No abstract

No abstract

Maintaining treatment fidelity when implementing evidence-based interventions is a significant challenge. The inability to deliver in-person services due to the COVID-19 pandemic critically challenged the foundation of implementation fidelity for home visiting programs across the globe. The Attachment and Biobehavioral Catch-Up (ABC) program is an evidence-based home visiting intervention designed to increase sensitivity in parents of infants who have experienced early adversity. ABC's community effectiveness is due to rigorous fidelity monitoring and supervision. Fidelity is measured by microanalytic coding of parenting opportunities and "in-the-moment" commenting, the active ingredient of ABC. In this study, we examined intervention fidelity among parent coaches implementing ABC through telehealth. Random 5-min clips from 510 telehealth ABC session videos conducted by 91 parent coaches at 48 agencies were coded for their frequency and quality of in-the-moment comments. On average, parent coaches were able to exceed in-person commenting fidelity standards when implementing ABC through the telehealth format. The active fidelity monitoring and supervision inherent to ABC's dissemination afforded a smooth transition to implementing ABC through telehealth while adhering to fidelity standards.Procedural and clinical challenges to telehealth implementation are discussed, along with future directions for telehealth program effectiveness.

This study uses a key informant approach to understand the nature, extent, and quality of outpatient mental health services for children in the child welfare system (CWS) in the United States. We interviewed 89 county child welfare administrators to determine the status of outpatient mental health services and provide recommendations for enhancing care and service delivery. Developed for this study (Caring for Children in Child Welfare), the interview was incorporated in the second formal data collection wave (i.e., 18 months after study baseline assessment) of the National Survey of Child and Adolescent Well-Being. The results highlighted general variability in the degree to which these agencies used evidence-based interventions within outpatient services, demonstrated clinical expertise with this population, and met the needs of their families. Community agency use of evidence-based interventions was found to predict their effectiveness in improving clients' mental health problems. Proposed suggestions for service improvement varied across domains and reflected the need for more communication/coordination, service access, options and resources, and practice refinements to accommodate families' needs. We discuss the implications of these recommendations from CWS stakeholders for enhancing the service delivery system.

No abstract

During the COVID-19 pandemic, home visiting services for families with young children pivoted to continue providing services virtually. One such service was Attachment and Biobehavioral Catch-up (ABC), a brief prevention/intervention program targeting increased parental sensitivity. Seventy families participated in a sensitivity assessment before and after receiving ABC. Forty-three families received the program fully through telehealth, and twenty-seven families received the program through an in-person/telehealth hybrid format. Parent sensitivity was assessed pre- and post-intervention, and results suggested that when ABC was delivered through a telehealth or hybrid format, parents showed increased following the lead and decreased intrusiveness from pre- to post-intervention, with moderate effect sizes. Ongoing supervision in the model, weekly fidelity maintenance checks, and the flexibility of families and parent coaches likely contributed to the maintenance of significant change in parental sensitivity from pre- to post-intervention during the move from face-to-face home visiting to the provision of virtual services.

Monitoring fidelity to evidence-based interventions is a critical component of successful dissemination. Attachment and Biobehavioral Catch-Up is a nationally and internationally disseminated evidence-based early intervention that uses observational methods (e.g., video review and content coding) to monitor fidelity as well as video conferencing to provide consistent and interactive feedback. The current study examined patterns of change in fidelity data, measured by "in-the-moment" commenting rate, across 2 cohorts of parent coaches. Coaches demonstrated a significant increase in commenting rate across the training year. However, there was also a significant amount of individual variation, with some coaches exhibiting initial high rates of commenting and others providing limited commenting, with individually varying patterns of change across time. The within-coach variability raises the possibility of individualized supervision processes based on regular quantitative feedback. Future investigations should identify common trajectories in fidelity across coaches and factors (e.g., coach, session, organizational) that may affect commenting. Public Significance StatementThis study found that all trained providers were able to reach fidelity to an evidence-based intervention (Attachment and Biobehavioral Catch-Up); however, there was also significant withinprovider variability in meeting fidelity requirements during the training period. Although follow-up studies are needed, results suggest the potential of an individualized, data-driven approach to supervision to support evidence-based intervention fidelity.

No abstract