Browsing by Subject "Treatment integrity"

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    Examining the role of treatment adherence and instructional quality in the context of a content-area reading instructional treatment for eighth graders
    (2018-05-04) Capin, Philip James; Vaughn, Sharon, 1952-; Clemens, Nathan; Roberts, Greg; Toste, Jessica
    Relatively few reading intervention studies have investigated treatment fidelity data and the extent to which fidelity is associated with student outcomes. This study extends the extant research by examining treatment adherence and quality and the extent to which these components of treatment fidelity relate to posttest performance for eighth grade students who received a content-area reading treatment targeting improved content knowledge and reading comprehension. Data were analyzed to address the following questions: (1) Do treatment adherence and quality indicate a general factor of fidelity? (2) Do treatment adherence and quality predict greater performance in content acquisition and reading comprehension? (3) To what extent are the effects of treatment adherence and quality on student outcomes moderated by teacher’s classroom management performance and student characteristics (pretest reading performance level, limited English proficiency status, special education status, and gender)? Situated within a larger randomized controlled trial examining the effects of a content-area instructional program, this study used data from the subsample of students (n = 790) in classes randomly assigned to treatment. Results showed a general factor of fidelity did not sufficiently predict treatment adherence and quality. Treatment adherence and quality were significant, positive predictors of content knowledge performance, which indicates that increases in both dimensions of treatment fidelity were associated with improvements in content knowledge posttest performance. However, a significant interaction between treatment adherence and quality was present. Interaction plots revealed instructional quality led to greater levels of posttest performance for students in classrooms with high levels of instructional adherence; however, instructional quality was not strongly associated with posttest performance when instruction was implemented with low adherence. Results also showed instructional quality was a significant, positive predictor of performance on the ASK Reading Comprehension subtest. Moderator analyses revealed teachers’ classroom management and students’ pretest performance influenced the effects of treatment adherence and quality on student outcomes. These findings help to elucidate the conditions under which the PACT instructional treatment leads to improved outcomes and, more broadly, underscores the importance of examining dimensions of treatment fidelity and the interplay between treatment fidelity dimensions and other teacher- and student-level characteristics when interpreting treatment effects.
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    Navigating two alliances with evidence-based practices : relating therapist competence and adherence to youth and caregiver therapeutic alliances
    (2018-08-14) Woo, Rebecca Yao Hay; Bearman, Sarah Kate
    Despite extensive research on specific treatments and relationship factors in child and adolescent psychotherapy, comparatively little research has addressed in-session process variables concerning how a treatment is delivered. This study examines treatment integrity (therapist adherence and competence) in the delivery of evidence-based practice (EBP) elements and the two therapeutic alliances in youth psychotherapy: the youth-therapist alliance and the caregiver-therapist alliance. Data come from an initial test of a modular, trans-diagnostic therapy protocol of EBP elements with 14 therapists seeing 24 clients and were analyzed using Hierarchical Linear Modeling (HLM). Therapist adherence, competence, and alliance were all measured observationally. In this sample, therapist adherence contributed a small, statistically trending effect on child alliance (d [subscript wt] = 0.008, p = 0.055), while therapist competence did not predict child alliance. Therapist adherence exhibited a small, statistically significant effect on parent alliance (d [subscript wt] = 0.007, p = 0.023). Therapist competence exhibited a large, statistically trending effect on parent alliance (d [subscript wt] = 0.675, p = 0.059). Results suggest that EBP does not harm the therapeutic alliance and may support a stronger alliance with caregivers. Future research should use larger samples to explore how these constructs interact with therapist, youth, and caregiver characteristics to produce outcomes.