The trajectory of fidelity in a multiyear trial of the family check-up predicts change in child problem behavior

Abstract

Objective: Therapist fidelity to evidence-based family interventions has consistently been linked to child and family outcomes. However, few studies have evaluated the potential ebb and flow of fidelity of therapists over time. We examined therapist drift in fidelity over 4 years in the context of a Family Check-Up prevention services in early childhood (ages 2-5 years).

Method: At age 2, families engaging in Women, Infants, and Children Nutritional Supplement Program services were randomized and offered annual Family Check-Ups. Seventy-nine families with a child in the clinical range of problem behaviors at age 2 years were included in this analysis.

Results: Latent growth modeling revealed a significant linear decline in fidelity over time (M = -0.35, SD = 0.35) and that steeper declines were related to less improvement in caregiver-reported problem behaviors assessed at ages 7.5/8.5 years (b = -.69, p = .003; β = -.95, 95% CI [-2.11, -0.22]).

Conclusion: These findings add to the literature concerning the need to continually monitor therapist fidelity to an evidence-based practice over time to optimize family benefits. Limitations and directions for future research are discussed.

(c) 2015 APA, all rights reserved).

Figures

Figure 1

Observed and estimated trajectory of the fidelity ratings from age 2 to age 5. Note. The observed COACH scores are connected with the solid line. The estimated trajectory is represented by the dashed line.

Figure 2

The trajectory of fidelity is related to child oppositional/aggressive behaviors in the home and school settings. Note: Covariates with significant paths are presented. See Table 2 for full path analysis results. Unstandardized coefficients are in parentheses.