Examining the Impact of Treatment Fidelity on Client Outcomes in a Statewide Implementation of Parent-Child Interaction Therapy

Abstract

Clinician treatment fidelity, consisting of treatment adherence and clinician competence, is commonly assessed during the implementation of evidence-based treatments to ensure that clinicians are delivering care according to an intended service model. Although resources are often expended in fidelity measurement, associations between fidelity and client outcomes has not been well established in the psychotherapy literature. The relationship between clinician fidelity and treatment outcomes was investigated in a longitudinal sample of clinicians (n = 17) and parent-child dyads (n = 32) following a statewide implementation of Parent-Child Interaction Therapy. Observer-rated measures of adherence and coaching competence collected from early treatment sessions were used to predict intake levels and growth trajectories of parent-reported behavior problems and positive parenting skills. Hierarchical linear modeling results indicated that higher levels of coaching competence were associated with greater behavior problem frequency at intake. Neither early session adherence nor early session competence, as they were measured in the current study, predicted changes in treatment outcomes over time. These results suggest that additional variables should be modeled alongside early treatment fidelity to predict treatment outcome change. Possible explanations for these findings, limitations of the current study, and directions for future research are discussed.

Measures of Facilitator Competent Adherence Used in Parenting Programs and Their Psychometric Properties: A Systematic Review

“…Only three (7.3%) studies reported on content validity (Table 6). Of these, two indicated using the knowledge and Forgatch et al, 2005) Competent adherence Video 6 COACH rating system (e.g., Smith et al, 2013) Competent adherence Video 5 Home visitation observation form (e.g., Roggman et al, 2001) Competent adherence Video 2 Leadership observation tool (Eames et al, 2007(Eames et al, , 2009 Competent adherence Video 2 Feedback observer global ratings form (Bustos, 2011) Competence Video 1 FIRST coach coding system (Snider, 2019) Competence Video 1 Parent program implementation checklist (Bywater et al, 2019) Competent adherence Live or video 1 Therapist Behaviour Rating Scale-2nd Version (Hogue et al, 2005;Singer, 2001) Competent adherence Video 2…”

“…Therapist Behaviour Rating Scale-Competence (Hogue et al, 2008) Competence Video 1 Therapist Behaviour Rating Scale (Hogue et al, 1998) Competent adherence Video 1 Therapist Skill Scale (Scott et al, 2008) Competent adherence Video 1 Treatment Integrity Checklist (Snider et al, 2019) Adherence Video 1 Video Supervision Manual (Sterrett-Hong et al, 2017) Adherence Video advice of experts to develop the measure (Feely et al, 2018;Hogue et al, 1998), two reported asking experts to assess a draft measure (Feely et al, 2018;Hogue et al, 1998), one described seeking feedback from program trainers about the developed measure (Bywater et al, 2019), and one asked a program developer to review their draft measure (Hogue et al, 1998). They all provided very little detail about the process, feedback, or use of feedback.…”

Searching for the Standard: The Impact of Level of Training on In Vivo Coaching in Parent-Child Interaction Therapy

“…Some trainers have recommended the use of “gateway” coaching codes or “mastery criteria” to assess whether coaches are using an adequate number of accurate and responsive coaching statements (e.g., 30 statements in 5 minutes, 10 Labeled Praises in 5 minutes; Funderburk et al, 2017). However, the only study to date to use “mastery criteria” for coaching found no relationship between coaching competence and child or parent treatment outcomes (Snider et al, 2021).…”