We're all in this together now: group performance feedback to increase classroom team data collection

This study's primary goal was to evaluate the use of performance feedback procedures delivered to a classroom team to increase daily data collection. Performance feedback (PFB) was delivered to four classroom teams responsible for the daily collection of data representing student performance during prescribed instructional activities. Using a multiple-baseline design, the effects of the team performance-feedback were evaluated for the target student, and for generalization to data collection for all classroom students. A secondary question evaluated if student on-task behavior correlated with increased data collection. Finally, social validity was investigated to evaluate team satisfaction with the PFB intervention. The results demonstrate improved data collection across all four classroom teams for the target student in each classroom and generalization within classrooms to all remaining students. Slight increases in student on-task behavior were observed in three of the four classrooms, and teacher satisfaction ratings were high.     

Implementation of Parent Management Training—Oregon Model (PMTOTM) in Iceland: Building Sustained Fidelity

Bringing empirically supported treatments (ESTs) into community settings is a challenge because of threats to therapy adherence. The nationwide implementation of Parent Management Training—the Oregon Model (PMTO) in Iceland was studied by comparing therapists' competent adherence to PMTO across three generations of therapists. To assess therapists' competence and adherence to the PMTO method, the Fidelity of Implementation Rating System (FIMP) was used as the measuring device. Of 16 therapists across three generations who entered training, 12 completed with certification. As expected, each of the three generations obtained adequate FIMP scores. Generations 1 and 3 showed equivalent levels of performance on FIMP scores at certification. A small drop in FIMP scores for Generation 2 was explained in terms of translating and culturally adjusting materials and strengthening training procedures. Results are parallel to earlier findings from the nationwide PMTO implementation in Norway and support the idea that PMTO can be implemented in community settings with high fidelity even when resources are scarce.     

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis

As evidence‐based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural‐strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off‐model, nonsystemic formulations/interventions). Of these, “failure to think in threes” appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.     

Implementing Housing First Across Sites and Over Time: Later Fidelity and Implementation Evaluation of a Pan-Canadian Multi-site Housing First Program for Homeless People with Mental Illness

This article examines later fidelity and implementation of a five‐site pan‐Canadian Housing First research demonstration project. The average fidelity score across five Housing First domains and 10 programs was high in the first year of operation (3.47/4) and higher in the third year of operation (3.62/4). Qualitative interviews (36 key informant interviews and 17 focus groups) revealed that staff expertise, partnerships with other services, and leadership facilitated implementation, while staff turnover, rehousing participants, participant isolation, and limited vocational/educational supports impeded implementation. The findings shed light on important implementation “drivers” at the staff, program, and community levels.     

Navigating Complex Implementation Contexts: Overcoming Barriers and Achieving Outcomes in a National Initiative to Scale Out Housing First in Canada

The scaling out of Housing First (HF) programs was examined in six Canadian communities, in which a multi‐component HF training and technical assistance (TTA) was provided. Three research questions were addressed: (a) What were the outcomes of the TTA in terms of the development of new, sustained, or enhanced programs, and fidelity to the HF model? (b) How did the TTA contribute to implementation and fidelity? and (c) What contextual factors facilitated or challenged implementation and fidelity? A total of 14 new HF programs were created, and nine HF programs were sustained or enhanced. Fidelity assessments for 10 HF programs revealed an average score of 3.3/4, which compares favorably with other HF programs during early implementation. The TTA influenced fidelity by addressing misconceptions about the model, encouraging team‐based practice, and facilitating case‐based dialogue on site specific implementation challenges. The findings were discussed in terms of the importance of TTA for enhancing the capacities of the HF service delivery system—practitioners, teams, and communities—while respecting complex community contexts, including differences in policy climate across sites. Policy climate surrounding accessibility of housing subsidies, and use of Assertive Community Treatment teams (vs. Intensive Case Management) were two key implementation issues.     

