Investigating Adherence Promoters in Evidence-Based Mental Health Interventions with Children and Adolescents

Abstract

The effectiveness of Evidence-Based Practice (EBP) interventions in child and adolescent mental health is undermined by poor client adherence to treatment protocols. To counter this trend, adherence promoters, supplemental interventions to facilitate client adherence to treatment protocols, have evolved to increase adherence. This study investigates patterns of adherence promoting interventions employed in conjunction with RCT of interventions for child and adolescent mental health problems. An 85 question survey on adherence promoters was sent to 85 researchers who published randomized controlled trials on three psychosocial interventions (Cognitive Behavioral Therapies (CBT), Interpersonal Therapy (IPT), and Psychoeducational (PE)) in the area of child and adolescent mental health, between January 2000 and March 31, 2008. Forty-six (54%) researchers completed the survey. Most researchers reported using multiple adherence promoting interventions throughout the duration of their studies. The intensity of adherence promoting efforts was increased for interventions targeting disruptive behavior disorders and for family based interventions. On average, respondents reported using little more than one promoter per session and devoting approximately 12 min per session on all adherence promoters. Clinical researchers expend considerable resources in active efforts to promote adherence to treatment among research participants. Findings of this study support best practice literature on adherence promotion and open new avenues for research into the adherence to evidence-based interventions for child and adolescent mental health problems.

Adolescent adherence to psychosocial treatment: Mental health clinicians' perspectives on barriers and promoters

“…In addition, research has begun to investigate specific adherence strategies employed by clinicians to maintain psychosocial adherence. A recent study found clinicians provided three broad categories of adherence promoters, specifically outreach adherence promoters (i.e., phone calls, letters), concrete adherence promoters (i.e., travel support, childcare), and motivational adherence promoters (i.e., incentives) (Gearing, Schwalbe, Dweck, & Berkowitz, 2011). However, the clinicians' perspectives on adolescent psychosocial treatment adherence remains underinvestigated (Pekarik & Finney-Owen, 1987;Pulford, Adams, & Sheridan, 2008).…”

The moderating effect of adherence‐promoting interventions with clients on evidence‐based practices for children and adolescents with mental health problems.

“…Across the general health care sector, adherence promoters have been developed to overcome adherence barriers. In general, adherence promotion strategies may fall into one of the three following categories: outreach, concrete, and motivational enhancement (Gearing et al., in press). Outreach promoters are contacts that take place outside of formal intervention sessions (Grote, Zuckoff, Swartz, Bledsoe, & Geibel, 2007; Kazdin, Holland, & Crowley, 1997; Shivack & Sullivan, 1989).…”

“…Adherence has long been recognized as an essential ingredient for intervention success (Nock & Ferriter, 2005), and adherence‐promoting interventions have been developed to support client adherence (Gearing, Schwalbe, Dweck, & Berkowitz, in press). Adherence promoter strategies include between‐session communication contacts (e.g., telephone calls, letters, and texting), motivational enhancement therapies (e.g., pretreatment motivational interviewing), ongoing therapeutic processes (e.g., problem solving, direct encouragement), and concrete strategies (e.g., parking, child care, and food), among others.…”

Using mobile health technology to improve behavioral skill implementation through homework in evidence-based parenting intervention for disruptive behavior disorders in youth: study protocol for intervention development and evaluation

“…Data from surveys of treatment providers, evidence-based treatment developers, and randomized clinical trials offer limited but useful information regarding the homework implementation process within the context of evidence-based treatments, including skill-based parenting interventions, and suggest that despite the common use of homework in evidence-based treatments for youth and families, the process of designing homework tasks is rarely theory-driven or investigated [25–28]. Methods to support homework implementation must attend to designing, assigning, and reviewing homework within-session to support successful implementation of homework between-sessions (do process).…”