Aurelie Lange

130 | Chapter 7 Summary of the Main Findings The aim of this dissertation was twofold. The first aim was to evaluate some of the factors that may affect the assessment of therapist adherence when disseminating evidence-based interventions. Using the Therapist Adherence Measure-Revised (TAM-R) as an example, we set out to investigate how the Dutch TAM-R related to the US original and how adherence scores may be affected by the level of experience that therapists, teams, or countries have with the treatment model. The second aim was to assess the unique and joint role of adherence and alliance within system therapy. Little is known on how adherence to the specific evidence-based elements of interventions relates to common factors such as alliance, nor on how they jointly or individually affect treatment outcome. This dissertation set out to investigate this topic within the context of Multisystemic Therapy. This chapter provides a summary of the main findings, followed by reflections on these findings, strengths and limitations, directions for future research, and recommendations for health policy and clinical practice. Aim I. Factors affecting reliable assessment of therapist adherence after cross-national dissemination 1. Is the Dutch TAM-R equivalent to the original US version? The TAM-R (Henggeler, Borduin, Schoenwald, Huey, & Chapman, 2006) measures adherence to Multisystemic Therapy (MST), an evidence-based, intensive home- and community-based intervention for 12-18 years old adolescents with antisocial and/or delinquent behavioral problems (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009). The TAM-R is one of the few adherence measures which is known to predict post-treatment outcomes, and to be reliable and valid (e.g., Henggeler, Halliday-Boykins et al., 2006; Schoenwald, Carter, Chapman, & Sheidow, 2008). Nevertheless, marked differences were observed between its functioning in the United States (US), where MST was originally developed, and in Europe. This led clinicians and scholars to question its reliability and validity after dissemination of MST and the TAM-R to European countries. Therefore, the first research question investigated how the Dutch TAM-R relates to the original US version using 1875 Dutch TAM-R reports and the response category frequency distributions of 1875 US TAM-R reports. Chapter 2 showed some significant differences between the Dutch TAM-R and the original US TAM-R. In the first place, differences were observed regarding the level of difficulty of some of the items. This means that some Dutch items were very ‘easy’ to score (most Dutch therapists had a high score on these items), whereas high scores on the same items proved very difficult to achieve in the US (few US therapists had a high score on them). For scores on other items, it was just the other way around, being hard to achieve in