Providers' Perspectives on Implementing a Multiple Family Group for Children with Disruptive Behavior

Background and Purpose:

The difficulty in concretizing research-supported treatments (RST) as standard practice is an issue of concern within behavioral health. The field of implementation science theorizes that the adoption of RSTs is contingent upon multiple, interactional levels . Provider-level factors (eg. sociodemographic factors and attitudes toward RSTs) have been shown to be critical to uptake. The purpose of this study is to examine the relationship between sociodemographic factors, attitudes, and perceived barriers/facilitators to implementation through a comparative approach involving practitioners trained to facilitate a multiple family group intervention for children with disruptive behavior.

Methods:

Sample: This study is part of a larger National Institute of Mental Health study examining a multiple family group model entitled the 4Rs and 2Ss for Strengthening Families. Providers were eligible for inclusion if they agreed to administer and received training in the model.

Measures: Demographic characteristics were collected via a socio-demographic questionnaire addressing provider age, race/ethnicity, education and credentials. Barriers and facilitators were assessed via a scale, developed by the authors and guided by the Consolidated Framework for Implementation Research, that explored provider views regarding the intervention, the systemic and organizational context, experience facilitating groups and involving families in treatment, and feelings toward involving families in treatment. Barriers to implementation were captured through open-ended questions which tapped into reasons for not facilitating a group (for those who did not implement the intervention), and barriers regarding planning for the group, attendance, and general issues (for those who did implement the intervention).

Data Analysis: Between group analyses were conducted to examine demographic and characteristic differences of providers by implementation status. Independent samples t-tests for continuous characteristics and chi-square tests for categorical characteristics were used. Responses to open-ended questions were compiled, reviewed, and coded, and frequencies and percentages were calculated.

Results:

Twenty-seven (29.7%) providers implemented the 4Rs and 2Ss, and 64 (70.3%) providers did not. Significantly more providers who implemented the intervention had prior experience in facilitating groups. Providers who implemented the intervention reported more positive attitudes towards the intervention (M = 28.7, SD = 3.5) compared to those who did not implement it (M = 26.0, SD = 4.4; t(76)= -2.66, p < .01).  Qualitative data revealed that common barriers to implementation included having an ineligible caseload and clinicians feeling unqualified to deliver the intervention.

Conclusions and Implications:

Consistent with the literature, further attention is needed to promote favorable attitudes toward RSTs. Additionally, having prior experience facilitating groups may be a driving factor in influencing uptake- it is therefore imperative that educational curricula, and on the job training and supervision incorporate further exposure to group facilitation skills to promote comfort in delivering group work. Finally, further attention should be placed on methods of recruitment into a group intervention.