The feasibility of measuring fidelity of implementation in parent-child interaction therapy: A clinician and parent fidelity study

PURPOSE: Measuring fidelity of implementation in parent-child interaction therapy (PCIT) involves assessing the training delivered by clinicians and how parents implement the techniques with their children. The aim of this study was to determine the feasibility of measuring fidelity of implementation for a PCIT intervention designed for young children with Down syndrome. METHOD: We applied a framework to measure dosage, adherence, quality, and participant responsiveness using a mixed methods approach with observational and interview data. RESULT: Our results showed that clinicians delivered 94% of the planned dosage; they adhered to the goals of program and reached the quality criterion in 4/6 rated sessions. Parents described their ability to engage with the program and perceived that it changed how they interacted and communicated with their children. Parents were unable to collect dosage data, but did adhere to 7/9 of the targeted techniques and met the quality criterion on 6/9 of these. It was also possible to measure the children's responsiveness scores when interacting with parents during the intervention. CONCLUSION: This study revealed the opportunities and challenges that occur when measuring fidelity of implementation. There is a need to refine definitions of fidelity measures and to develop appropriate measurement tools so that a more consistent and useful framework can be used by speech-language pathologists (SLPs) to measure fidelity.