Child / Adolescent - Anxiety
Robert Cross, B.A.
Project Coordinator
Virginia Commonwealth University
Charlottesville, Virginia
Stephanie Violante, Ph.D.
Postdoctoral Fellow
University of California, Los Angeles
Los Angeles, California
Bryce D. McLeod, Ph.D.
Professor
Virginia Commonwealth University
Richmond, Virginia
Michael A. Southam-Gerow, Ph.D.
Professor
Virginia Commonwealth University
Richmond, Virginia
John R. Weisz, ABPP, Ph.D.
Professor
Harvard University
Cambridge, Massachusetts
Bruce F. Chorpita, Ph.D. (he/him/his)
Professor
University of California Los Angeles
Los Angeles, California
Objective: Measures designed to assess the quantity and quality of practices found across treatment programs for specific youth emotional or behavioral problems may be a good fit for evaluating treatment fidelity in effectiveness and implementation research. Treatment fidelity measures must demonstrate certain reliability and validity characteristics to realize this potential. This study examines the extent to which two observational measures, the Cognitive-Behavioral Treatment for Anxiety in Youth Adherence Scale (CBAY-A) and the CBAY-Competence Scale (CBAY-C), can assess the quantity (the degree to which prescribed therapeutic techniques are delivered as intended) or quality (the competence with which prescribed techniques are delivered) of practices found in two distinct treatment programs for youth anxiety.
Methods: Treatment sessions (N = 796) from 55 youth participants (M age = 9.89 years, SD = 1.71; 46.0% female; 55.0% White) with primary anxiety problems who participated in an effectiveness study were independently coded by raters who coded quantity, quality, and the youth-clinician alliance. Youth received one of three treatments: (a) Standard (i.e., cognitive behavioral therapy program); (b) Modular (i.e., a cognitive-behavioral and parent-training program); and (c) Usual Clinical Care.
Results: Interrater reliability scores for the CBAY-A items were good across the Standard (M ICC = .84) and Modular (M ICC = .71) conditions but received mixed results for the CBAY-C items (M Standard ICC = .71, M Modular ICC = .50). Across both conditions, the CBAY-A subscale scores demonstrated evidence of convergent and discriminant validity via associations with other instruments of treatment fidelity and an instrument of alliance, but the CBAY-C subscale scores showed mixed evidence.
Implications: The results provide preliminary evidence that the CBAY-A can be used to rate treatment fidelity across different treatment programs but raise concerns about the generalizability of the CBAY-C.
