Implementation and process effects on prevention outcomes for middle school students.

This study addressed 5 research questions about the role of implementation (dosage and fidelity) and process (alliance with the provider, and satisfaction/engagement with the intervention) characteristics in explaining effects on parenting characteristics targeted by a selective family-focused violence prevention program for high-risk, socially influential, middle school youth. The intervention was part of a multisite trial involving random assignment of 37 schools to 4 conditions: (a) a universal intervention composed of a student social-cognitive curriculum and teacher training, (b) this selective intervention, (c) a condition combining these two interventions, and (d) a no-intervention control condition. The present study uses data from 334 participating families who attended at least 1 intervention session at which process measures of alliance with the provider and satisfaction with the intervention were administered. Although parent and child alliance with the provider and satisfaction with the program increased over the course of the intervention, these process characteristics were not associated with higher levels of intervention attendance. Higher intervention dosage was associated with more positive change in the parenting characteristics targeted by the intervention. Process characteristics had mixed positive and negative effects that were limited to a single outcome. Within structured, manualized, family-focused preventive efforts, as contrasted with less structured therapeutic interventions, these findings suggest that monitoring and improving program dosage may have stronger effects on parenting practices than improving therapeutic alliance or engagement in the intervention.