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.

Appendix

Survey of Adherence Promoting Interventions*: Sub-sample on Telephone Promoters

Concrete Adherence Promoting Interventions

The next series of questions asks if you have used any of the following concrete strategies to increase adherence:

• □ Telephone reminders

• □ Mailed reminders

• □ Technology-assisted correspondence

• □ Increasing convenience

• □ Reinforcement/incentives

• □ Other

When you answer “yes,” you will be directed to a set of questions to elaborate on the strategies

Telephone Reminders

• 1. Did your study protocols include telephone reminders?

• □ Yes

• □ No

• 2. Who was the intended recipient of the phone call?

• □ Child/adolescent

• □ Parent or caregiver of the child/adolescent

• □ Both parent or caregiver and child/adolescent

• □ Other (please specify) ___________________

• 3. How often were telephone reminders provided

• □ 100% of session

• □ More than 50% of all sessions

• □ 50% of all sessions

• □ Less than 50% of all sessions

• □ For the first session only

• □ As needed

• 4. How much staff time was devoted for each telephone reminder?

• □ 5 min or less

• □ 10 min or less

• □ 20 min or less

• □ More than 20 min

• 5. What were the qualifications of the person implementing the

• □ High school or equivalent

• □ Undergraduate research assistant or equivalent

• □ Graduate research assistant or equivalent

• □ Post graduate clinical/research staff

• 6. Estimate the approximate number of hours of pre-treatment training (i.e. initial) provided to conduct telephone reminders?

• □ None

• □ 1 h or less

• □ 4 h or less

• □ 8 h or less

• □ 16 h or less

• □ More than 16 h

• 7. How frequently was training/supervision to conduct telephone reminders provided during the course of the mental health treatment?

• □ Once (or more) weekly

• □ Twice monthly

• □ Once monthly

• □ Less than once monthly

• □ None

* The full questionnaire is available by contacting the authors.