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Therapist Adherence and Organizational Effects on Change in Youth Behavior Problems One Year After Multisystemic Therapy

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Abstract

The current study investigated the relations among therapist adherence to an evidence-based treatment for youth with serious antisocial behavior (i.e., Multisystemic Therapy), organizational climate and structure, and improvement in youth behavior problems one-year post treatment. Participants were 1979 youth and families treated by 429 therapists across 45 provider organizations in North America. Hierarchical Linear Modeling (HLM) results showed therapist adherence predicted improvement in youth behavior. Two structure variables and one climate variable predicted changes in youth behavior, and the climate variable also predicted therapist adherence. No statistical support for formal mediation of organizational effects through adherence was found, though examination of changes in parameter estimates suggest a possible interplay of organizational climate with adherence and youth behavior change.

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Notes

  1. Refer to Table 2 for estimated equations.

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Acknowledgements

Preparation of this manuscript was supported by grants DA018107 and K23DA015658 from the National Institute on Drug Abuse and grant MH59138 from the National Institute of Mental Health. The authors thank Amy Wahlquist for her assistance in the preparation of this manuscript. The authors are particularly grateful to Charles Glisson and Philip Green, Children’s Mental Health Services Research Center, University of Tennessee-Knoxville, for their generous consultation and examination of our organizational climate and structure data, and to Judith Singer of Harvard University and David Mackinnon of the University of Arizona for their consultation regarding the testing of mediation models using multi-level data.

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  1. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, P.O. Box 250861, 67 President Street, Ste MC 406, Charleston, SC, 29425, USA

    Sonja K. Schoenwald, Jason E. Chapman & Ashli J. Sheidow

  2. Department of Biometry, Medical University of South Carolina, Charleston, SC, USA

    Rickey E. Carter

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  1. Sonja K. Schoenwald
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Correspondence to Sonja K. Schoenwald.

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Dr. Schoenwald is a Board Member and stockholder in MST Services, LLC, which has the exclusive licensing agreement through MUSC for the dissemination of MST technology.

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Schoenwald, S.K., Carter, R.E., Chapman, J.E. et al. Therapist Adherence and Organizational Effects on Change in Youth Behavior Problems One Year After Multisystemic Therapy. Adm Policy Ment Health 35, 379–394 (2008). https://doi.org/10.1007/s10488-008-0181-z

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