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Dissemination & Implementation Science

SSCP Submission: Client-Level Predictors of Therapists’ Measurement-Based Care Fidelity

(SSCP1-9) SSCP Submission: Client-level Predictors of Therapists’ Measurement-based Care Fidelity

Friday, November 15, 2024
4:30 PM – 5:30 PM EST
Location: Grand Ballroom A, Level 5, Downtown Marriott
Abstract Text: Measurement-based care (MBC) has shown promise in improving treatment outcomes. By allowing therapists to administer and view results of regularly administered assessments, therapists can monitor treatment outcomes and enhance clinical decision-making (Rognstad et al, 2023; Delgadillo et al, 2022). Though there is an abundance of literature exhibiting MBC’s effectiveness in improving alliance, reducing treatment drop-out, and reducing symptoms (De Jong et al, 2021), there remains low reported rates of fidelity to MBC within community settings (Kwan et al, 2021; Sale et al, 2021). Prior research has focused on examining therapist- and organizational-level predictors of MBC fidelity (e.g., Bear et al, 2022; Janse et al, 2023; Williams et al, 2022); however, not many studies have investigated patient-level predictors. One study found that parents of youth who were female, Caucasian, and African American were less likely to report discussion of MBC data with their child’s therapist, compared to those with youth who were male, Latinx, or from other racial backgrounds (Stein et al, 2010). Another study found that client diagnosis could influence MBC administration among adults, suggesting that greater alignment between client diagnosis and MBC measures is associated with greater MBC administration (Liebmann et al, 2022). By examining patient-level predictors of MBC fidelity further, researchers may be able to identify what specific demographic and/or diagnostic groups are disproportionately experiencing gaps in therapists’ MBC fidelity, informing efforts to improve MBC fidelity. Our research thus aims to explore client-level predictors of MBC fidelity using data collected from an electronic health record (EHR) and usage data from a digital MBC platform. Our sample consists of 1,530 youth who were enrolled in trauma-focused treatment at a child advocacy setting. To better understand patterns of MBC fidelity, we will examine age (M = 10.9, SD = 4.0, range = 2 to 18), sex (74% female, n = 1123), race/ethnicity (66% Hispanic White, n = 1040), treatment language (66% English, n = 1013), number of initial abuse allegations (M = 1.4, SD = 1.0, range = 0 to 7), trauma diagnosis (87% with a diagnosis, n = 1338), and internalizing disorder diagnosis (23% with a diagnosis, n = 358) as predictors of MBC fidelity using Generalized Estimating Equations to account for clustering (i.e. clients within therapist). Therapist fidelity to MBC will be operationalized using the Implementation Index, which is an index focused on the rate of MBC measure administration and feedback viewing, two key indicators of MBC fidelity (Bickman et al., 2011). Given the literature, we hypothesize that younger clients, boys, identification as Hispanic, and the presence of an internalizing disorder will all be associated with higher levels of MBC fidelity. The implication of study findings for training clinicians to use MBC equitably will be discussed.