Clinical Representativeness Coding Manual

Criterion for clinical representativeness	Definition and code
Clinically representative setting	1: Setting where clinical services are commonly provided in nonuniversity settings (e.g., outpatient mental health clinics, CMHCs, general hospitals, private practices, prisons, school systems) in which the primary purpose is clinical care. ½: Patient setting affiliated with a university research program but primary purpose of setting is clinical care. 0: University research setting.
Clinically representative referrals	1: Clients initially referred through usual clinical routes (e.g., MDs). ½: Clients referred through usual clinical routes (e.g., MDs) and recruitment solicitations/advertisements. 0: Clients referred by recruitment solicitations/advertisements.
Clinically representative therapists	1: Practicing and experienced clinicians with regular caseloads for whom provision of services is a substantial part of job. The primary therapists at the clinical setting—interns are included. 0: Research therapists.
Clinically representative structure	1: Treatment either with a structure used in clinical practice or not structured in a detailed and uniform way according to a manual (e.g., general CBT). ½: Treatment “based on” or “inspired by” a clinical manual, which can be used flexibly (e.g., include treatment procedures not in the manual, flexible number of sessions). 0: Strict manualization, or manual-driven treatment (e.g., set number of sessions).
Clinically representative monitoring	1: Implementation of treatment was not monitored in any way that could influence therapist behavior (no formal adherence checks and no supervision). ½: Only monitoring was supervision and/or outlines containing information to be covered in session (no formal adherence checks). 0: Supervision and adherence checks.
No pretherapy training	1: Therapists did not receive special training immediately before study in specific techniques to be used. Of course, therapists may have received training in that treatment at some point in their career but not for purposes of study in which they participated. ½: Only novice therapists are trained, and they represent less than 25% of therapists. 0: Pretherapy training; also give 0 when percentage of novice therapists not specified.
No randomization	1: Patients were not part of a randomized trial, did not meet criteria for a particular trial, or refused randomization. 0: Patients were randomized to treatments.
Clinically representative patients	1: No exclusionary criteria aside from psychosis, suicidality, organic brain disease, or substance dependence if patient meets criteria for disorder under study. 0: Exclusion criteria beyond those above, including comorbidity and medication.
Medications allowed	1: Medication is allowed. If no specific mention in exclusion criteria, assume medication is allowed. 0: Patients on medication are forced to go off medication or are excluded from study.

Note. CMHCs = community mental health centers; MDs = medical doctors; CBT = cognitive–behavioral therapy.