Enhancing Social Responsibility and Prosocial Leadership to Prevent Aggression,Peer Victimization,and Emotional Problems in Elementary School Children

Testing the theories that form the basis of prevention programs can enhance our understanding of behavioral change and inform the development, coordination, and adaptation of prevention programs. However, theories of change showing the linkages from intervention program components to risk or protective factors to desired outcomes across time are rarely specified or tested. In this 2‐year longitudinal study, we test the theory that increases in two protective factors (i.e., children's prosocial leadership and their teachers’ expectations of social responsibility) targeted by the WITS Programs (Walk Away, Ignore, Talk it Out, and Seek Help) would be associated with declines in peer victimization, aggression, and emotional problems. Participants included Canadian students, in grades 1–4 at baseline (n = 1329) and their parents and teachers. Consistent with our theory of change, variability in program implementation (adherence and integration) and in children's use of program skills (child responsiveness) are related to increases in both protective factors. Increases in these protective factors are associated with subsequent declines in children's aggression, victimization, and emotional problems. We discuss how enhancement of these protective factors may operate to improve child outcomes and the need for theory‐based research to refine and improve the effectiveness of intervention strategies and to improve program scale‐up.     

“Till Death Us Do Part”: Issues of Fidelity in End of Life Care

SUMMARY

This paper was born of the experience of caring for a loved one at the end of life. The sense of being torn between accepting one's lot and wishing for something “other” is at the heart of the concept described as “intimate fidelity.” Intimate fidelity is discussed as part of a multi-layered concept of fidelity, embracing aspects of the professional caring relationship, and which builds into a value that shapes the fabric of the community.

Academic literature fails to address this understanding of fidelity, so with some creativity, we turned to popular literature—novels and biographies—to find rich understandings of the concept of fidelity. Then following a traditional system of thematic analysis, three aspects of the concept of fidelity are presented, in the context of caring for loved ones, professional caring, and caring in the community.     

The Integration of Family and Group Therapy as an Alternative to Juvenile Incarceration: A Quasi‐Experimental Evaluation Using Parenting with Love and Limits

The current study employed a quasi‐experimental design using both intent‐to‐treat and protocol adherence analysis of 155 moderate‐ to high‐risk juvenile offenders to evaluate the effectiveness of Parenting with Love and Limits® (PLL), an integrative group and family therapy approach. Youth completing PLL had significantly lower rates of recidivism than the comparison group. Parents also reported statistically significant improvements in youth behavior. Lengths of service were also significantly shorter for the treatment sample than the matched comparison group by an average of 4 months. This study contributes to the literature by suggesting that intensive community‐based combined family and group treatment is effective in curbing recidivism among high‐risk juveniles.     

A preliminary examination of the role of psychotherapist fidelity on outcomes of cognitive processing therapy during an RCT for military sexual trauma-related PTSD

While cognitive processing therapy (CPT) is an effective evidence-based treatment for many veterans with military-related post-traumatic stress disorder (PTSD), not all veterans experience therapeutic benefit. To account for the discrepancy in outcomes, researchers have investigated patient- and research design-related factors; however, therapist factors (e.g. fidelity) have received less attention. The present study is a preliminary examination of the effect of psychotherapists’ fidelity during CPT on clinical outcomes during a randomized clinical trial (RCT) for military sexual trauma-related PTSD. PTSD symptoms, trauma-related negative cognitions (NCs), and depression symptoms were assessed for 72 participants at baseline, and 1-week, 2-month, 4-month, and 6-month posttreatment. Of the four CPT therapists, two were found to have significantly poorer (i.e. “below average”) treatment fidelity scores compared to the other two therapists who had “good” treatment fidelity scores. To examine possible therapist effects on outcomes, hierarchical linear modeling was utilized with therapist fidelity entered as a Level 2 predictor. Participants treated by a therapist with “good” treatment fidelity experienced significantly greater reductions in PTSD symptoms, NCs, and depression symptoms than patients treated by a therapist with “below average” treatment fidelity. Our preliminary findings highlight the importance of monitoring, maintaining, and reporting fidelity in psychotherapy treatment RCTs.