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

Abstract

Treatment fidelity, including adherence and competence, is assessed during the implementation of evidence-based treatments to ensure that care is delivered as intended. Although fidelity monitoring is often resource-intensive, a relationship between fidelity and treatment outcomes has not been clearly demonstrated. Associations between observer-rated clinician fidelity and family treatment outcomes were investigated in a longitudinal sample of clinicians (n = 18) and parent-child dyads (n = 39) following a statewide implementation of Parent-Child Interaction Therapy. Results indicated that neither adherence nor coaching competence predicted changes in treatment outcomes. Explanations for these findings, study limitations, and directions for future research are discussed.

Keywords:

• Adherence
• competence
• externalizing behavior problems
• implementation
• parent training
• treatment fidelity

Acknowledgements

This study was part of a larger trial that was guided by a statewide steering committee and Shelley Hiegel, the project coordinator. We are grateful for their substantial contributions. This study also benefitted from feedback by Dr. Aaron Metzger and Dr. Claire St. Peter.

Disclosure statement

The authors have no conflicts of interest to report.

Additional information

Funding

This research was supported by funding from the National Institute for Mental Health [RO1 MH095750]; A Statewide Trial to Compare Three Training Models for Implementing an EBT; PI: Herschell; 9/18/2012–12/31/2017.