Toward high-fidelity treatment as usual: Evidence-based intervention structures to improve usual care psychotherapy

The psychotherapy field has focused on evidence-based intervention (EBIs) packages as the primary vehicle for implementing evidence-based practices. EBIs tend to employ a replacement paradigm that is both inconsistent with the skill augmentation approach service providers prefer and relatively ineffective for changing clinician behavior. EBIs comprise both intervention content (i.e., specific clinical techniques) and intervention structures (i.e., supports that organize content). Although usual care typically includes delivery of some EBI content elements, insufficient attention has been paid to the contextually-appropriate improvement opportunities provided by evidence-based intervention structures. Two candidate structures-measurement-based care and structured supervision-are reviewed surrounding their ability to support "high-fidelity treatment as usual," or the explicit planning and deployment of practices already present in experienced providers' clinical repertoires.