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Treatment Fidelity of a Randomized Controlled Trial for Suicidal Risk

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Abstract

Treatment fidelity is a crucial consideration within randomized controlled trials (RCTs). The present study relies on data from a feasibility RCT conducted with 62 treatment-seeking suicidal college students. Issues of experimental fidelity were germane in this investigation because the same clinicians provided both the experimental (the Collaborative Assessment and Management of Suicidality—CAMS) and the control (treatment as usual—TAU) care. The first aim of the current study was to determine adherence to the CAMS model within the experimental (CAMS) and control (TAU) treatment conditions. A second exploratory aim was included to examine how treatment fidelity impacted treatment outcomes (i.e., depression, suicidal ideation, hopelessness, and potential treatment moderators). The CAMS Rating Scale (CRS.3-R) was used to determine treatment adherence to the CAMS model and to ensure between-group fidelity within the trial. The CRS.3-R was completed throughout the course of care based on reviews of a selected number of video recordings of both CAMS and TAU sessions to measure treatment fidelity. Mean CRS.3-R scores revealed differences across treatment conditions such that clinicians were successfully able to provide each treatment separately without contamination. Further, higher CRS.3-R scores in CAMS sessions resulted in decreased hopelessness over the treatment period. Higher CRS.3-R scores in TAU sessions resulted in an increased likelihood of suicidal ideation and less reduction in hopelessness over the treatment period. Overall, clinicians can serve as their own controls in a RCT and levels of adherence to the CAMS model have different effects on suicidal ideation and hopelessness.

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Acknowledgements

The research reported in the present study was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R34MH104714 (PI: J. Pistorello). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank the clinicians who participated in this study.

Funding

This study was funded by Foundation for the National Institutes of Health (R34MH104714).

Author information

Authors and Affiliations

  1. Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA

    Samantha A. Chalker

  2. Applied Statistics Program, Department of Mathematics, West Chester University, West Chester, PA, USA

    Robert Gallop

  3. Department of Psychology, The Catholic University of America, Washington, DC, USA

    David A. Jobes

  4. Harvard Medical School, McLean Hospital, Belmont, MA, USA

    Josephine S. Au

  5. Counseling Services, University of Nevada, Reno, NV, USA

    Jacqueline Pistorello

Authors
  1. Samantha A. Chalker
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  2. Robert Gallop
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  3. David A. Jobes
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  4. Josephine S. Au
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  5. Jacqueline Pistorello
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Correspondence to Samantha A. Chalker.

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Chalker, S.A., Gallop, R., Jobes, D.A. et al. Treatment Fidelity of a Randomized Controlled Trial for Suicidal Risk. J Contemp Psychother 52, 99–107 (2022). https://doi.org/10.1007/s10879-021-09528-1

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