Setting up sustainable systems for effective implementation: moving fidelity support from developer to agency
Date
2020
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Publisher
University of Delaware
Abstract
Delivering evidence-based interventions with high fidelity is critical to successful dissemination (Durlak & DuPre, 2008; Dusenbury, Brannigan, Falco, & Hansen, 2003). Sustaining fidelity in the long term depends on the effectiveness and feasibility of the fidelity monitoring method that is chosen by a disseminating agency (Hogue, Ozechowski, Robbins, & Waldron, 2013). One strategy of fidelity monitoring involves localization of fidelity management (Altman, 1995; Hogue et al., 2013). This study examines clinicians’ trajectories of fidelity after developer support has ended and tests the effectiveness of local fidelity support. Attachment and Biobehavioral Catch-up (ABC) is an evidence-based parenting program that aims to enhance parental sensitivity. Fidelity to ABC is defined as the frequency, accuracy, and quality of in-the-moment comments that coaches make to parents. Fidelity to ABC is monitored by the ABC team throughout the training year, with certification determined at the end. Post-certification, coaches deliver ABC independently. Leveraging dissemination efforts at a non-profit agency, the study examines trajectories of the frequency of commenting from the period under the developer’s supervision to the period when supervision shifted to localized fidelity support. Using Hierarchical linear modeling, results were that under the developer’s supervision, parent coaches were estimated to be making 1.55 comments per minute. The estimated rate of commenting when coaches were delivering ABC independently was significantly lower than the period under the developer’s supervision. This study highlights the need for fidelity monitoring and support, as high fidelity ultimately leads to intended outcomes. Assessing this fidelity monitoring model will also inform the development of supports at other ABC dissemination sites.
Description
Keywords
Attachment, Dissemination, Families, Fidelity, Intervention, Treatment