OBJECTIVE This study estimated the size of therapist effects (TEs) for dropout and clinical effectiveness of two trauma-focused psychotherapies (TFPs) and evaluated whether therapy delivery and clinic organizational factors explained observed TEs. METHOD Participants were 180 therapists (54.4% psychologists, 42.2% social workers) from 137 Veterans Health Administration facilities and 1,735 patients (24.7% women; 27.2% people of color) who completed at least two TFP sessions. Outcomes were dropout (< 8 TFP sessions) and for a subsample (n = 1,273), clinically meaningful improvement and recovery based on posttraumatic stress disorder checklist for DSM-5 (PCL-5) scores. Therapist-level predictors were ascertained through survey, manual chart review, and administrative data. Multilevel models estimated TEs. RESULTS Over half (51.2%) of patients dropped out and those who dropped out were less likely to meet criteria for clinically meaningful improvement or recovery (ps < .001). Adjusting for case-mix and TFP type, therapists accounted for 5.812% (p < .001) of the unexplained variance in dropout. The average dropout rate for the 45 therapists in the top performing quartile was 27.0%, while the average dropout rate for the 45 therapists in the bottom performing quartile was 78.8%. Variation between therapists was reduced to 2.031% (p = .140) when therapists' mean of days between sessions, adherence, implementation climate, and caseload were added to multilevel models. TEs were nonsignificant for clinically meaningful improvement and recovery. CONCLUSIONS Interventions targeting therapy delivery and clinic organization have the potential to reduce variation between therapists in TFP dropout, so that more patients stay engaged long enough to experience clinical benefit. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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治疗实施和诊所组织因素在解释退伍军人健康管理局针对创伤的心理治疗的治疗师效果方面的作用。

目的 本研究估计了两种针对创伤的心理治疗 (TFP) 的退出治疗师效应 (TE) 的大小和临床有效性，并评估了治疗实施和临床组织因素是否解释了观察到的 TE。方法 参与者包括来自 137 个退伍军人健康管理机构的 180 名治疗师（54.4% 是心理学家，42.2% 是社会工作者）和 1,735 名患者（24.7% 是女性；27.2% 有色人种），他们至少完成了两次 TFP 疗程。结果为退出（< 8 TFP 疗程）以及子样本（n = 1,273）、基于创伤后应激障碍检查表的 DSM-5 (PCL-5) 评分的临床有意义的改善和恢复。治疗师级别的预测因素是通过调查、手动图表审查和管理数据确定的。多级模型估计 TE。结果 超过一半 (51.2%) 的患者退出，而退出的患者不太可能达到有临床意义的改善或恢复的标准 (ps < .001)。调整病例组合和 TFP 类型后，治疗师占了无法解释的退出方差的 5.812% (p < .001)。表现最好的四分位数的 45 名治疗师的平均退出率为 27.0%，而表现最差四分位数的 45 名治疗师的平均退出率为 78.8%。当治疗师的治疗间隔平均天数、依从性、实施气氛和病例量添加到多级模型中时，治疗师之间的差异减少到 2.031% (p = .140)。TE 对于有临床意义的改善和恢复并不显着。结论 针对治疗实施和临床组织的干预措施有可能减少治疗师之间 TFP 退出的差异，从而使更多患者保持足够长的时间来体验临床益处。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。