1. Background Treatment fidelity in group based parent training: Predicting change in parent and child behaviour Dr. Catrin Eames, Bangor University, UK c.eames@bangor.ac.uk Research questions and methods Study 1 results Study 2 results Treatment fidelity The extent to which an intervention is delivered as intended (IOM, 2001; Mihalic et al., 2002) Both content (adherence) and process skills (competence) during intervention delivery should be monitored Tools to monitor treatment fidelity necessary in order to preserve the behaviour change mechanisms of the intervention Especially important when interventions are widely disseminated Figure 3: Intervention groups divided into either high or low groups of leader levels of praise and control group mean change in parent level of praise. Background to research questions Parent Training (PT) widely disseminated for Conduct Disorder (CD) in the UK Twelve IY BASIC PT groups delivered in Sure Start areas (government funded initiatives, similar to Head Start) Participants Parents of pre-school children identified as ‘at risk’ of developing CD 2: 1 randomisation intervention: control Intention to treat sample N = 104 intervention, 49 control Per protocol intervention only sample N = 86 Hutchings, Bywater, Daley, Gardner, Whitaker, Jones, Eames & Edwards (2007). BMJ, 334, 678-682. Bywater, Hutchings, Daley, Whitaker, Yeo, Jones, Eames & Edwards (2009). British Journal of Psychiatry, 195, 1-7. Study 2 results Study 1: Do group leader behaviours predict change in parenting behaviour after parent training? Eames et al (2009). Treatment Fidelity as a predictor of behaviour change in parents attending group based parent training. Child: Care Health and Development, 35 (5), 603-612. Study 2: What are the key mechanisms of change in parent training, and are group leader behaviours associated with these changes in parent behaviour? Eames et al (2010). The impact of group leaders behaviour on parent acquisition of key parenting skills during parent training. Behaviour Research and Therapy, 48 (12), 1221-1226 Global and specific parent praise combined Leader praise exposure score calculated Control families received zero levels of exposure Leader exposure divided into high and low (N=52 for both groups, above or below the median) One-way ANOVA – parental praise change and leader praise Parent reflective statements and questions combined Leader exposure score calculated as before High, low and control One-way ANOVA: parent reflective change and leader reflective behaviour Figure 4: Intervention groups divided into either high or low groups of leader levels of reflective behaviours and control group mean change in parent level of reflection. Significant effect observed: F [2, 150] = 10. 90, p<.01 Significant effect observed: F [2, 150] = 4.81, p<.01 Leader positive behaviour Positive parenting Child positive behaviour Child compliance to direct commands (ß =.28, p<.01; R 2 =.08) (ß =.60, p<.01; R 2 =.36) (ß =.23, p<.05; R 2 =.05) Leader physical encouragement Change parenting scale ECBI - Intensity ECBI - Problem (ß =.26, p<.01; R 2 =.07) (ß =.23, p<.05; R 2 =.05) (ß =.34, p<.01; R 2 =.12) Figure 1: Observed leader behaviour predicting change in observed parent and child behaviour Figure 2: Observed leader behaviour predicting change in parent reported parenting style and child behaviour change Regression analysis Leader level of praise and parent praise  =.35, p<.01; R 2 =.12 Leader level of reflective behaviours and parent reflective behaviours  =.20, p<.05; R 2 =.04 Composite scores provide an overall account of construct outcome Positive parenting composite considered a partial mediator of child outcome Parental praise and reflective behaviours appears to be the key mechanisms of change within the positive parenting composite The more groups leaders model these behaviours, the more likely parents are to implement them in the home Table 2: Trends and significant ANCOVA for DPICS categories (N = 153). The IY programme comprises 12 weekly 2-hour sessions Divided into four sections Play and relationship building Praise and reward Effective limit setting Handling misbehavior One session from each section selected for coding both leaders of each intervention group Exposure score coded per parent, based on attendance Parent and child data collected pre- and post- intervention on separate home visits Change scores calculated pre-post for parent and child data All parent-reported and observed-parent behaviours demonstrated moderate to very large magnitude of change (Cohen’s 1988 criteria) ANOVA: LOT composites (low, medium and high) and observed-parent composites and parent-reported behaviours Stepwise regression Leader  Parent Parent  Child Even in groups when programme content is adhered to, there are differences in the way groups are delivered Variations in treatment delivery can have an impact on intervention outcome Having tools in place to aid monitoring treatment delivery helps ensure dissemination of evidence-based interventions are effective and delivered with fidelity, and should differences occur, these can be accounted for