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Articles   |    
Improving Therapist Fidelity During Implementation of Evidence-Based Practices: Incredible Years Program
Carolyn H. Webster-Stratton, M.P.H., Ph.D.; M. Jamila Reid, Ph.D.; Lynne Marsenich, L.C.S.W.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200177
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Dr. Webster-Stratton is professor emeritus of the School of Nursing and Dr. Reid is with the Department of Psychology, both at the University of Washington, Seattle (e-mail: cwebsterstratton@comcast.net). Ms. Marsenich is with Western Implementation Research and Evaluation, Eugene, Oregon.

Copyright © 2014 by the American Psychiatric Association


Objective  The aim of the study was to extend research on the potential benefits of adding ongoing feedback, coaching, and consultation to initial therapist training workshops to ensure fidelity of delivery of evidence-based practices, specifically for the Incredible Years parenting program.

Methods  A randomized controlled trial compared two models for training therapists to deliver the parenting program for children at high risk of developing conduct problems. Therapists (N=56) from ten community-based mental health service organizations in California were trained in either a three-day workshop model (N=25), based on active, experiential, self-reflective, principle-based learning, video modeling, and manuals, or an enhanced training model (N=31) that included all elements of the workshop model plus ongoing expert coaching, video review of and feedback on group sessions, and consultation for therapists and agency supervisors.

Results  Overall fidelity across both conditions was rated >3 on a 5-point scale in seven of eight domains measured. Therapists in the condition that received ongoing coaching and consultation were significantly stronger in four of the domains: practical support, collaboration, knowledge, and skill at mediating vignettes.

Conclusions  Consultation and expert coaching for training therapists beyond the standard three-day training enhanced skills and therapists’ adherence to the model.

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Table 1Characteristics of Incredible Years group leaders in the workshop-only and expert consultation conditions
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a Included M.A., M.F.T., and M.S.W. degrees

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Table 2Therapists’ fidelity to Incredible Years program, as assessed by independent raters
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a Possible scores range from 1 to 5, with higher scores indicating better fidelity and stronger skills.

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b In some cases, items were not observable for all 56 therapists because rater or parents were in a different room or video quality was poor.

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c Intraclass correlation coefficient

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Table 3Intercorrelations between fidelity dimensions
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*p<.05, **p<.01, ***p<.001

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Table 4Fidelity ratings and effect size differences for therapists assigned to workshop only and to workshop plus consultation, by fidelity dimensiona
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a Possible fidelity scores range from 1 to 5, with higher scores indicating higher fidelity.

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Table 5Leader- and participant-reported characteristics of Incredible Years group delivery in workshop-only and expert consultation conditions
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a Percentage of sessions leaders reported providing these elements of the program

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b Some fathers participated in the groups, but data were collected for mothers only.

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c Rated by therapists on a 3-point scale ranging from 1, not at all involved, to 3, very involved

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d Proportion of time that mothers completed home activities; p<.05 for comparison between groups

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e Mothers’ group ratings could range from 1 to 4, with higher scores indicating more satisfaction with Incredible Years program.

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f Values are percentages and percentage standard deviations.



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