(PS5-9) Case-level Characteristics and Therapist Adherence to MST on Family Engagement

Abstract Text:

Background: Treatment fidelity is posited to be a key to successful implementation (e.g., Allen et al., 2017), though data have been mixed on the relationship between fidelity and outcome (e.g., Collyer et al., 2020; Southam-Gerow et al., 2021; Webb et al., 2010). One clear exception to this pattern of mixed findings has been the relationship of fidelity with outcome for multisystemic therapy (MST), an intensive, evidence-based family-focused approach for youth substance use, antisocial practices, and delinquent behavior. Multiple studies have demonstrated that fidelity predicts MST treatment outcomes in both research and clinic settings (e.g., Henggeler, Melton, Brondino, Scherer, & Hanley, 1997; Timmons-Mitchell, Bender, Kishna, & Mitchell, 2006). These results have been demonstrated across diverse youth outcomes, including youth rearrests, affiliation with delinquent peers, and youth psychiatric symptomatology have been reported (Schoenwald et al., 2003; Timmons-Mitchell et al., 2006). Within MST, the family is considered the focus of treatment as the caregivers are considered to be critical in facilitating youth behavior change (Henggeler et al., 1997; Schoenwald et al., 2005). Therefore, the engagement of caregivers is pivotal to successful treatment outcomes; studies have shown that improved parenting and family relationships through engagement, aided in the sustainability of youth’s changed behavior in a qualitative study of family's experiences with MST (Tighe et al., 2012) and change in antisocial behavior will not occur without active participation in treatment (Cunningham & Henggeler, 1999; Henggeler et al., 2009 as cited in Cunningham et al., 2010). This study aims to assess the following research questions: (a) Do client-level characteristics such as race/ethnicity and referral source influence therapist's adherence to the MST protocol? and (b) Does therapist adherence to MST protocol influence treatment outcomes?

Method: The present study used six quarters of data from a statewide evaluation of MST in a large mid-Atlantic state including eleven MST teams, 25 therapists, and 59 families. Fidelity data were collected via the Therapist Adherence Measure-Revised (TAM-R), a caregiver-reported instrument. Outcome variables included family engagement and out-of-home placement post-treatment. Hypothesized predictors included race, ethnicity, and referral source. The results will contribute by clarifying if fidelity predicts outcomes for this sample. Further, the study will provide data on whether family cultural factors and the mandated treatment status of the youth influence fidelity.