The current study aims to clarify how therapist competence/adherence relates to client characteristics, consumer satisfaction, and dropout rates for family interventions for schizophrenia. The study was conducted as part of a larger treatment trial which will test the efficacy of a culturally informed therapy for schizophrenia (CIT-S), against a treatment as usual (TAU) comparison group. Encouragingly, overall, therapists were found to demonstrate very high levels of competence/adherence in both treatment conditions. As hypothesized, less severe psychiatric symptoms and lower ratings of family difficulty were related to greater therapist competence/ adherence in several non-specific (e.g., establishing rapport) and CIT-S specific (fostering family cohesion) domains of treatment. Also as hypothesized, certain aspects of greater competence/ adherence were related to lower dropout rates and higher consumer satisfaction. Contrary to expectations, general emotional distress and family cohesion were not related to competence/adherence. This study suggests that clinicians and clinical researchers may want to take certain client characteristics into account when evaluating therapist performance, choosing clients who are most suitable for therapy, and providing feedback to supervisees. Additionally, clinicians and researchers may want to monitor therapist performance early on in treatment in order to address issues which may impact consumer satisfaction and treatment retention.

The growing number of school-aged children displaying challenging behavior has increased the need for effective interventions. School-based consultants (SBC) report using behavioral consultation to assist teachers in designing behavior intervention plans (BIP) that help students engage in appropriate behavior in the classroom. Research indicates that direct training methods increase teacher's implementation of the BIP. One commonly used direct training method, performance feedback (PF), is used to assess teachers' treatment integrity. Research also indicates that checklists (non-direct measures) are more cost efficient methods. The purpose of this paper was to evaluate a direct training method used to train teachers to self-monitor their own implementation of their student's BIP in an effort to increase accuracy of self-report and sustainable treatment integrity outcomes. Two educators who worked with children with challenging behavior participated in this study. The effect of using self-monitoring on both educators' implementation of BIPs was evaluated. Results indicated that both educators' implementation increased and maintained into the maintenance phase. Also, results indicated that educator's accuracy of reporting was similar to independent observers.

The success of behavioral interventions depends not just on the quality of procedures employed but on the extent to which procedures are implemented. This study used a multiple-baseline across participants single-case design to assess the impact of an online data management application (the Individual Student Information System; ISIS- SWIS) on the fidelity and impact of individual student behavior support plans in typical school contexts. Three students with patterns of problem behavior and their supporting adults participated in the study. The research question examined if a functional relation exists between use of (a) performance self-assessment and (b) student impact assessment via ISIS-SWIS on the fidelity of behavior support plan implementation by adults and improvement in academic engagement and problem behavior by students. Results indicate the efficacy of ISIS-SWIS in improving treatment fidelity, decreasing student problem behavior, and increasing student academic engagement. Potential contributions of the study are discussed in terms of establishing efficient data systems for schools to use in monitoring staff and student behavior and using these data in a meaningful way that results in improved student outcomes and sustained behavior change.

Emerging adulthood is a unique developmental stage during which significant transitions in living environment, social networks, personal responsibilities, and identity development occur. Stress resulting from such transitions relates to increases in health risk behaviors. As such, emerging adults (EAs) have a high prevalence of substance use disorders and sexually transmitted infections. However, EAs are less likely to seek treatment. Therefore, brief methods of intervention, such as Motivational Interviewing (MI) and the Family Check-up (FCU), might be useful approaches for working with this unique population. MI and the FCU are linked with decreases in health risk behaviors. The FCU comprises three sessions: an initial interview, an ecological assessment, and a feedback session. MI techniques are used during the feedback session. Only a few studies have investigated treatment fidelity of the FCU and no studies have examined the use of MI techniques within the FCU. The current study aims to assess treatment fidelity of the FCU, specifically measuring the extent to which therapists adhere to principles of MI during FCU feedback sessions. The current study also aims to determine if a positive relationship exists between therapists’ MI-adherence and client change talk (CT), and to determine if MI-adherence and client CT predict post-intervention health risk behaviors among the 134 EAs who participated in the FCU. Measures of health risk behaviors were collected pre- and post-intervention. MI-adherence was measured with the Motivational Interviewing Treatment Integrity (MITI 4) and client change language was measured using the Client Language Easy Rating Scale (CLEAR) and the Motivational Interviewing Skills Code 2.1 (MISC 2.1) self-exploration code. Four therapists were assessed for treatment fidelity. Results indicate overall fair treatment fidelity. Significant differences between therapists were observed. MI-adherence was positively related to client CT, but not client self-exploration. Several indicators of MI-adherence predicted decreases in EA post-intervention health risk behaviors. Client CT predicted a decrease in EA post-intervention marijuana quantity and client self-exploration predicted increases in marijuana quantity and number of sexual partners. These results have important implications for FCU training and implementation, and indicate that MI-adherence might be a mechanism of change within the FCU intervention.

