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The Swedish Implementation of Multisystemic Therapy for Adolescents: Does Treatment Experience Predict Treatment Adherence?

Journal of Clinical Child & Adolescent Psychology
Treatment effects may not be observed if an empirically supported intervention is not
administered with treatment adherence. This retrospective study investigated how
therapists’ adherence to Multisystemic therapy (MST) varied during a 6-year period
in Sweden. Adherence was measured using the Therapist Adherence Measure, which
was provided by caregivers. The associations between treatment adherence and
therapist-reported posttreatment youth outcomes were also assessed. Retrospective
adherence data were obtained for 973 families with youths between 12 and 17 years
old who received MST from 68 therapists divided into 10 teams. Implementation of
MST occurred in 2 waves between March 2003 and August 2009. Multilevel structural
equation modelling was used to evaluate family- and cohort-level predictors and outcomes
of treatment adherence. The results confirm previous research: Treatment adherence
predicts MST treatment outcomes. With respect to the relationship between MST
treatment experience and MST treatment adherence, the analysis showed mixed results.
An increase in years that a team had been active predicted an increase in therapist
adherence to MST. Therapists from the 2nd implementation wave had higher therapist
adherence rates than therapists from the 1st implementation wave. Nevertheless, a
therapists’ experience with MST did not predict MST treatment adherence. The results
suggest that the found links among treatment experience, treatment adherence, and
treatment outcomes provide support for the hypothesis that the collective experience
of the team members promotes treatment adherence. However, results are mixed and
further research is needed.