(PS5-C53) Effects of Consultation on Measurement-based Care Fidelity for Clinicians Delivering Measurement-based Care Only and with Cognitive Behavioral Therapy

Measurement-based care (MBC), the process of regularly administering outcome measures to clients to inform clinical decision making, improves youth mental health. MBC can be delivered in conjunction with other evidence-based treatments (EBTs), including Cognitive Behavioral Therapy (CBT). However, few studies have compared implementation of MBC only and MBC + CBT. Training and consultation are widely used implementation strategies to increase the fidelity of EBT delivery but have rarely been studied with clinicians learning MBC or multiple EBTs. It is important to understand the process of multiple EBT implementation as it may be more pragmatic for organizations. The current study will examine the relationship between the amount of time each client case was discussed in consultation on MBC fidelity among clinicians delivering MBC alone and MBC + CBT. Participants included 53 clinicians and 115 youth in the MBC only and MBC + CBT conditions of a randomized controlled community effectiveness trial. Clinicians represented 14 community mental health agencies in Florida and Connecticut. Clients and clinicians reported demographic and background information before beginning treatment. Time spent discussing a case in consultation was extracted from detailed consultation call notes. Separate consultation calls were held for each condition. MBC fidelity was measured using the Implementation Index, which combines the rates of measure administration and feedback report viewing using objective data from the online MBC system. Multi-level modeling was used, controlling for study site and condition. The average MBC fidelity was 56.75% (SD = 30.36) and was significantly higher in the MBC only condition (ß = -18.18, SE= 6.90 t(43.86) = -2.64, p = 0.012). Cases were discussed for an average of 119.44 minutes (SD = 79.14) during the consultation period, and there was significantly higher minutes of case discussion in the MBC + CBT condition (ß = 54.19, SE = 14.84, t(33.14) = 3.70, p < .001). The effect of consultation on MBC fidelity was moderated by the treatment condition. Greater minutes of case discussion significantly predicted higher MBC fidelity in the MBC only condition (b = 0.24, SE = 0.06, p < .001). However, greater minutes of case discussion did not significantly predict MBC fidelity in the MBC + CBT condition (b = 0.002, SE = 0.04 p = .956). The results of this study suggest there are differential effects of consultation based on the context of the treatment(s) the clinician is implementing. While more discussion of cases in the MBC only condition predicted increased MBC fidelity, greater discussion of cases for clinicians delivering both MBC and CBT was not predictive of greater MBC fidelity. It is hypothesized that learning CBT took priority over learning MBC during consultation. There may be utility to staggered implementation of EBTs, such that clinicians would only learn one EBT at a time. In situations where staggered implementation is not possible, additional implementation supports may be necessary. This study suggests that just increased time discussing cases in consultation in the MBC + CBT condition was not sufficient to meet the higher demands on clinicians simultaneously learning multiple EBTs.