With accountability on the rise, educators are changing their focus to optimizing instructional strategies in the classroom. Their job performance depends upon their ability to show progress on child outcomes. One way teachers advance this process is by executing more evidence-based practices in their classroom. There is a lack of research in early childhood that report treatment integrity of the treatment package. This study utilized a multicomponent coaching intervention to increasing treatment fidelity of teacher implementation of naturalistic teaching strategies in an early childhood classroom. This coaching intervention could prove to be more efficient and practical for educators. This study added to the external validity and generalization of the findings in an early childhood classroom by using one-two year old children with social communication delays. This study found a functional relationship between training early childhood teachers through a multicomponent coaching intervention and the increase in treatment fidelity of implementing naturalistic teaching strategies with children with communication delays. The percentage of child responses per opportunity increased once the teachers implemented the strategies.

xiii, 122 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / This dissertation study explored the dimensions of fidelity to aid both researchers and practitioners in their measurement of the construct and use of the data. Understanding the dimensions of fidelity is important for three reasons: (a) limited agreement on a definition, (b) variability in measurement, and (c) inconsistent relations demonstrated between fidelity and outcomes. Leaders in the fields of program evaluation, behavioral health, psychology, and education have begun to promote an expanded definition of fidelity that looks beyond whether surface level components of interventions were delivered to include examination of whether interventions are delivered with quality and whether students are engaged. With this issue in mind, an expanded definition of fidelity was used to explore surface/content dimensions of fidelity or total fidelity, quality/process dimensions of fidelity, and student engagement. Specifically, this study examined how these dimensions relate to each other and how each dimension relates to student literacy outcomes. Multi-process multi-level models were used to study the interrelations among the dimensions of fidelity and the interrelations among the group level fidelity measures and multiple measures of student literacy development. The results of this study indicated that the construct of fidelity is multidimensional and potentially more complicated than has been discussed in the literature to date. When examining the relations among the dimensions of fidelity, total fidelity and quality were highly related, quality and engagement may be related, and total fidelity and engagement were not related. The relation between total fidelity and student outcomes was in the opposite direction of what was hypothesized--lower total fidelity was related to higher student outcomes. The relation between student engagement and student outcomes was in the hypothesized direction--higher engagement was related to higher student outcomes. The relation between quality of delivery and student outcomes was also in the hypothesized direction with higher quality related to higher student outcomes. The results highlight several issues related to fidelity that need to be considered by both researchers (measuring multiple components, repeated assessment, data analytic methods) and practitioners (how and what to measure, general variability in implementation, use of the data) in the field of education. / Committee at large: Elizabeth Ham, Co-Chairperson, Special Education and Clinical Sciences; Kenneth Merrell, Co-Chairperson, Special Education and Clinical Sciences; David Chard, Member, Special Education and Clinical Sciences; Yvonne Braun, Outside Member, Sociology

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To advance social work practice and decrease the research practice gap, this dissertation followed a model development paradigm consisting of several phases. Based on the task-centered model of social work practice and motivational interviewing, a new combined model was construed. The two underlying models were analyzed and synthesized, using technical eclecticism as the integrative approach. The resulting combined model was described by guidelines and manualized. To test the combined model in an applied setting, a study was designed in collaboration with social workers at a substance abuse counseling center. There, the combined model intervention was implemented in an outpatient medication assisted treatment program dispensing methadone and buprenorphine to a mainly African-American population. The agency program aimed at detoxification, but also provided methadone maintenance. It offered additional groups and acupuncture. Ten clients and four social work practitioners participated in the intervention study. The study used a mixed-method approach in data collection and analysis. Client practitioner verbal interaction was recorded using digital audio recording. The digital audio files were loaded directly into Atlas.ti software to be used for analysis. Qualitative data analysis with Atlas.ti was performed for two research tasks, a) assessing implementation fidelity of the manual based intervention and b) exploring model development aspects to improve model guidelines. Treatment fidelity was analyzed through deductive coding and frequency counts. Model development analysis was performed similar to a grounded theory model and used content analysis and constant comparison methodologies. Addiction Severity Index and Readiness Ruler, urine drug screens, problem change, and task accomplishment ratings were used as quantitative outcome measures to produce time series data in order to chart individual case progress in a single system design. After testing the intervention, a focus group with participating practitioners was conducted. Overall beneficence with clients improving and progressing successfully in the program was found. The integration of the underlying models was deemed successful. Their elements were found to be complementary and intricately linked. Crucial for successful implementation is that the program environment supports and accepts client choices. Model guidelines were reviewed and improved for further field testing.