Intervention Integrity and Interventionists' Behaviors in a School-Based Preventive Intervention

Introduction: Implementation fidelity is the degree to which programs are implemented as planned by program developers (Dusenbury et al, 2003). The need to focus on intervention integrity has become clearly apparent in school-based interventions for children’s behavioral and emotional adjustment (Cochrane & Laux, 2008; Kratochwill & Shernoff, 2004). Traditionally, intervention fidelity has referred to therapist adherence to an intervention manual (Gresham et al, 1993). However, it has recently been argued that other important ways to conceptualize intervention fidelity besides procedural or content integrity should be considered, including measuring the therapists’ ability to effectively carry out the intervention (Leff et al, 2009). Indicators of therapists’ competence in quality of implementation could include the extent to which therapists effectively manage child behavior, respond to child questions, and encourage children’s active involvement in sessions. One of the chief concerns in the dissemination of evidence-based interventions is that the quality of program implementation may not be maintained and expected positive effects may not occur (Boxmeyer et al, 2008). The lack of concordant effects between procedural integrity and quality of implementation was evident in a dissemination study in which counselors who received intensive training in Coping Power produced behavioral changes in the aggressive students and had good quality of implementation, in comparison to children seen by less intensively trained counselors, but the two intervention conditions surprisingly did not differ in indicators of procedural integrity (e.g. number of objectives completed) (Lochman et al, 2009). 

Method:

The current study will extend research on different methods of considering the integrity of an intervention, and will examine how clinician reports of intervention fidelity are related to observers’ ratings of interventionists’ behaviors within school-based group sessions for aggressive children. For these analyses 180 4^th grade children received the Coping Power child component in 30 different small groups in 10 schools. Children were screened as being aggressive based on teacher and parent reports, and the purpose of the indicated preventive intervention was to reduce their risk for subsequent drug use, school violence, and delinquent behavior.

Results:

Over 900 group sessions have been coded. Twenty-seven ratings were made of interventionists’ behaviors in the early, middle and ending parts of sessions (in 15 minute intervals). These ratings fall into four factors for: behavioral management strategies, interventionists’ leadership style, teaching strategies, and managing deviant talk.

Discussion:

Interrater reliability will be reported. HLM analyses will address two primary questions: (1) the degree to which interventionists’ behaviors in sessions (therapist competence) predict their procedural intervention integrity, and (2) the degree to which therapist competence and procedural intervention integrity predict changes in children’s externalizing behavior, using parent and teacher BASC ratings before and after the program. Implications of these findings for prevention science will be discussed.