THERAPIST PREDICTORS OF TREATMENT COSTS AND OUTCOMES IN A PSYCHOLOGY TRAINING CLINIC: A MULTI-PERSPECTIVE COST-EFFECTIVENESS EVALUATION

Costs are a barrier to both providing and receiving mental health services. The present study evaluated the costs, effectiveness, and cost-effectiveness of cognitive-behavioral therapy (CBT) delivered in a training clinic (TC) at a private Mid-Atlantic university from the therapist, client, and summed perspectives. Although extant literature suggests that therapists differ in their treatment effectiveness, years of clinical experience has not consistently predicted treatment outcomes. We attempted to replicate findings that therapists, but not years of experience, have a statistically significant impact on self-reported distress. We also sought to extend this literature by examining effects of therapists and therapist clinical experience in a sample of predoctoral trainees in their 2nd or 3rd year of clinical training delivering CBT in a TC. Treatment costs were higher for 3rd-year, compared to 2nd-year, therapists from all perspectives. Also, treatment length interacted with therapist experience to significantly predict costs from the therapist perspective. A three-level hierarchical linear growth model revealed that approximately 10.6% of variance in outcomes was accounted for by between-therapist differences, therapist experience did not significantly predict distress reductions, and higher distress at baseline was associated with faster distress reductions. A probabilistic sensitivity analysis confirmed conclusions that therapists with two years of experience may be more cost-effective than therapists with three years of experience. However, CBT may be more cost-effective when delivered by 3rd-year therapists, relative to 2nd-year therapists, if decisionmakers are willing to pay an additional $35 to $60 for an additional one-point reduction on the OQ.