Treatment Fidelity during Therapist Initial Training is related to Subsequent Effectiveness of Parent Management Training—Oregon Model

Abstract

The present study examined the association between treatment fidelity during therapist initial training and subsequent treatment outcome of Parent Management Training - Oregon model (PMTO) in The Netherlands. Clinically referred children (N = 86) aged 4 to 11 years and their parents received PMTO and were assessed at four time points: at baseline, and after 6, 12, and 18 months. Difference scores between baseline and follow-up assessments of externalizing behavior problems, parenting practices, and parental psychopathology and parents' overall ratings of working alliance, were correlated with treatment fidelity scores measured prior to the intervention. Furthermore, differences in therapists' fidelity scores between treatment completers and drop-outs were examined. Results showed that higher fidelity scores of PMTO therapists during initial training were associated with larger improvements in externalizing behavior, parenting practices, and parental psychopathology, especially after 18 months. In addition, parents who completed the treatment had a significantly more adherent therapist than families who dropped out. However, the correlations between treatment fidelity and working alliance were non-significant. These findings indicate that therapists' high adherence to the PMTO treatment principles during initial training decreases the chance of treatment drop-out and positively affects the longterm effectiveness of PMTO.

Process Evaluation of a Stress Management Program for Low-Income Pregnant Women: The SMART Moms/Mamás LÍSTAS Project

“…Greater quality of instruction also resulted in 81% of participants feeling more confident in using the CBSM skills they learned. These results are consistent with that of a parenting management program that showed greater quality of instruction to be associated with lower parental stress and enhanced parenting skills up to 18 months postintervention (Thijssen, Albrecht, Muris, & de Ruiter, 2017).…”

Therapist Factors Matter: A Systematic Review of Parent Interventions Directed at Children’s Behavior Problems

“…In two studies (Hukkelberg & Ogden, 2013; Thijssen, Albrecht, Muris, & Ruiter, 2017), therapist fidelity to intervention was associated with improvements in child externalizing behaviors, but there were more studies that were unable to find a relationship between fidelity and change in behavior problems (Giannotta et al, 2019; Kjøbli et al, 2012; Maaskant et al, 2016). The relationship between the therapist’s fidelity and parenting stress was not consistently demonstrated as the two studies assessing this outcome (using the same assessment measure of fidelity) reached different results: Higher fidelity scores were linked to increased improvements in parental stress and psychopathology (Thijssen et al, 2017) in contrast with the findings where the higher the therapist fidelity, the greater the increase in parenting stress (Maaskant et al, 2016). It is worth mentioning that significant differences were found in the two study samples (biological parents and foster parents, respectively).…”

Parental Occupational Executive Training: Feasibility and Parental Perceptions

“…Fidelity. Therapist fidelity was assessed using the therapist's session reports, Part B, including items that examined whether the therapists implemented the required knowledge and followed the intervention's exact structure (Thijssen et al, 2017). For example, therapists circled targeted functional domains (self-care, morning routine, dressing, eating, participating in meals, playing and self-employment, leisure, social functioning, evening routine, and learning functions); up to two EF (inhibition, nonverbal/verbal working memory, emotional regulation, planning/problem-solving) they determined as underlying the targeted goal; and additional factors affecting the child's performance (problems in child's nonexecutive skills, challenges attributed to parental characteristics or cultural context, task characteristics, or none); and estimated their emotional support (listening, empathy, reframing, guidance, encouragement) using a binary response of yes or no.…”