Emergent Life Events During Youth Evidence-Based Treatment: Impact on Future Provider Adherence and Clinical Progress

摘要

Emergent life events (ELEs)-unexpected stressors disclosed in psychotherapy that have a significant negative impact on the client-commonly occur in community populations of youth and are associated with decreased provider adherence to evidence-based treatment (EBT) in session. The present study extends previous research by examining longer term associations of ELEs with (a) provider adherence to planned EBT practices in subsequent sessions and (b) clinical progress. Data were drawn from the modular EBT condition (MATCH) of the Child STEPs California trial conducted with primarily Latino youth, ages 5-15, who were 54% male (Chorpita et al., 2017). Study 1 utilized data from 57 MATCH participants who reported at least one ELE during treatment. Provider adherence was measured by identifying whether planned practices were covered in either the session in which the ELE was reported or the following session using the MATCH Consultation Record. In Study 2, clinical progress for 78 MATCH participants was assessed using weekly youth- and caregiver-ratings of symptomatology (Brief Problem Checklist) and functioning (Top Problems Assessment). Study 1 revealed that ELEs were associated with reduced adherence to planned practices for at least two sessions. Study 2 demonstrated that each disruptive ELE (i.e., an ELE for which no EBT content was covered) was associated with a 14%-20% slower rate of clinical improvement, with greater declines for functioning and externalizing symptoms. Findings suggest that ELEs can be a major barrier to the effectiveness of an EBT and require further research in order to be addressed effectively.