Fidelity and Adaptation: Implementing an Evidence-Based Parenting Program in Community Multicultural Early Learning Centers (WITHDRAWN)

Background and Purpose:  This study prospectively examined treatment fidelity and adaptation in implementation of an evidence-based prevention program in community settings. The research was conducted in collaboration with a child mental health center implementing The Incredible Years parenting program (IYPP) through community partnerships with early learning centers in a large multicultural North American city. Fidelity is key for evidence-based interventions to make the transition to real world settings and achieve desired outcomes while, at the same time, new contexts may call for flexible delivery and adaptations. Objectives: (1) examine fidelity (adherence and competence) in a universal prevention context and under real world conditions of implementation and supervision (2) increase understanding of barriers and facilitators and social workers’ adaptations when they depart from the protocol.

Methods: IYPP is a group prevention/early intervention program for high-risk families or those with young children with early onset conduct problems. Consistent with fundamental principles of social work practice, IYPP uses a collaborative approach to empower parents and increase parenting confidence and self-efficacy. Treatment content protocol and group process procedures are specified in a comprehensive manual. Eighteen therapists in varying combinations co-led 29 groups at multiple sites serving a range of parents across diverse ethnic groups and socioeconomic levels over 3 years. Mixed methods were used to assess and facilitate understanding of group leaders’ (GLs) adherence to the IYPP protocol. Measures:  Session Leader Checklist, a self-report content adherence checklist that included departures and rationale; Leader Collaborative Process Rating Scale completed during observation of the 4^th and 8^th sessions; ongoing supervisory contact notes, audiotapes of GLs’ regular joint supervisory meetings. The Evaluation of Program and Implementation was completed and a focus group conducted in Yr3 to provide an opportunity for GLs to reflect on their experience of conducting multiple groups over an extended time period. We report both the degree to which all components were implemented with fidelity throughout intervention and adherence to carrying out each component across sessions in the quantitative analysis, and describe strategies for coding and ensuring rigor in the qualitative analyses.

Results: Quantitative and qualitative data converged indicating that the IYPP protocol and collaborative group processes were implemented with high fidelity with exceptions of variability in roleplays, video modeling dosage and buddy calls. Fidelity was maintained over time with improvement in ratings for the noted areas in Years 2 & 3. Nine themes emerged around barriers 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.  Facilitators included the emphasis on accountability and ongoing session monitoring, problem-solving barriers and reinforcing adherence in supervision, GLs’ belief in the program’s core components and collaborative process, and therapists’ sense of ownership and responsibility for quality control.

Implications: Given the documented relationship between fidelity and outcomes our findings advance knowledge of successful strategies to foster the transportability of efficacious prevention programs into communities. Perceived barriers will be discussed in the context of successful adaptations and strategies that enhanced fidelity.