.e., an expert consultant and the treatment manual) within youth community mental health settings. Consultant recommendations were compared with manual-prescribed therapy procedures, which identified instances of agreement between the sources as well as consultant adaptations. To determine clinicians’ integrity to each source, clinician-reported therapy procedures were compared with consultant recommendations and manual prescriptions. Participants consisted of 30 clinicians, five consultants, and 78 youths (53% male; M age = 9.73 years, SD = 2.84; 81% Latino). Findings indicated that consultants generally recommended content from the manual but also made frequent adaptations that involved changing the sequence or problem focus of practices and adding additional content. Clinicians followed both information sources in a majority of their sessions when these sources agreed but were more likely to follow only one or neither source when they disagreed. Findings suggest that consultants often make adaptations to the manual and that clinicians are more likely to employ recommendations from the manual and/or consultant when the information sources are in agreement. Although it is as yet unclear whether consultant recommendations are effective when they differ from the prescriptions of the manual, results from this study indicate that information sources that supplement treatment manuals may benefit clinical decision making.