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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 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

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

Leader  Parent  Child

  • Leader: LOT
  • Parent: Parenting Scale, Positive Parenting
  • Child: ECBI, Child positives, Compliance
  • 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
  • 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

Thank you for listening

For further information please contact:

Catrin Eames

School of Psychology

College of Health and Behavioural Sciences

Bangor University


LL57 2DG

01248 38 2651