School Psychology Review,
2009, Volume 38, No. 4, pp. 541–546
Conceptual and Methodological Issues in Treatment
Bryce D. McLeod and Michael A. Southam-Gerow
Virginia Commonwealth University
John R. Weisz
Harvard University and Judge Baker Children’s Center
This special series focused on treatment dan and colleagues are to be commended for
integrity in the child mental health and education focusing so clearly on psychometrics and em-
ﬁeld is timely. The articles do a laudable job of phasizing the importance of making this a cen-
reviewing (a) the current status of treatment in- tral issue for future research efforts. Their work
tegrity research and measurement, (b) existing also highlights two other important issues in
conceptual models of treatment integrity, and (c) measuring treatment integrity: (a) use of multi-
the limitations of prior research. The multidi- ple methods and (b) the cost of measurement.
mensional model described by Schulte, Eaton, We return to these issues shortly.
and Parker (2009) provides an incisive summary The article by McKenna, Rosenﬁeld,
of current conceptual work. Thus, important and Gravois (2009), which describes another
conceptual ground is covered in the series, and strong psychometric study, evaluates the psy-
the articles are likely to serve as an important chometric properties of a measure designed to
starting point for future work in the area. assess adherence to a consultation model; this
The empirical studies in the series raise a is a level of abstraction higher than one typi-
host of signiﬁcant issues relevant to the ﬁeld. cally sees in integrity research. Their work is
First, the work of Sheridan, Swanger-Gagne, ´ akin to that of Henggeler, Schoenwald, Liao,
Welch, Kwon, and Garbacz (2009) emphasizes Letourneau, and Edwards (2002), who have
the critical importance of establishing psycho- demonstrated the relevance of adherence at the
metric properties for integrity measures. Sheri- therapist and supervisor levels in their work
Preparation of this article was supported in part by grants from the National Institute of Mental Health (K23
MH69421, Southam-Gerow; R01 MH68806, Weisz) the John D. and Catherine T. MacArthur Foundation
(Weisz), and the Norlien Foundation (Weisz).
Correspondence regarding this article should be addressed to Bryce D. McLeod, Department of Psychol-
ogy, Virginia Commonwealth University, 806 W. Franklin Street, P. O. Box 842018, Richmond, VA
23284-2018; E-mail: email@example.com
Copyright 2009 by the National Association of School Psychologists, ISSN 0279-6015, which has
nonexclusive ownership in accordance with Division G, Title II, Section 518 of P.L. Law 110-161 and NIH
Public Access Policy
School Psychology Review, 2009, Volume 38, No. 4
with multisystemic therapy. Assessing adher- technical and relational elements of treatment.
ence to a consultation model is key to research Each component captures a unique aspect of
on the dissemination of interventions, because treatment integrity that together, and/or in isola-
consultation is central to the dissemination tion, is hypothesized to be responsible for ther-
process for many interventions. apeutic change (Perepletchikova et al., 2007).
Finally, the paper by Ransford, Green- These three components overlap with the four
berg, Domitrovich, Small, and Jacobson dimensions described by Sanetti and Kratoch-
(2009) nicely illustrates an emerging line of will (2009)— content (i.e., adherence, differenti-
work that is expanding the research applica- ation), quality (competence), quantity (adher-
tions of integrity measurement. Ransford and ence), and process (competence)—and are sim-
colleagues demonstrate that characteristics of ilar to the dimensions described by Schulte et al.
the provider may moderate the quality and (2009).
dosage of treatment implementation. Few Despite the importance of each integrity
studies have evaluated how provider, client, or