When CRA is introduced there is a major challenge of ensuring that therapists are authentically delivering the program. Given the limitations of an one-time workshop with respect to the treatment integrity, many clinicians may inaccurately perceive, recall, or describe what they did. Therapists often drift from delivering the intended method and require redirection. If supervision occurs at all, it typically occurs subjectively. Nevertheless, it has been shown that supplying therapists with objective feedback about their patients' progress throughout therapy yielded twice the improvement rate of the patients of therapists who received no such feedback. Consequently, tape reviews and supervision booster sessions are highly recommended, as skill acquisition is a continuous process. The audio and video registration of sessions permits a supervisor to observe directly what is actually delivered during treatment. The identical learning principle that gave rise to CRA can also being used as the foundation of supervision. Systematic feedback, when combined and compared with behavioral goals, shape behaviors and enhances performance. It has been shown that therapists were highly responsive to reinforcement. Positive feedback within a supportive supervisory relationship is key in putting new evidence-based methods into practice. Recent research has shown that there is a clear relationship between treatment fidelity and reductions in substance use and related problems. The importance of measuring treatment fidelity is growing as the field moves towards the adoption of evidence based interventions, such as CRA. To obtain objective insight information of the traditional black-box of treatment gives us the unique opportunity to determine what actually promotes behavioral change. See also the comment of Tom Delaney, MSW, MPH The CRA intervention can be described as ‘procedure-based', meaning that the therapist decides which tools are appropriate to use within a session to promote treatment progression. Together with the patient the CRA-therapist selects the procedures based upon the material the patient brings up during a session. Therapists will be provided clinical supervision on regular base highlighting both the therapist's strengths in actually doing CRA and the areas needing further attention. To ensure the accuracy of CRA, supervisors will monitor the reliability of therapists by listening to session tapes and independently coding which procedures they heard the therapist provide. The supervision, contingent on every tape that's submitted, will be employed based on a pre-defined supervision checklist, and a written narrative describing. It must be noted that there is no exact number of tapes that needs to be turned in to be certified. Instead, we require demonstration of the mastery of specific CRA procedures. It is common for therapists to turn in tapes of therapy sessions that contain several of these procedures (i.e., you don't need a separate tape for each required procedure. Example: the Overview of CRA takes about 5 min, and thus may be easily be combined in sessions with other procedures). Please click on the following link to obtain a further in-depth document about tape and on-site supersion support (Dutch).
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CRA Supervision document (Dutch) |