Development and Initial Validation of a Client-Rated MET-CBT Adherence Measure

Area of Science:

• Addiction treatment research
• Psychotherapy fidelity assessment
• Behavioral health quality improvement

Background:

• Traditional methods for assessing treatment adherence and fidelity are often resource-intensive and time-consuming.
• Accurate measurement of adherence to therapies like Motivational Enhancement Therapy-Cognitive Behavioral Treatment (MET-CBT) is crucial for quality assurance and treatment effectiveness.

Purpose of the Study:

• To develop and validate a tool for rating adherence to MET-CBT using anonymous client surveys.
• To assess the feasibility and psychometric properties of client-reported adherence measures.

Main Methods:

• An instrument was developed to capture client perceptions of adherence to MET-CBT.
• The tool was administered to clients across three methadone programs over two assessment waves.
• Explanatory and Confirmatory Factor Analyses were employed to establish construct validity, and Cronbach's alpha was used to assess internal consistency.

Main Results:

• The client survey demonstrated adequate internal consistency (Cronbach's alpha > 0.70) for most subscales.
• Interrater reliability, indicated by r(wg(j)) scores, ranged from 0.6 upwards, suggesting moderate to strong agreement among clients rating the same counselor.
• Factor analyses supported the construct validity of the MET and CBT components of the treatment.

Conclusions:

• Anonymous client surveys represent a viable, objective, and less resource-intensive alternative to counselor self-reports or supervisor reviews for monitoring MET-CBT adherence.
• This client-centered approach can enhance quality monitoring in addiction treatment programs.
• Further research and scale refinement are recommended to optimize this measurement tool.