Fidelity and Monitoring of Multidimensional Treatment Foster Care Using a Multi-Media Internet-based System
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Abstract
Background
While there have been numerous validated interventions developed to address a variety behavioral and mental health concerns, it has been difficult to move these treatment approaches into the community while retaining the effectiveness found in the clinical trials. Multidimensional Treatment Foster Care (MTFC) is a well-researched psycho-social intervention in which multiple treatment agents work in a coordinated manner to address behavioral issues and provide young people with in vivo behavioral interventions. There have been several randomized controlled trials that have demonstrated the effectiveness of this intervention approach, and program developers have created a clear set of criteria by which implementing agencies can demonstrate that they are meeting fidelity criteria. These criteria have been formalized as a certification process. A central difficulty for community agencies is the concern that despite their efforts and expense in trying to run this complex intervention, they may not be certified and it is difficult to track progress toward this goal during development. This presentation describes an Internet-based Treatment Fidelity Monitoring System created to assist MTFC consultants and implementing agencies to improve clinical outcomes by moving more efficiently towards and maintaining fidelity of program implementation.
Methods
The research will involve a randomized control trial nested design, wherein foster adolescents (as secondary subjects, with foster-parent report on their behavior) and their foster family will be nested within community agency and agency nested within TFC consultant. Community agencies will be randomly assigned to one of two conditions: Internet-based Fidelity implementation vs. usual care MTFC implementation.
Results
Preliminary tests of this fidelity monitoring system have demonstrated feasibility for community agency, foster parent, and program consultant use with favorable initial data regarding ease of use and follow through by participants. Current research efforts will be reviewed regarding this fidelity management system and a randomized controlled trial of the effectiveness of the system. Within our effectiveness examination, we will focus on outcomes related to increasing MTFC agency and program consultant efficiency in moving towards criteria for implementation fidelity. This presentation will include qualitative data from beta-testing agencies, quantitative data regarding system usage, and information about the iterative process of program development with key stakeholders, program developers, and website developers. The system will be demonstrated along with key features that assist MTFC implementing agencies to move toward program certification with full information.
Conclusions
A critical contributor to unsuccessful dissemination efforts is the prohibitive need for intensive monitoring by intervention developers/consultants; a difficulty exacerbated as the distance increases between these individuals and community agencies attempting to achieve and maintain implementation fidelity. The current project proposes one possible solution to this problem by developing an Internet-based fidelity feedback mechanism for program consultants, clinical supervisors and interventionists as part of an empirically-validated program’s data collection and reporting functions; mechanisms that would link local clinical programs and nationally-based dissemination teams through direct, immediate, high quality data and make it more likely that local service organizations can implement services at the highest possible level of fidelity and achieve stronger community-based intervention outcomes.
While there have been numerous validated interventions developed to address a variety behavioral and mental health concerns, it has been difficult to move these treatment approaches into the community while retaining the effectiveness found in the clinical trials. Multidimensional Treatment Foster Care (MTFC) is a well-researched psycho-social intervention in which multiple treatment agents work in a coordinated manner to address behavioral issues and provide young people with in vivo behavioral interventions. There have been several randomized controlled trials that have demonstrated the effectiveness of this intervention approach, and program developers have created a clear set of criteria by which implementing agencies can demonstrate that they are meeting fidelity criteria. These criteria have been formalized as a certification process. A central difficulty for community agencies is the concern that despite their efforts and expense in trying to run this complex intervention, they may not be certified and it is difficult to track progress toward this goal during development. This presentation describes an Internet-based Treatment Fidelity Monitoring System created to assist MTFC consultants and implementing agencies to improve clinical outcomes by moving more efficiently towards and maintaining fidelity of program implementation.
Methods
The research will involve a randomized control trial nested design, wherein foster adolescents (as secondary subjects, with foster-parent report on their behavior) and their foster family will be nested within community agency and agency nested within TFC consultant. Community agencies will be randomly assigned to one of two conditions: Internet-based Fidelity implementation vs. usual care MTFC implementation.
Results
Preliminary tests of this fidelity monitoring system have demonstrated feasibility for community agency, foster parent, and program consultant use with favorable initial data regarding ease of use and follow through by participants. Current research efforts will be reviewed regarding this fidelity management system and a randomized controlled trial of the effectiveness of the system. Within our effectiveness examination, we will focus on outcomes related to increasing MTFC agency and program consultant efficiency in moving towards criteria for implementation fidelity. This presentation will include qualitative data from beta-testing agencies, quantitative data regarding system usage, and information about the iterative process of program development with key stakeholders, program developers, and website developers. The system will be demonstrated along with key features that assist MTFC implementing agencies to move toward program certification with full information.
Conclusions
A critical contributor to unsuccessful dissemination efforts is the prohibitive need for intensive monitoring by intervention developers/consultants; a difficulty exacerbated as the distance increases between these individuals and community agencies attempting to achieve and maintain implementation fidelity. The current project proposes one possible solution to this problem by developing an Internet-based fidelity feedback mechanism for program consultants, clinical supervisors and interventionists as part of an empirically-validated program’s data collection and reporting functions; mechanisms that would link local clinical programs and nationally-based dissemination teams through direct, immediate, high quality data and make it more likely that local service organizations can implement services at the highest possible level of fidelity and achieve stronger community-based intervention outcomes.
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