Evaluating process in child and family interventions: Aggression prevention as an example.

Abstract

This article reports on 2 studies designed to develop and validate a set of measures for use in evaluating processes of child and family interventions. In Study 1 responses from 187 families attending an outpatient clinic for child behavior problems were factor analyzed to identify scales, consistent across sources: Alliance (Satisfactory Relationship with Interventionist and Program Satisfaction), Parenting Skill Attainment, Child Cooperation During Session, Child Prosocial Behavior, and Child Aggressive Behavior. Study 2 focused on patterns of scale scores among 78 families taking part in a 22-week preventive intervention designed to affect family relationships, parenting, and child antisocial and prosocial behaviors. The factor structure identified in Study 1 was replicated. Scale construct validity was demonstrated through across-source convergence, sensitivity to intervention change, and ability to discriminate individual differences. Path analysis validated the scales' utility in explaining key aspects of the intervention process. Implications for evaluating processes in family interventions are discussed.

A Theoretical Model of Common Process Factors in Youth and Family Therapy

“…However, it was studied even earlier in the adult treatment literature (Bellak & Smith, 1956;Kirtner & Carwright, 1958;Strupp, Chassan, & Ewing, 1966). Client participation includes constructs that have been labeled as client effort, collaboration, client involvement in therapy, cooperation, treatment engagement, on-task behavior, and homework completion (Adelman et al, 1984;Braswell et al, 1985;Clarke et al, 1992;Gorin, 1993;Green, 1996;Johnson, 2000;Sarlin, 1992;Tolan, Hanish, McKay, & Dickey, 2002). These studies have explored client participation with a wide variety of clients across numerous treatment settings such as school-based clinics, outpatient mental health clinics, and home-based treatment.…”

“…A participating client would also be one who completed therapeutic homework and in-session assignments. This can include (if appropriate to the tasks of therapy): verbally discussing feelings and experiences in session and responding to therapist requests (Jackson-Gilfort, Liddle, Tejada, & Dakof, 2001;Tolan et al, 2002). In addition, Colson et al (1991) defined hostility, inaccessibility, and treatment difficulty as lack of client participation in a study of hospitalized adolescents.…”

Intervention fidelity in family-based prevention counseling for adolescent problem behaviors

“…Finally, in prevention studies that do measure program implementation, greater fidelity is consistently associated with better outcomes across a diverse set of prevention models such as social skills training~Botvin, Baker, Dusenberry, Tortu, & Botvin, 1990;Kam, Greenberg, & Walls, 2003!, coordinated community-based prevention~Pentz et al, 1990!, and classroom ecology intervention~Harachi, Abbott, Catalano, Haggerty, & Fleming, 1999 Ideally, fidelity research helps to establish the internal validity of intervention studies, allowing investigators to attribute study effects directly to the interventions themselves~Carroll et al, 1994!. The most rigorous kind of fidelity research is fidelity process analysis, a subcategory of intervention process research~Tolan, Hanish, McKay, & Dickey, 2002! that investigates how the core, change-promoting elements of a given model are delivered, with the aim of understanding successes and failures in model application as well as the pragmatics of implementation with various populations Hogue, Liddle, & Rowe, 1996!.…”

Early parenting intervention aimed at maternal sensitivity and discipline: a process evaluation

“…Tolan, Hanish, McKay, and Dickey (2002) showed that the alliance between mother and intervener in a preventive intervention program aimed at improving child mental health predicted a positive change in parenting, which, in turn, predicted a decrease in antisocial child behavior. A process evaluation of the Memphis New Mothers Study by Korfmacher and colleagues (1998) demonstrated that the quality of the relationship between intervener and parent was related to increases in empathic attitudes towards their child, albeit only for mothers with high levels of psychological resources.…”

“…Other moderating aspects of the intervention process that have been found to predict positive outcomes are the extent to which the program was implemented as planned, regarding content of the intervention, and whether the number of planned contacts was reached. The term fidelity has been used to describe these aspects of the intervention process (e.g., Heinicke et al, 2000;Matthews & Hudson, 2001;Tolan et al, 2002).…”