08 December 2016
Therapistcompetence is an important component of treatment integrity. This paper reports on the development and initial psychometric assessment of the Cognitive-Behavioral Treatment for Anxiety in Youth Competence Scale (CBAY-C), an observational instrumentdesigned to capture therapist limited-domain competence (i.e., competence in the delivery of core interventions and delivery methods found in a specific psychosocialtreatment program) in the delivery of the core practice elements in individual cognitive-behavioral treatment (ICBT) for youth anxiety.
Treatment sessions (N = 744) from 68 youth participants (M age = 10.60 years, SD = 2.03; 82.3% Caucasian; 52.9% male) of the same ICBT program for youth anxiety from (a) an efficacy study and (b) an effectiveness study were independently scored by four coders using observational instruments designed to assess therapist competence, treatment adherence, treatment differentiation, alliance, and client involvement.
Inter-rater reliability (intraclass correlation coefficients, ICC(2,2)) for the item scores averaged 0.69 ( SD = 0.11). The CBAY-C item, scale, and subscale (Skills, Exposure) scores showed evidence of validity via associations with observational instruments of treatment adherence to ICBT for youth anxiety, theory-based domains (CBT, psychodynamic, family, client-centered), alliance, and client involvement. Importantly, although the CBAY-Cscale, subscale, and item scores did overlap with a corresponding observational treatment adherence instrument independently rated by coders,the degree of overlap was moderate, indicating that theCBAY-C assessesa distinct component of treatment integrity.