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Transport Findings Update and Summary_____________________________________
Website: Pre
Sonja Schoenwald, Ph.D.January 14, 2009
FSRC Update & Publications
MST Transport & Implementation Research
Thanks to:Office of Juvenile Justice and Delinquency Prevention
National Institute of Mental HealthNational Institute of Drug AbuseFamily Services Research Center
Charles GlissonDon Hedeker
David MackinnonService systems, organizations, clinicians, and families
Transporting New Treatments: MST as Test
Case
Funded by National Institute of Mental Health
MH59138 1999 – 2004
National Institute of Drug AbuseDA018107
2005 – 2007Schoenwald, PI
MST Transportability Study Aims
To Examine Relations Between: MST therapist adherence and outcomes Organizational climate and structure,
adherence, & outcomes Supervision, adherence, & outcomes Impact of clinician training & experience on
adherence A mediation model of transport
Social Ecological Model of Treatment
TransportabilityExtra-Organizational Context(Referral, Reimbursement, Disposition)
Organization Clinician Child (Structure,Climate,) Adherence Outcomes
MST Supervision (Behavior, functioning,
criminal activity)
Clinician Variables Professional Training & Experience
Design
Prospective, uncontrolled study Children nested within therapists nested within
organizations within service systems Repeated measures
Youth: Pre, post, 6 & 12 months post-treatment; lifetime pre through 1-year post criminal charges
Clinicians: TAM monthly; SAM bimonthlyOrganizations: biannuallyService system: biannually, & per case
Participants
45 MST programs in 12 states and Canada 452 therapists: 73% female, 73% Caucasian,
15% African American, 6% Asian/PI, 2% Hispanic 64% masters (social work, counseling,
psychology) 1979 youths and their caregivers Youths were: 15.5 years old, 65% male,
58% Caucasian, 19% African American, 6% Asian, 4% Hispanic, 13% Biracial
Predictors of Post-Treatment Change
Therapist Adherence (Schoenwald, Sheidow, Letourneau, & Liao, 2003; FSRC Pub. # 235)
Select Organizational Climate & Structure Scales (Schoenwald et al., 2003; same as above)
Consultant Adherence (Schoenwald, Sheidow, & Letourneau, 2004; FSRC Pub. # 242)
Organizational Factors Assessed
Climate Psychological impact of work environment Validated measure, OCQ, has 10 scales
Structure Formal features of organization
Hierarchy of Authority Procedural & Rule Specification Participation in Decision-making
“Fit” of work with structure is more important than structure per se
Organizational Predictors
Select climate and structure factors predicted short-term outcomes, some in unexpected directions.
Climate & structure did not predict adherence.
Adherence moderated relations between climate and structure and outcomes.
Youth Change Over Time
Significant reductions in behavior and
functioning problems through 1-year post-
treatment
Significant reductions in criminal charges
through 4-year post-treatment
Did Adherence Predict Longer-Term Post-Treatment Change?
Reductions in behavior problems one-year post-treatment differed significantly as function of therapist adherence ratings
Schoenwald, S. K., Carter, R. E., Chapman, J. E., & Sheidow, A. J. (2008). Therapist adherence and organizational effects on change in youth behavior problems one year after Multisystemic Therapy. Administration and Policy in Mental Health and Mental Health Services Research, 35, 379-394; FSRC Pub #326)
Adherence – Criminal Outcomes
At the highest level of adherence, the annualized rate of post-treatment charges for youth was 47% lower than at the lowest level of adherence.
When therapist adherence scores were one SD above the mean, annualized rate of post-treatment charges was 29% lower than when therapist adherence scores were one SD below the mean.
Schoenwald, S.K., Chapman, J.E., Sheidow, A.J., & Carter, R.E. (in press). Long-term youth criminal outcomes in MST transport: The impact of therapist adherence and organizational climate and structure. Journal of Clinical Child and Adolescent Psychology.
Structure & Climate Findings
Higher Therapist Adherence Was Predicted By
Greater organizational average levels of Growth & Advancement
Therapist perception of greater Growth & Advancement and Job Satisfaction
Lower Therapist Adherence Predicted By Therapist perception of greater Emotional
Exhaustion
Greater reductions in youth Externalizing behavior were predicted by:
Higher organizational average levels of Growth & Advancement
Lower organizational average levels of Hierarchy of Authority
Therapist perceptions of greater Participatory Decision making
Structure & Climate Findings (2)
However, When therapist adherence was added to the
statistical models, the effects of these organizational climate and structure factors
on youth outcomes weakened.
Structure & Climate Findings (3)
Structure & Climate Findings (4)
Youth Criminal Charges (on average 4 years post-treatment) Were Predicted By
Therapist perceptions of greater Job Satisfaction, Growth & Advancement
Higher organizational average Participatory Decision making
But,These effects washed out when therapist
adherence was included in the model
What Does This Mean For Your Work?
When adherence is good, but youth long-term outcomes are not, it may be that select aspects of organizational climate or structure are affecting the outcomes.
BUT: Depending on the outcome in question, those organizational effects are either weak or wash out compared to the effects of adherence
SO: Keep focusing on adherence
Supervisor Adherence
Supervisor Adherence Measure (SAM) Subscales
Supervision structure & process (SP)
Promotion of MST principles (AP)
Promotion of MST analytic process (ANP)
Supervisor development of clinician’s skills and competencies (CD)
*
Supervisor Adherence Findings
Greater supervisor average focus on Adherence to Principles predicted therapist adherence.
Greater supervisor adherence to the Structure and Process (SP) of supervision during a youth’s treatment episode predicted greater reductions in youth behavior and functioning problems.
Greater average focus on Clinician Development predicted a lesser decrease in youth functioning problems.
Schoenwald, S.K., Sheidow, A.J., & Chapman, J.E. (in press). Clinical supervision in
treatment transport: Effects on adherence and outcomes. Journal of Consulting and Clinical Psychology.
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