UCLA

Despite the existence of a large evidence base for youth psychotherapy (Becker & Chorpita, 2023), evidence is inconsistently applied in practice, leading to suboptimal treatment outcomes (Weisz et al., 2013). One approach to bridging the science-to-practice gap is evidence-based practice (EBP), which refers to the integration of psychotherapy evidence, client-specific evidence, and clinical expertise to inform practice (Spring, 2007). EBP is achieved through a process of intentionally using evidence to make decisions about care; decision-making is considered the “lynchpin” of EBP (Spring, 2008). Clinical supervision, or ongoing consultation between a therapist and supervisor to ensure safe and effective practice, has been found to play a key role in determining how care is delivered (e.g., Schoenwald et al., 2009; Bearman et al., 2013); thus, supervision offers a promising avenue for facilitating decision-making that can support EBP—or in other words, EBP-aligned decision-making. However, there has been little research to date on any form of decision-making in supervision. This dissertation aimed to examine how supervisors’ behaviors and characteristics influence the extent that distinct decisions made in supervision (i.e., selection of problems to target, consideration of practices to deliver, and selection of practice to deliver) align with EBP. Results indicated that the proportion of variance in EBP-aligned decision-making was largely attributable to supervisors. Further, results showed that supervisor topic initiation positively predicted the extent that some decisions aligned with EBP (e.g., decisions about which problems to target and which practices to consider), but that supervisor use of questions did not significantly predict the extent that any decisions aligned with EBP. Supervisor knowledge of psychotherapy evidence was found to positively predict the extent that all examined decision types aligned with EBP, whereas supervisor openness to innovative and evidence-based interventions was found only to predict the extent that one type of decision (i.e., selection of a practice to apply in the next treatment session) aligned with EBP. By providing preliminary insight into how supervisors can support EBP-aligned decisions in supervision, this study lays groundwork for future work examining how supervision can support EBP in public settings.