WITHDRAWN: Are Common Element Therapist Skills Sufficient to Improve Behavior Problems?: Family Check-up Vs. Treatment As Usual

Introduction. Maintaining fidelity to the protocol of an evidence-based family prevention program is critical when going to scale. Variation in clinical fidelity to family-centered prevention programs, which comprises both adherence to the content of the protocol and the quality or acumen with which it is delivered, is consistently, but not uniformly, related to changes in parenting practices and child outcomes. It is important to understand which domains of a protocol are most important to inform training and supervision and identify the necessary and sufficient aspects of fidelity that need to be measured, which would guide training and streamline fidelity monitoring. Previous research has established the reliability and validity of the COACH fidelity rating system (Chiapa, et al., 2015; Smith et al., 2013), which is used with the Family Check-Up (FCU) program, an evidence-based brief intervention for caregivers of youth ages 2 to 17 (Dishion & Stormshak, 2007). Previous findings indicate that therapists delivering the FCU differ on specific fidelity dimensions compared to therapists practicing treatment as usual (TAU); we were interested in determining if these differences were indeed meaningful; that is, whether they relate to improvements in child behavior problems. Methods. 75 family intervention sessions were coded for fidelity using the COACH (50 FCU and 25 TAU). Children were an average age of 11.6 years (49% female). Trained coders achieved reliable fidelity ratings (ICC = .74). Caregiver reported child conduct problems (pre and post) were used (alpha = .83). Results. Path analysis was conducted in Mplus (Version 7.2) using Bayesian estimation, which produces more reliable estimates with smaller samples. Overall, higher fidelity was related to greater reductions in child conduct problem post-intervention, controlling for pretreatment levels. Multiple group analysis tested the significance of the interaction between individual COACH dimension scores (there are 5) and intervention condition (FCU vs. TAU). Conceptual accuracy in the FCU model was significantly related to child conduct–the other dimensions were not. Conclusions. The COACH rating system assesses meaningful dimensions of family–centered intervention that relate to child outcomes. Further, it appears that the FCU’s conceptual framework is an important dimension that both distinguishes FCU sessions from TAU but also predicts change. It seems that having a framework from which to apply other therapeutic skills improves outcomes. If these findings can be replicated, therapist training might focus on this key dimension of the FCU and fidelity rating might be able to be constrained to this one dimension.