# Fidelity Training and Feedback System for Adolescent Externalizing Problems

> **NIH NIH R34** · PARTNERSHIP TO END ADDICTION · 2020 · $256,526

## Abstract

This R34 study will advance the science of mental health services for adolescent externalizing problems
(AEPs) by developing therapist training procedures to increase fidelity to evidence-based interventions (EBIs)
in usual care. Two widely endorsed approaches are consistently effective for treating AEPs: family therapy and
CBT. Importantly, stronger fidelity to core EBIs of these approaches predicts better outcomes in research and
community settings. Yet these EBIs are not widely implemented with fidelity. To help close this quality gap in
adolescent services, we will develop an online intervention to strengthen fidelity to these EBIs in routine care:
Fidelity Training and Feedback System (FTFS). FTFS will target two essential aspects of EBI fidelity: Training
components will seek to improve EBI self-monitoring, and a Feedback component will seek to increase EBI
utilization. In keeping with NIMH’s Experimental Therapeutics paradigm, this study will examine whether an
Intervention (FTFS) has direct impact on its immediate Targets (EBI self-monitoring and utilization); If
promising, future R01 studies will examine links among Intervention, Targets, and ultimate Outcomes (AEPs).
The FTFS package will be an online quality assurance system completed by therapists and supervisors that
can be readily sustained in usual care. Two weekly Training components will adapt gold-standard
observational fidelity coding procedures to promote improved self-monitoring of the targeted EBIs, and a
monthly Feedback component will adapt a measurement feedback system to promote increased utilization of
these EBIs in everyday practice. To maximize provider investment, sites will delineate their own fidelity
standards for family therapy and CBT and help design their own feedback report templates. The proposed
study will be among the first to (1) test whether training therapists in observational assessment of EBI fidelity
increases the accuracy with which they self-monitor use of those EBIs and (2) adapt measurement feedback
procedures to track and improve therapist utilization of EBIs. To achieve study aims we will first partner with
two community clinics to develop sustainable FTFS procedures using a three-phase Pilot process. We will then
initiate an experimental Trial during which therapists (n = 32, treating 192 clients) at four different clinics will be
randomized to FTFS versus no-intervention Control. In both conditions we will collect three kinds of data:
therapist-report checklists on use of core family therapy and CBT techniques with adolescent cases, treatment
session audiorecordings, and recordings of supervision meetings. FTFS uptake will be tracked electronically
for online components and via observer ratings of supervision meetings (Aim 1: FTFS feasibility). Session
recordings will be coded by observers for three facets of EBI fidelity: adherence (extent of EBI utilization),
working alliance, and therapist competence. Observer ratings will measure the stren...

## Key facts

- **NIH application ID:** 9988504
- **Project number:** 5R34MH117212-03
- **Recipient organization:** PARTNERSHIP TO END ADDICTION
- **Principal Investigator:** Aaron Hogue
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $256,526
- **Award type:** 5
- **Project period:** 2018-09-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9988504

## Citation

> US National Institutes of Health, RePORTER application 9988504, Fidelity Training and Feedback System for Adolescent Externalizing Problems (5R34MH117212-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9988504. Licensed CC0.

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