I have a background in psychology (BSc Psychology, MSc Health Psychology) with over seven years of experience of working in mental health. I have a particular interest in addiction research. I am a researcher at the Leeds Addiction Unit and an Honorary Tutor at the University of Leeds for the DipHE and BHSc in Addiction Studies. I have contributed to the Addiction Research in Acute Settings (ARiAS) research programme, funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC). The programme investigated methods of improving the physical and mental health of people with alcohol and/or illicit drug problems who are identified within an acute hospital setting. I have gained considerable experience in measuring treatment fidelity by process rating the delivery of psychosocial treatments in clinical trials and research projects. This experience led to my applying for a SSA PhD studentship to develop further the Addiction Therapist Rating Scale (ATRS).
PhD project aims
The ATRS project aims to develop and evaluate a scale for treatment fidelity in routine practice. Methods of evaluating practice in the addiction field have typically been designed to measure treatment fidelity in research trials (e.g. Carroll et al. 2000, Moyers et al. 2005, & Martino et al. 2008). Such scales determine the extent to which treatments are delivered according to the research protocol or manual and are important for supporting claims of treatment effectiveness. There is a need for treatments shown to be effective in research trials to be delivered with fidelity in routine practice. Guiding successful implementation requires a measure to monitor delivery in routine practice (Schoenwald & Garland 2013); there is no established scale for rating treatment fidelity in routine practice. The ATRS project aims to address this by providing a validated scale that applies to evidence based cognitive behavioural and network therapies for alcohol and drug use problems.
Background literature/previous work
The ATRS project builds on previous work at the Leeds Addiction Unit. In particular it will draw on the validated UKATT Process Rating Scale (PRS). The UKATT PRS was designed to detect the delivery of interventions used in the UK Alcohol Treatment Trial, and to rate frequency and quality of delivery of treatment components (Tober et al. 2008). The scale was adapted for use in measuring delivery of treatment as usual (Raistrick et al. 2010) and two brief interventions in the ADAPTA study (Watson et al. 2013a). The ATRS project seeks to develop a psychometrically sound treatment fidelity rating scale for use in routine practice.
Work plan and timeline
The ATRS project comprises of three studies: Study 1 will develop the scale – item selection will be informed by a review of the literature on existing measures of treatment delivery and the components of effective treatment for alcohol and drug use problems. Study 2 will validate the scale by investigating its psychometric properties. Study 3 will explore implementation of the ATRS in routine practice; this will be divided into two stages: Stage 1 will pilot the scale with a clinical team at a specialist addiction unit, and Stage 2 will implement the scale in other addiction services.
Raistrick, D., Tober, G., Sweetman, J., Unsworth, S., Crosby, H., & Evans, T. 2014. Measuring clinically significant outcomes – LDQ, CORE-10, and SSQ as dimension measures of addiction. The Psychiatrist, 38, 112-115.
Sweetman, J., Raistrick, D., Mdege, N. & Crosby, H. 2013. A systematic review of substance misuse assessment packages. Drug and Alcohol Review, 32(4), 347-355.
Tober, G., Raistrick, D., Crosby, H.F., Sweetman, J., Unsworth, S., Suna, L. & Copello, A. 2013. Co-producing addiction aftercare. Drugs and Alcohol Today, 13(4), 225-233.
Thurgood, S., Crosby, H.F., Raistrick, D., & Tober, G. 2014. Service user, family and friends’ views on the meaning of a ‘good outcome’ of treatment for an addiction problem. Drugs: Education, Prevention & Policy, 21(4), 324-332.
Watson, J.M., Crosby, H., Dale, V.M., Tober, G., Wu, Q., Lang, J. & McGovern, R. Newbury-Birch, D., Parrott, S. Bland, J.M., Drummond, C., Godfrey, C., Kaner, E. & Coulton S. on behalf of the AESOPS trial team. 2013. AESOPS: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care. Health Technology Assessment, 17(25).
Watson, J., Tober, G., Raistrick, D., Mdege, N., Dale, V., Crosby, H., Godfrey, C., Lloyd, C., Toner, P., & Parrott, S. on behalf of the ARiAS Research Group, NIHR CLAHRC for Leeds, York and Bradford. 2013. An alcohol-focused intervention versus a healthy living intervention for problem drinkers identified in a general hospital setting (ADAPTA): study protocol for a randomized, controlled pilot trial. Trials, 14(117).
Relevance of your work for the field
The ATRS will provide a useful tool for training and supervision, and will have the potential to impact on therapists’ competence and patient outcomes. Planned applications include:
Use in routine clinical supervision to inform feedback on clinical skills and protocol adherence.
Use in evaluating the training of addiction therapists. The tool will be used to assess the delivery of cognitive behavioural and network treatments for alcohol and illicit drug use problems.
Fidelity rating in research projects. The ATRS will provide a valid and reliable measure for monitoring fidelity in research trials that compare addiction interventions delivered in community settings. This will provide an indirect means of disseminating the scale and support implementation of evidence based treatments into routine practice (Baer et al. 2007).
A tool that will be offered to the Skills Consortium to provide a platform for disseminating good practice widely across the addiction field.
The SSA funding has enabled extended supervision of the project and exacting timescales as well as the opportunity to work towards a PhD qualification.