Addressing Trauma, Grief and Loss to Increase Permanency: Fidelity Findings from the Evaluation of Pathways to Permanency 2

Background/Purpose: The QIC-AG Texas site used implementation science to explore the root causes of delayed permanency for foster youth whose parental rights had been terminated. The state hypothesized that caregivers needed additional knowledge and support to successfully parent a child who has experienced trauma, grief and loss. Additionally, the site hypothesized that if caregivers had such knowledge and support, caregivers would be more likely to commit to be a permanent caregiver for the foster youth. In order to increase the number of children moving from foster care into permanent living situations, the site selected the Pathways to Permanency 2 intervention, a seven session (21-hour intervention) for groups of caregivers in one region of the state. This presentation focuses on the fidelity findings of the program evaluation.

Methods: Pathways 2 is designed to be a manualized series presented by two facilitators. Facilitators are required to attend a 3-day intensive training that provides both the knowledge base and the practical experience to conduct the intervention series. For this study, the QIC-AG Texas team worked with the developers to operationalize the Pathways 2 core components: 1) use of experienced facilitators; 2) experiential delivery of material; 3) participant engagement and participation; and 4) opportunities to practice and apply techniques. Five tools were developed to capture fidelity. A facilitator questionnaire was completed by facilitators prior to teaching their first session. A fidelity assessment log was completed after each session to determine the extent to which content was delivered as intended. Participant evaluations were collected at the end of each session to ask about their experience. An attendance log was created to gather information about the number of sessions completed by each participant. Finally, an observation was completed once per series by the evaluation team.

Results: Seventeen facilitators completed 23 series (161 sessions) with 178 participants. The majority of the 178 participants (75%) attended at least five sessions. Facilitators reported that 93% of content was taught as suggested while evaluators observing sessions noted that only 87% of content was taught as suggested. Changes most often related to time management and technology issues. Additionally, participants rated each session from one (strongly disagree) to five (strongly agree) on various criteria (meeting objectives, relevance, interesting delivery, usefulness of material, quality of audio visual products, time for questions, and encouragement of participation). The average score for all participants was between four (agree) and five (strongly agree) for all criteria in all sessions. 73% of facilitators were rated as satisfactory or above on their use of activities during observed sessions.

Conclusions/Implications: In general, lack of fidelity to the model was largely minimal and due to time management. Because the curriculum requires co-facilitation, facilitators should practice together, review practice sheets for guidance around time management, prioritize and teach material through the activities, identify key messages in each section, and work with one another to identify how they will condense material if needed. Additionally, the developer should also update much of the audio-visual content.