A parametric analysis of errors of commission during discrete-trial training

We investigated the effects of systematic changes in levels of treatment integrity by altering errors of commission during error-correction procedures as part of discrete-trial training. We taught 3 students with autism receptive nonsense shapes under 3 treatment integrity conditions (0%, 50%, or 100% errors of commission). Participants exhibited higher levels of performance during perfect implementation (0% errors). For 2 of the 3 participants, performance was low and showed no differentiation in the remaining conditions. Findings suggest that 50% commission errors may be as detrimental as 100% commission errors on teaching outcomes.     

Broad versus narrow traits: Conscientiousness and honesty–humility as predictors of academic criteria

Recent research has suggested that the six‐dimensional personality model, and especially the dimension Honesty–Humility/Integrity, adds incremental validity to the prediction of important criteria. We expected both this dimension and the dimension Conscientiousness to explain incremental variance in two academic criteria, namely grade point average (GPA) and counterproductive academic behaviour (CAB). In addition, we expected the more specific, so‐called narrow traits of Conscientiousness and Honesty–Humility/Integrity to be stronger predictors of academic criteria than the broad traits. To test these expectations, two studies were conducted using the HEXACO Personality Inventory Revised (HEXACO‐PI‐R) and the Multicultural Personality Test—Big Six (MPT‐BS). The results confirmed our expectations and suggest that academic criteria may be predicted with greater accuracy by focusing on the narrow traits of Conscientiousness and Honesty–Humility/Integrity. Copyright © 2010 John Wiley & Sons, Ltd.     

Sustaining the Utilization and High Quality Implementation of Tested and Effective Prevention Programs Using the Communities That Care Prevention System

This paper describes the extent to which communities implementing the Communities That Care (CTC) prevention system adopt, replicate with fidelity, and sustain programs shown to be effective in reducing adolescent drug use, delinquency, and other problem behaviors. Data were collected from directors of community‐based agencies and coalitions, school principals, service providers, and teachers, all of whom participated in a randomized, controlled evaluation of CTC in 24 communities. The results indicated significantly increased use and sustainability of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, during the active phase of the research project when training, technical assistance, and funding were provided to intervention sites, and 2 years following provision of such resources. At both time points, intervention communities also delivered prevention services to a significantly greater number of children and parents. The quality of implementation was high in both conditions, with only one significant difference: CTC sites were significantly more likely than control sites to monitor the quality of implementation during the sustainability phase of the project.     

Adherence to Wraparound Principles and Association with Outcomes

Maintaining fidelity to the principles of the Wraparound process in serving children with emotional and behavioral disorders is a high priority. However, the assumption that greater adherence to the model will yield superior outcomes has not been tested. The current study investigated associations between adherence to Wraparound principles, as assessed by the Wraparound Fidelity Index, second version (WFI), and child and family outcomes in one federally funded system-of-care site. Results demonstrated that higher fidelity was associated with better behavioral, functioning, restrictiveness of living, and satisfaction outcomes. No associations were found for several additional outcomes making interpretation difficult. Our study provides initial support for the hypothesis that maintaining fidelity to the philosophical principles of Wraparound is important to achieving outcomes. The study also provides support for the construct validity of the WFI as a service process measure.     

Group CBT for Externalizing Disorders in Urban Schools: Effect of Training Strategy on Treatment Fidelity and Child Outcomes

Public schools are an ideal setting for the delivery of mental health services to children. Unfortunately, services provided in schools, and more so in urban schools, have been found to lead to little or no significant clinical improvements. Studies with urban school children seldom report on the effects of clinician training on treatment fidelity and child outcomes. This study examines the differential effects of two levels of school-based counselor training: training workshop with basic consultation (C) vs. training workshop plus enhanced consultation (C +) on treatment fidelity and child outcomes. Fourteen school staff members (counselors) were randomly assigned to C or C +. Counselors implemented a group cognitive behavioral therapy protocol (Coping Power Program, CPP) for children with or at risk for externalizing behavior disorders. Independent coders coded each CPP session for content and process fidelity. Changes in outcomes from pre to post were assessed via a parent psychiatric interview and interviewer-rated severity of illness and global impairment. Counselors in C + delivered CPP with significantly higher levels of content and process fidelity compared to counselors in C. Both C and C + resulted in significant improvement in interviewer-rated impairment; the conditions did not differ from each other with regard to impairment. Groups did not differ with regard to pre- to- posttreatment changes in diagnostic severity level. School-based behavioral health staff in urban schools are able to implement interventions with fidelity and clinical effectiveness when provided with ongoing consultation. Enhanced consultation resulted in higher fidelity. Enhanced consultation did not result in better student outcomes compared to basic consultation. Implications for resource allocation decisions with staff training in EBP are discussed.     

Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment

Mental health systems need scalable solutions that can reduce the efficacy–effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high-quality care are providers’ fidelity to evidence-based treatment models and children’s and caregivers’ engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of trauma-focused cognitive-behavioral therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed-method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.     

Introduction to the Special Series: Clinical Applications of the Inhibitory Learning Model

Exposure therapies (ETs) are treatments of choice for a number of mental health disorders, particularly anxiety and associated conditions, and problems due to avoidance. Exposure has received broad empirical support as a primary intervention. Recent efforts have focused on improving the efficacy and acceptability of exposure-based treatments. As proposed by Craske etal. (2014), strategies to improve ETs based on the inhibitory learning model have shown notable promise. However, surveys suggest that clinicians continue to avoid ETs, or implement them in a manner that interrupts their efficacy. In this special series, articles focus on specific inhibitory learning strategies in exposure, and their adaptation to multiple patient populations. The aim of the special series is to critically assess the research support for inhibitory learning approaches to exposure, and provide guidance for clinicians to implement these strategies in everyday practice.     

Infant mental health home visiting therapists’ fidelity to the Michigan IMH-HV model in community practice settings

Implementation research suggests that fidelity to a therapeutic model is important for enhancing outcomes, yet can be difficult to achieve in community practice settings. Furthermore, few published studies have reported on characteristics of treatment fidelity. The present study examined fidelity to the Infant Mental Health Home Visiting (IMH-HV) model among 51 therapists with a range of experience practicing in community settings across the state of Michigan. IMH therapists completed fidelity checklists after every session with participating families to track use of 15 treatment strategies central to the IMH-HV model across the 12-month study period. Results indicated that the most commonly endorsed components utilized in home visits were developmental guidance and infant–parent psychotherapy, followed by the provision of emotional support. Use of IMH-HV components did not vary over time for the entire sample; however, patterns of strategies used showed somewhat more variability among more experienced therapists and when serving higher risk families. Findings demonstrate that IMH-HV therapists report a range of adherence to the model in community settings, with greatest fidelity to several model core components. Ongoing training in the flexible use of all core strategies may further enhance fidelity and contribute to positive outcomes for caregivers and their children receiving IMH-HV services.