Investigating adherence promoters in evidence-based mental health interventions with children and adolescents

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.