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					          Developing a Leader
        Observation Tool for the
            Assessment of
      Implementation Fidelity of the
        Webster-Stratton BASIC
         Parenting Programme.
                            Catrin Eames
                     University of Wales, Bangor
                       c.eames@bangor.ac.uk
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
 The importance of implementation fidelity
 History of implementation fidelity research
 Current implementation fidelity Ph.D.
  research
What is implementation fidelity?
 Fidelity may be referred to as the degree to
  which intervention delivery adheres to the
  original intervention protocol (IOM, 2001).
 Many terms have developed in reference to
  fidelity research
    Fidelity research terminology
   Adherence
   Treatment delivery
   Treatment differentiation
   Treatment exposure
   Treatment integrity
   Participant responsiveness
     History of treatment fidelity
               research
 Early treatment research provided little information to
  enable sufficient replication or comparisons of treatment
  methods (Bond et al., 2000)
 Surge of treatment manuals
 Manuals developed to monitor treatment delivery,
  treatment exposure and in-session data collection
  (Luborsky & De Rubeis, 1984)
 Manuals alone does not guarantee competent
  implementation of programme adherence (Forgatch,
  Patterson & DeGarmo, 2005)
    History of treatment fidelity
              research
 Of 539 studies dated from 1968 to 1980, only 20%
  reported treatment manipulation information
  (Peterson et al., 1982)
 Of 181 studies published between 1980 and 1990,
  only 15% had systematically measured integrity
  data (Gresham et al., 1993)
 A review of 1,200 published prevention studies, 5%
  had presented implementation data in their studies
  (Durlak, 1997)
          A cause for concern
 Lack of information provided on implementation
  fidelity in both prevention and treatment trials
 Difficulties in replicating interventions
 Multi-site, community based replications
 Typically a fidelity scale is developed
          The importance of
        implementation 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)
 Fidelity measurement has many implications for
  both the practice and research field
   The importance of assessing
            fidelity
 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)
   The Incredible Years BASIC
      Parenting programme
 One of few programmes that address
  fidelity
 Parent Group Leader Rating Scale
 Peer and Self Evaluation
 Session specific checklists
 Supervision
 Certification
      Current fidelity research
 Developing an implementation fidelity
  measure for the Incredible Years BASIC
  Parenting Programme
 Ensuring measure reaches reliability criteria
 Relating conclusions from the fidelity
  measure to changes in parent and child
  behaviour, as collected by the Sure Start
  Parent Support Research
    New observational measure
 Objective frequency count
 Continuous time sampling at 10-minute intervals
  throughout the 2-hour session
 Both leaders coded
 18 behaviour categories
 Behaviour categories developed based on IY
  BASIC parenting protocol
      New observational measure
   Feelings acknowledgement
   Positive body language
   Engagement
   Praise
   Principle reflection
   Reframing
   Thought provoking
   Role play
   Reflective
   On agenda/Off agenda
         Inter-rater reliability
 Randomly selected 30% of tapes to be
  second coded
 84% average inter-rater agreement
 Intra-class correlations of each category;
  ranging from .83 to .98
      Application of the leader
           observations
 Video tapes of research group leaders
 Leaders attributed with fidelity scores
 Correlated with the parent and child
  measures already collected by the Sure Start
  Parent Support Research team
 Coders blind to the behavioural change
  scores already obtained to avoid coder bias
              Predicted results
 Previous research indicates that the probability of
  behaviour change was increased when a
  programme was delivered with high fidelity
  (Happe, 1983; Forgatch et al, 2005)
 It is predicted that groups with high fidelity index
  scores will have greater improvements in
  behaviour change for both parent and child
                 Conclusion
 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)
 The current research aims to demonstrate the
  impact varying degrees of intervention fidelity can
  have upon behavioural change
Thank you for listening

For further information please contact:

Catrin Eames
School of Psychology
University of Wales, Bangor
Gwynedd
LL57 2DG

01248 38 2651

c.eames@bangor.ac.uk