Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Bryce D. McLeod, Ph.D.

Second Advisor

Michael A. Southam-Gerow, Ph.D.

Third Advisor

Terri N. Sullivan, Ph.D.

Fourth Advisor

Jason C. Chow, Ph.D.

Fifth Advisor

Bruce D. Rybarczyk, Ph.D.


Objective: The relation between treatment integrity and youth client outcomes in psychosocial treatment research has implications for therapist training, study design, and study interpretation. Despite work done in this area, this relation remains unclear. The aim of the current study was to meta-analyze and describe characteristics of investigations of integrity and outcome in youth.

Method and Analytic Plan: A total of N = 30 studies were identified. Conceptual and methodological factors were coded. Pearson’s r represented the magnitude of the integrity-outcome correlation. Robust variance estimation was used to account for dependency of within-study effect sizes. Two models were run with identical methods, Model 1 did not impute/estimate effect sizes and Model 2 imputed/estimated missing effect sizes. Each model was built iteratively, including an unconditional model and moderator model. Tests of heterogeneity, publication bias, and sensitivity analyses were conducted.

Results: The mean integrity-outcome effect size in Model 1 and Model 2 were negative and statistically significant (r = -.11, p < .0001; r = -.09, p < .0001, respectively). Treatment integrity component and quality of treatment integrity procedures did not moderate the integrity-outcome correlation. Publication bias revealed some trim-and-fill analyses, indicating the possibility of publication bias. Outliers did not play a role in study findings.

Discussion: There appears to be a small correlation between treatment integrity and outcome. A small sample and inconsistent reporting practices made additional moderation analyses inadvisable. Potential explanations for findings were explored. Recommendations are provided, including consistent reporting standards and sophisticated research paradigms for therapy process research.


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