Incredible Years Wales:
The Welsh Centre for Promoting
the Incredible Years Programmes
Title:
“What
makes parent training effective? The role of treatment fidelity”
Presented
by: Anne
Carby, Institute of Psychiatry, London.
Authors:
Carby, A. and Scott, S.
Abstract:
The paper
describes the Treatment Fidelity Scale (TFS) which was developed using video
taped observations of parenting groups in a multi-centre controlled trial,
funded by the Department of Health, to evaluate the effectiveness of the Webster-Stratton
parent management training for 110 children referred to clinics with severe
antisocial behaviour (Scott et al, 2001).
A multi-disciplinary
team of thirteen practicing clinicians which included Psychiatrists, Psychologists,
Family Therapists, Senior Community Nurses and Occupational Therapists underwent
a three-month training process prior to delivering the treatment to a total
of fifteen parenting groups across five treatment sites in the south east
of England. Parents were allocated in each of five sites to waiting list or
active treatment conditions and videotaped recordings were available for all
groups. Each group ran for 12-16 weeks. In the main trial, child antisocial
behaviour reduced considerably, by 1.06 standard deviations.
The degree
of adherence by therapists to prescribed treatment procedures, and skill of
delivery of the behaviourally-based intervention for parents were measured
to evaluation of treatment fidelity. Eleven dimensions proved to have satisfactory
inter-rater reliability and were entered into a factor analysis. One factor
predominated, and covered activities by therapists to ensure behaviour change
by parents, such as use of role-play and reviewing homework with praise. This
factor was then assessed for its contribution to child antisocial behaviour
change and was shown to significantly predict the amount of change (p = <.02).
It is concluded that treatment fidelity can be measured reliably and that
it is an important contributor to the effectiveness of evidence based interventions
when delivered in service settings. This has implications for the training
and ongoing supervision of mental health practitioners.
Scott, S. Spender, Q., Doolan, M., Jacobs, B. and Aspland,
H. C. (2001) Multicentre controlled trial of parenting groups for childhood
antisocial behaviour in clinical practice. British Medical Journal, 323, 194
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