Improving Adherence and Competence of Delivery of Classroom-Based Prevention Via Practice-Based Coaching: Year 1 Results of an Efficacy Trial of Best in CLASS

Introduction: The number of young children demonstrating problem behavior in early childhood settings that interferes with social/emotional development continues to rise, and many of these young children will not receive intervention services until approximately age 9, which is alarming as evidence shows early problem behavior is alterable with early intervention. BEST in CLASS was created to address a gap in the early intervention literature by emphasizing the classroom as an ecological system with a focus on improving positive teacher-child interactions to reduce instances of challenging behavior. BEST in CLASS is a value-added model that utilizes training and practice-based coaching in order to maximize the integrity of implementation (quantity and quality) of the components of the intervention, many of which occur naturally in preschool classrooms.

In order to draw valid inferences from randomized clinical trials (RCTs) evaluating intervention programs, investigators must establish that the program was implemented as intended. Treatment adherence refers to the extent to which BEST in CLASS is delivered as designed (i.e., delivery of prescribed interventions). Competence refers to the level of skill and degree of responsiveness demonstrated by the teacher when delivering the technical and relational elements prescribed by the BEST in CLASS protocol. Each component captures a unique aspect of treatment integrity that is important to assess in RCTs.

Methods: Trained observers measured treatment integrity on two dimensions (Adherence and Competence) using a 7-point Likert-type scale. Observations of teachers in BEST in CLASS (n = 26) and comparison (n = 27) conditions occurred at eight time points over approximately five months during year 1 of a 4-year RCT examining the efficacy of BEST in CLASS.

Results: Results indicate that at both the end of intervention and one month after intervention completion teachers in the BEST in CLASS condition had higher Adherence and Competence ratings than did teachers in the comparison condition. Results also indicate that teachers in the BEST in CLASS condition had increases in Adherence and Competence across time that corresponds to the weekly practice-based coaching they received on specific intervention components.

Discussion: These findings suggest that practice-based coaching is a promising tool for increasing teachers’ adherence to treatment delivery as well as the competence with which they implement treatment components.