Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: This study examined factors that facilitate and hinder fidelity in implementing an evidence-based parenting model in community settings. The project is a university partnership with a child mental health center to implement an evidence-based prevention program through community partnerships with early learning child care centers in a large multicultural North American city. Methods: The Incredible Years parent training is a 12-week group prevention and early intervention program for high risk families or those with children with early onset of conduct problems. Consistent with fundamental principles of social work, the IYPP uses a collaborative approach to learning and aims to empower parents and increase their parenting confidence and self efficacy. The treatment content protocol and group process procedures are specified in a comprehensive program manual. Eighteen therapists in varying combinations co-led 29 IYPP groups at multiple sites serving a range of parents across diverse ethnic groups and socioeconomic levels over a 2.5 year period. Mixed methods were used to assess and facilitate understanding of group leaders' adherence to the IYPP protocol. Adherence was measured by the Session Leader Checklist, a self-report session content adherence checklist that includes departures and rationale; the Leader Collaborative Process Rating Scale completed during observation of the 4th and 8th session at each site for fidelity checks; ongoing supervisory contact notes, and audiotapes of group leaders' joint supervisory meetings throughout the project. The Group Leaders' Evaluation of Program and Implementation was completed and a focus group conducted at the project's end to further illuminate the findings. We report both the degree to which all components were implemented according to the manual throughout intervention, and adherence to carrying out each intervention component across sessions in the quantitative analysis, and describe strategies for ensuring rigor in the qualitative analyses. Results: The quantitative and qualitative data converge suggesting that the IYPP protocol and collaborative group processes are implemented with high fidelity with three exceptions of role plays, videotape modeling dosage, and buddy calls. Nine themes emerged that constituted barriers to adherence including balancing parent preferences with structured program components, ESL, and a disconnect between the IYPP as developed for a high risk population and offering it in a universal preventive setting. Factors that contributed to fidelity included the emphasis on accountability and ongoing session monitoring, problem-solving barriers and reinforcing adherence in supervision, therapists' belief in the program's core components and collaborative process, and therapists' sense of ownership and responsibility for quality control. Implications: This study addresses the challenges of maintaining treatment integrity and issues of external validity when extending an evidence-based intervention to a new population and context. Given the documented relationship between fidelity and outcomes our findings advance knowledge of successful strategies to foster the transportability of efficacious programs into community-based practice. The findings should be useful to a range of agencies and social workers interested in increasing their use of research based programs with diverse families. We will discuss maintenance of program integrity, the three areas with lower fidelity,and the relationship of therapist adherence to intervention outcomes.