(PS5-A16) Does Provider Extensiveness in Covering Modules Predict Youth Outcomes? A Look at a Brief Tier 3 Skills-based Intervention for Internalizing Symptoms

Background: There is ample empirical support for the association between treatment fidelity and effectiveness. Fidelity in the treatment literature includes three components: adherence, or the degree to which the provider utilizes prescribed procedures, differentiation, or the degree to which the treatment provided is sufficiently distinct from others, and competence, or the level of the provider's skill and judgment in applying the treatment procedures (Perepletchikova et al., 2007). One element of treatment delivery that the current definition of fidelity does not encompass is the question of how and to what extent the treatment content is covered during sessions. Though delivery extensiveness may be an integral part of provider competence or an important corollary to treatment fidelity, its impact on intervention effectiveness is yet unknown.

Method: The present study was an examination of Show Me FIRST, a brief six-module intervention with common therapy elements that have research support for youth depression, anxiety, and disruptive behavior problems. We conducted a randomized trial to compare the Show Me FIRST intervention against school-based usual care plus waitlist in 69 middle schoolers with elevated internalizing symptoms. Forty-five youth were initially assigned to receive Show Me FIRST, while an additional 22 youth from the usual care group also received Show Me FIRST after the initial comparison. At each Show Me FIRST session, providers completed an adapted version of the Universal Fidelity Tool (UFIT-A), which included an adherence checklist and a self-report measure of the provider’s extensiveness in delivering each Show Me FIRST module. Providers rated their use of the following five strategies on a 0-4 scale: explicit teaching of the skill, modeling of the skill, role-playing the skill, giving feedback to youth on their use of the skill, and setting goals/assigning homework on use of the skill. Data were collected on the youth’s levels of depression and anxiety pre- and post-treatment using the Revised Children's Anxiety and Depression Scale (RCADS) and the Patient Health Questionnaire (PHQ-8), both completed by youth.

Result: We will present descriptive results on the extensiveness data collected from the UFIT-A. We will look at the frequency with which each of the five delivery strategies were used, as well as the extensiveness with which the six modules were delivered. We will also use a linear regression model to examine whether providers’ overall extensiveness ratings in delivering the intervention modules significantly predict treatment outcomes among participating youth.

Conclusion: Looking at the intervention delivery strategies and extensiveness may be worthwhile, especially with brief, skills-based psychosocial curricula that require intervention content be delivered as efficiently as possible. Study limitations include a lack of long-term follow-up, a lack of reliable information on specialty mental health services participating youth may have received outside of the trial, and variability in data collection and participant attrition due to the COVID-19 pandemic.