Smith Justin D, Dishion Thomas J, Shaw Daniel S, Wilson Melvin N
Child and Family Center, University of Oregon.
J Consult Clin Psychol. 2013 Dec;81(6):962-74. doi: 10.1037/a0033950. Epub 2013 Jul 29.
This study examines observations of client in-session engagement and fidelity of implementation to the Family Check-Up (FCU) as they relate to improvements in caregivers' positive behavior support (PBS) and children's problem behavior in the context of a randomized prevention trial. The psychometric properties of fidelity scores obtained with a new rating system are also explored.
The FCU feedback sessions of 79 families with children with elevated problem behavior scores at age 2 were coded by trained raters of fidelity, who used an observational coding system developed specifically for this intervention model.
Path analysis indicated that fidelity to the FCU results in greater caregiver engagement in the feedback session, which directly predicts improvements in caregivers' PBS 1 year later (β = 0.06, 95% CI [.007, .129]). Similarly, engagement and PBS directly predict reductions in children's problem behavior measured 2 years later (β = -0.24, 95% CI [-.664, -.019]).
These results suggest fidelity within the context of this randomized intervention trial. Ratings of fidelity to the FCU covary with observed improvements in parenting and children's problem behavior in early childhood. Overall reliability of the fidelity scores was found to be acceptable, but some single-item reliability estimates were low, suggesting revisions to the rating system might be needed. Accurately assessing fidelity and understanding its relationship to change during intervention studies is an underdeveloped area of research and has revealed some inconsistent findings. Our results shed light on the mixed conclusions of previous studies, suggesting that future research ought to assess the role of intervening variable effects, such as observed engagement.
本研究考察了在一项随机预防试验背景下，客户在治疗过程中的参与度以及对家庭检查（FCU）实施的保真度，因为它们与照顾者积极行为支持（PBS）的改善以及儿童问题行为有关。还探讨了使用新评分系统获得的保真度分数的心理测量特性。
对79个孩子在2岁时问题行为得分较高的家庭的FCU反馈会议，由经过培训的保真度评分者进行编码，他们使用专门为该干预模型开发的观察编码系统。
路径分析表明，对FCU的保真度会导致照顾者在反馈会议中更多地参与，这直接预测了1年后照顾者PBS的改善（β = 0.06，95%可信区间[.007，.129]）。同样，参与度和PBS直接预测了2年后测量的儿童问题行为的减少（β = -0.24，95%可信区间[-.664，-.019]）。
这些结果表明了在该随机干预试验背景下的保真度。对FCU的保真度评分与幼儿期养育和儿童问题行为的观察改善相关。发现保真度分数的总体可靠性是可以接受的，但一些单项可靠性估计较低，表明可能需要对评分系统进行修订。在干预研究中准确评估保真度并理解其与变化的关系是一个未充分发展的研究领域，并且已经揭示了一些不一致的发现。我们的结果揭示了先前研究的混合结论，表明未来的研究应该评估干预变量效应的作用，例如观察到的参与度。
