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Dissemination & Implementation Science

Clinician characteristics associated with adherence and competence in a statewide implementation of Parent Child Interaction Therapy

(PS5-D79) Clinician Characteristics Associated with Adherence and Competence in a Statewide Implementation of Parent Child Interaction Therapy

Friday, November 18, 2022

3:00 PM – 4:00 PM EST

Location: Westside Ballroom, 5th Floor

Author(s)

Mira D H Snider, M.S.

Psychology Intern
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois

Co-Author(s)

AH

Amy Herschell, Ph.D.

Outcomes Director
Community Care Behavioral Health Organization
Pittsburgh, Pennsylvania
DK

David J. Kolko, Ph.D.

Professor
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania

Background: Clinician fidelity is often assessed during the implementation of evidence-based treatments to ensure that care is being delivered as intended by trainers. Previous research indicates that greater treatment fidelity may be associated with certain clinician characteristics, such as self-efficacy. However, few studies looking at these associations differentiate adherence and competence as unique fidelity components. The current project examines clinician characteristics that are related to higher adherence and competence ratings in a statewide implementation of Parent Child Interaction Therapy (PCIT).

Methods: Clinicians in 50 behavioral outpatient clinics (n = 100) were asked to submit videos of PCIT therapy sessions following participation in a PCIT training to be scored for adherence and competence using the Treatment Integrity Checklist and FIRST Coach Coding System. Bivariate correlations were run to identify associations between adherence, competence, and various clinician characteristics. Characteristics assessed included clinician-rated attributes of self-efficacy, growth mindset, and adaptability (measured using the Texas Christian University Survey of Organizational Functioning), as well as demographic features such as years of professional experience.

Results: Clinician adherence was significantly associated with lower feelings of self-efficacy (r = -.20, p = .022) and fewer perceived opportunities for growth (r = -.39, p = < .001) at the time of training. Similarly, clinician competence was negatively associated with years of experience (r = -.29, p = .003), self-efficacy (r = -.47, p = < .001), perceived opportunities for growth (r = -.55, p = < .001), and adaptability (r = -.41, p = < .001) at the time of training.

Conclusion: These findings suggest that in our study, both adherence and competence were inversely correlated with ratings of clinician self-efficacy and clinician perceptions of growth opportunities within their organizations. These findings also suggest that clinicians who demonstrated greater competence on an objective coding system tended to have fewer years of experience as a clinician and lower rated willingness to adapt to changing environments. Although these findings are unexpected in the context of extant literature, it reinforces the importance of accounting for multiple levels of factors (e.g., organizational, family characteristics) when attempting to understand complex implementation outcomes such as fidelity.