Cognitive Charateristics of Clinicians Influence Fidelity in Implementing the Attachment and Biobehavioral Catch-up Intervention

Fidelity in implementing evidence-based interventions is key to ensuring effectiveness in the community (Breitenstein et al., 2010). Understanding the factors that influence fidelity can inform efforts to enhance and monitor fidelity, hence reaching the intended outcomes of interventions (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005). Attachment and Biobehavioral Catch-up (ABC) is a 10-session parenting program for parents and children who have experienced or face adversity. ABC uses in-vivo feedback (called in the moment commenting) as an index of fidelity. Hierarchical linear growth modeling (HLM) was used to investigate the association between clinicians’ cognitive characteristics and their fidelity in implementing ABC, with fidelity defined as rate of commenting and percentage of missed opportunities to comment. One hundred and thirty-two observations were made for 22 clinicians. Cognitive flexibility significantly influenced the starting values and slopes of both percentage of missed opportunities and rate of commenting across time during the training year. Inhibitory control had a significant and favorable effect on the slope of the percentage of missed opportunities. In summary, cognitive characteristics influence fidelity to the ABC intervention. Though further study is necessary, implications for dissemination efforts are discussed.