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The Youth-Focused Cognitive and Behavioral Therapy Adherence Measure: A Multi-Informant, Transdiagnostic,
Evelyn Cho1,2,3, Jack H Andrews4, Rebecca Woo5,6
1Ballmer Institute for Children's Behavioral Health, University of Oregon, Portland, OR, USA. choe@uoregon.edu.
Administration and Policy in Mental Health
|August 14, 2025
Summary
A new measure, the Cognitive and Behavioral Therapy Adherence Measure (CBTAM), shows promise for tracking provider adherence to evidence-based practices (EBPs) in youth mental health. This tool may improve treatment delivery in real-world settings.
Area of Science:
- Psychology
- Clinical Psychology
- Child and Adolescent Psychiatry
Background:
- Adherence to evidence-based practices (EBPs) is crucial for optimal clinical outcomes but can be challenging in usual care (UC) settings.
- Developing practical tools to monitor EBP adherence is essential for improving delivery in community-based mental health services.
- The Cognitive and Behavioral Therapy Adherence Measure (CBTAM) was developed as a multi-informant tool to assess provider adherence to cognitive and behavioral therapy (CBT).
Purpose of the Study:
- To examine the psychometric properties of the CBTAM, a multi-informant measure of provider adherence to CBT for youth mental health conditions.
- To evaluate the convergent and discriminant validity of the CBTAM by comparing provider, caregiver, and youth ratings with observational coder ratings.
- To assess the potential of the CBTAM as a session-level adherence monitoring tool in usual care settings.
Main Methods:
- The CBTAM was administered by providers, caregivers, and youths after each treatment session for youth anxiety, depression, and behavior problems.
- A subset of treatment sessions was also rated by independent coders using the CBTAM and established observational systems for CBT adherence and therapeutic alliance.
- Psychometric properties, including range of ratings, concordance, convergent validity, and discriminant validity, were analyzed.
Main Results:
- Provider, caregiver, and youth CBTAM ratings covered a full range of adherence but were generally higher than coder ratings.
- Caregivers and youths showed concordance with coders on some items, while providers demonstrated higher concordance across most items.
- Provider CBTAM ratings correlated more strongly with similar observational measures (convergent validity) and less with dissimilar measures (discriminant validity), supporting its validity.
Conclusions:
- The provider version of the CBTAM shows initial support as a valid session-level measure of adherence to CBT for common youth mental health problems.
- The findings suggest that the CBTAM can be a useful tool for monitoring adherence in usual care settings.
- Further research is recommended to evaluate the CBTAM's reliability and clinical utility in diverse community settings.
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