Flexibility within Fidelity: Implementing empiricallybased practices with children and adolescents

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Flexibility within FidelityImplementing
empirically-based practices with children and
adolescents

• Philip C. Kendall, Ph.D., ABPP
• Laura H. Carnell Professor of Psychology
• Temple University
• APA, August, 2006

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Empirically-Based and Empirically-Supported
Treatments

• What are empirically-based treatments?
• What are empirically-supported treatments?
• What are the criteria that were applied when
  selecting empirically-supported treatments?
• What would we do/use if we rejected these
  criteria? Keep this question in mind.

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Empirically-Based Treatments

• For depressed youth
• For ADHD
• For conduct problem youth
• For anxiety disordered youth

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Empirically-Supported Treatments

• For depressed youth
• For ADHD
• For conduct problem youth
• For anger management
• For anxiety disorders in youth

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Sources Journals and chapters

• Journal of Consulting and Clinical Psychology,
  66, 1998. Special Issue (February).
• Journal of Clinical Child Psychology, 27, 1998
  Special Issue.
• Ollendick T., King, N., Chorpita (2006).
  Empirically supported treatments for children and
  adolescents. In P. C. Kendall (Ed.) Child and
  adolescent therapy (3rd ed.). New York Guilford
  Press.

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Sources Books

• Kazdin, A. Weisz, J. (Eds.) (2003).
  Evidence-based psychotherapies for children and
  adolescents. New York Guilford Press.
• Hibbs, E.D., Jensen, P S. (Eds.) (2005).
  Psychosocial treatments for child and adolescent
  disorders Empirically based strategies for
  clinical practice (2nd ed.). Washington DC APA.

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What is treatment fidelity?

• The treatment as written was the treatment that
  was provided
• Features of the target treatment (as written and
  provided) did not bleed over into a comparison
  treatment
• Treatment fidelity in not treatment quality
  Treatment quality refers to an expert judgment

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Implementing ESTs

• Empirically-supported treatments typically
  incorporate empirically-based strategies and have
  available (and follow) therapist manuals.
• What is it like implementing a manual for
  treatment?

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Manual-based treatmentsWhat do the critics and
advocates say?

• CRITICS
• Steadfast and linear
• Cookbooks
• Prevent creativity
• Lack individuality
• Do not match real client presentations

• ADVOCATES
• Manuals require clinical skill
• Facilitate training
• Necessary for evaluation
• CAN be done flexibly

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Flexibility within FidelityThe case of treating
anxious youth

• 16 sessions psychoeducation and exposure tasks
• www.WorkbookPublishing.com
• www.childanxiety.org
• The FEAR plan
• Exposure tasks
• Rewards
• Parental participation
• Celebrating success (e.g. certificate, commercial)

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Easing transportability Studying the process of
an EST

• Child involvement
• (Chu Kendall, 2004 Braswell, Kendall,
  Braith, Carey, Vye, 1985)
• Therapist relationship building strategies
• (Creed Kendall, 2005)
• Therapist flexibility
• (Kendall Chu, 2000)
• Timing and interaction of these processes?
  (Kendall, Hudson, Gosch, Chu, in progress)

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Easing transportability Flexibility within
fidelity

• Highly creative, not rule bound, within a
  proscribed approach
• Tailored to the individual, within the target
  goal
• Sensitive to child/parent factors
• Capable of being evaluated scientifically

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Easing transportability Next steps?

• We now face the challenge of providing
  evidence-based explanations for change.
• Examine mediators (Treadwell Kendall, 1996
  Kendall Treadwell, 2005)
• Lets face it, Kiesler (1966 1971) was at least
  partially right. Theres no one treatment that is
  effective for everyone.
• We need to continue to address the question What
  therapeutic approaches are effective with which
  types of clients in producing which kinds of
  change? and to disseminate the findings.
• Goin' fishing and showing slides

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Empirically-based and empirically-supported
treatments

• Flexibility within treatment fidelity
• What else would we do?