Saturday, 15 January 2005 - 10:00 AM

This presentation is part of: Services for High-Risk Families

Treatment Adherence In The Dissemination Of An Evidence-Based Parenting Program

Purpose: This study examined factors that facilitate and hinder therapist fidelity in implementing an evidence-based treatment model in community settings. The project is a university partnership with a leading child mental health center that has received multi-year funding to implement an evidence-based prevention program through community partnerships with early learning child care centers in a large multicultural North American city. This research addresses a critical issue in child mental health and clinical research regarding enhancing adherence to treatment protocols and achieving favorable outcomes for empirically supported treatments in the natural environments of youth and families.

Methods: The Incredible Years parent training is a 12 week empirically validated group prevention and early intervention program for high risk families or those with young children with early onset of conduct problems. Incredible Years emphasizes a collaborative process that builds on both leaders’ and parents’ knowledge, strengths, and perspectives. The treatment content protocol and group process procedures are specified in a comprehensive program manual. A series of three parenting groups are conducted each year at four child care centers serving a range of parents across diverse ethnic groups and socioeconomic levels. Co-therapists facilitate the groups at each center for a total of eight group leaders. The lead agency provides supervision. This study examines 12 groups in Year 1. In light of the importance of treatment fidelity to outcomes and the difficulty in obtaining fidelity in dissemination efforts, mixed methods were used to capture themes and processes in understanding group leaders’ adherence to the Incredible Years’ protocol. Therapist adherence was measured by the Session Leader Checklist, a self-report session-to-session content adherence checklist that includes departures from procedures and rationale; the Parent Group Leader Collaborative Process Checklist, completed by group leaders following the 4th and 8th sessions; Leader Collaborative Process Checklist and Rating Scale for independent fidelity checks, following observation of the 4th and 8th session at each site; weekly supervisory contact notes, and audiotapes of group leaders’ joint supervisory meetings midway and at the end of each group.

Results: Overall, there was high therapist adherence to the treatment protocol with few departures noted by group leaders. Factors that appear to contribute to treatment integrity include the emphasis on accountability and ongoing session monitoring, attention to adherence in supervision, therapists’ belief in the importance of the program’s core components and collaborative process, and therapists’ sense of ownership and responsibility for quality control. It should be noted that these procedures are implemented as part of the agency’s supervisory process rather than by the researchers, thus increasing their likelihood of maintenance. We will discuss maintenance of program integrity, overcoming barriers to “drift,” and the relationship of therapist adherence to treatment outcomes.

Implications for Practice: This study addresses the challenges of maintaining treatment integrity and issues of external validity when extending an empirically validated treatment to a new population and context. Given the documented relationship between treatment fidelity and outcomes our findings advance knowledge of successful strategies to foster the transportability of efficacious treatments into community-based practice.

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