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The Importance of Treatment Fidelity in Delivering Parent Programmes Presentation for the Incredible Years Wales Conference Llandrindod Wells, 7th February 2008. Catrin Eames Bangor University [email protected] Supervisory committee: Dr Judy Hutchings, Dr Carl Hughes, Dr David Daley

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Catrin eames bangor university c eames@bangor ac uk

The Importance of Treatment Fidelity in Delivering Parent ProgrammesPresentation for the Incredible Years Wales ConferenceLlandrindod Wells, 7th February 2008

Catrin Eames

Bangor University

[email protected]

Supervisory committee: Dr Judy Hutchings, Dr Carl Hughes, Dr David Daley

Funded in collaboration by ESF/Objective 1 fund and Incredible Years Wales


Overview of presentation

Overview of presentation

  • The importance of treatment fidelity

  • History of treatment fidelity research

  • Current Ph.D. research


What is fidelity

What is fidelity?

  • Fidelity may be referred to as the degree to which intervention delivery adheres to the original intervention protocol (IOM, 2001).


Fidelity research terminology

Fidelity research terminology

  • Adherence

  • Treatment delivery

  • Treatment differentiation

  • Treatment exposure

  • Treatment integrity

  • Participant responsiveness


Effective delivery

Effective delivery

  • Adequate evidence base

  • Methods used

  • Means of assessing fidelity


History of treatment fidelity research

History of treatment fidelity research

  • Poor methodologies

  • Surge of treatment manuals

  • Manuals alone do not guarantee fidelity

  • Few studies reported any fidelity issues

  • Of those that did, no reference to the development of valid fidelity measures


The importance of fidelity

The importance of fidelity

  • It is necessary to implement all components of a programme fully in order to preserve the behaviour change mechanisms that made the original programme model a successful one (Arthur & Blitz, 2000; Mihalic et al., 2002)

  • Can offer a template of service delivery

  • Further resources/supervision/training

  • Ensure adherence to delivery of intervention models

  • Programme drift most common reason for poor treatment outcomes (Mills & Ragan, 2000; Mowbray et al, 2003)


Current fidelity measures

Current fidelity measures

  • Typically, manuals or checklist format

  • Measure programme content

  • Threats to validity


Benefits of observation

Benefits of observation

  • Precise account of behaviour as it unfolds

  • Bias reduced with independent observation

  • Continuous sampling, quantitative


Rationale for current research

Rationale for current research

  • IY : Internationally delivered and evaluated

  • Over 10,000 trained in the BASIC

  • Numbers of independent replications increasing

  • Quantitative observational measure of process skills

  • Ensure measure is reliable and valid

  • Relate leader fidelity scores to changes in parent and child behaviour from the Sure Start Study


Leader observation tool lot

Leader Observation Tool (LOT)

  • Objective frequency count

  • Continuous time sampling at 10-minute intervals throughout the 2-hour session

  • Both leaders coded

  • 18 behaviour categories forming five skills subgroups:

    • Listening

    • Empathy

    • Physical Encouragement

    • Positive Behaviour

    • Other/Negative


Data set

Data set

  • 12 groups, two leaders per group, 2 hour sessions

  • Course split up into :

    • Play and relationship building

    • Praise and reward

    • Effective limit setting

    • Handling misbehaviour

  • Four sessions selected for coding for each group

  • Of these, 30% randomly selected for second coding

  • Coders blind to behaviour change scores to avoid bias


  • Lot reliability and validity

    LOT reliability and validity

    • Internal reliability at both p<.05 and p<.01

    • 84% average inter-rater agreement

    • Intra-class correlations of each category: mean of .92 and .95 for code-recode and inter-rater reliability respectively

    • Concurrent validity with parent and leader reports of the group intervention process

    • LOT identified variability between groups, highlighting the heterogeneity in process skills and treatment fidelity


    Lot scores and behaviour change

    LOT scores and behaviour change

    • Leaders attributed total score per subgroup

    • Parent data = 86 completers

    • Each parent attributed a leader fidelity exposure score

    • Predict that probability of parent behaviour change greater when attending a group delivered with high fidelity

    • Greater change in parent behaviour in turn predict greater change in child behaviour


    Measures

    Measures

    Leader  Parent  Child

    • Leader: LOT

    • Parent: Parenting Scale, Positive Parenting

    • Child: ECBI, Child positives, Compliance


    Results

    Results


    Therefore

    Therefore….

    • In order to change child behaviour, need to change parenting behaviour

    • Leader treatment fidelity of process skills significantly predict both observed change in parenting behaviour as well as parent self reported behaviour

    • In turn, predict the change in child behaviour


    Conclusion

    Conclusion

    • Need to report fidelity criteria in treatment outcome studies, especially considering the number of manual based interventions that are replicated in the community today

    • Poor implementation fidelity is the most common factor for poor treatment outcome (Mills & Ragan, 2000)

    • Valid fidelity measurement can predict treatment outcome, as well as document treatment differentiation in multi-centre research


    Catrin eames bangor university c eames bangor ac uk

    Thank you for listening

    For further information please contact:

    Catrin Eames

    School of Psychology

    College of Health and Behavioural Sciences

    Bangor University

    Gwynedd

    LL57 2DG

    01248 38 2651

    [email protected]


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