WITHDRAWN: Dissemination of an Evidence-Based Parent-Training Program: Evaluation of Its Implementation in a Child Protection Agency

Purpose

Each year, in the United States, one child out of 58 is a victim of maltreatment. These victims are left with severe consequences. Since parenting practices are an important risk factor of maltreatment and its consequences, parents under child protection supervision are often offered or ordered to participate in parent-training programs (PTP).These programs aim to improve parenting practices to ultimately prevent maltreatment recidivism and support child adaptation. Incredible Years (IY) is an evidence-based, adaptable and widely disseminated PTP. It has been implemented since 2003 in a child protection agency in Montreal (Canada). During the dissemination of a program, the risks of modification are highly possible. It is therefore essential to evaluate the fidelity of its implementation. The purposes of this study are: (1) to describe the implementation of IY in a child protection agency in Montreal in comparison to the protocol adopted and previously approved by the IY founder (2) to test if the fidelity of implementation varies over time.

Method

IY was implemented with 38 groups of parents between 2003 and 2013. Facilitators (n=18) and participants (n=228) completed questionnaires in order to monitor implementation’s fidelity of the program. 14 sessions were filmed to gather observational data. Implementation components that were considered are:  dosage (number of sessions offered and duration), adherence to the program (9 indicators of methods delivery by facilitators), participation (presence and engagement rated by facilitators), and quality (participants’ satisfaction with the program). Descriptive statistics compare what was delivered to what had been outlined in the protocol. For each component, percentages were categorized according to the following criteria: high fidelity implementation (≥75%), medium fidelity (between 61% and 74%) and low fidelity (≤ 60%).Pearson correlation analyses evaluate if there is a linear relationship between the fidelity of implementation and the passage of time.

Results

Dosage : 92% of the scheduled sessions were offered; this percentage decreased throughout the years (r=-0,42; p≤0.01). Adherence: two indicators were not implemented with high fidelity: 42% of the scheduled role play were done, but this percentage increased over the years (r=0,66; p≤0.01); 70% of the scheduled vignettes were shown and this percentage stayed stable throughout the years (r=0,16; p>0,05). Other adherence indicators range between 91 and 98 %. Participation: 71% of participants were present in the session; this percentage stayed stable throughout the years (r=0,01; p>0,05). Participants obtained an implication score of 78%; this score decreased over the years (r=-0,26; p≤0.01). Quality: Overall satisfaction of participants is of 89%; this percentage stayed stable throughout the years (r=-0.03; p>0,05).

Conclusion

The results indicate that the implementation is generally of medium to high fidelity. They also confirm that IY may be generalized to different cultural and clinical settings. Discussion addresses the barriers and facilitators of the implementation’s fidelity of a PTP in child protection services.