Organizational and Practitioner Characteristics that Impact Implementation Fidelity of Trauma Focused-Cognitive Behavioral Therapy

Abstract

In the field of child welfare, previous research has largely focused on assessing the efficacy and effectiveness of interventions rather than the implementation of the intervention. The primary aim of this dissertation was to expand understanding of implementation fidelity of an evidence-based practice (EBP) among community setting practitioners working with trauma exposed youth impacted by the child welfare system. The goal was to document specific practitioner and organizational characteristics that may influence implementation fidelity. This dissertation is a secondary analysis of implementation fidelity of a volunteer practitioner group (N=201) that participated in TF-CBT training. To identify organizational and practitioner predictors of implementation fidelity, binary and multivariate logistical regression analyses were conducted. The following predictor variables were examined: practitioner belief in the value of EBPs; practitioner belief in personal skillset; practitioner endorsement of supervisory requirements; and, practitioner age and clinical experience. Possible moderating organizational variables, organizational readiness and management support also were explored. Analyses revealed a significant positive association between practitioner belief in their skillset and implementation fidelity. Additionally, practitioner years of experience were inversely related to implementation fidelity; the odds of implementing TF-CBT with fidelity were lower for more senior practitioners. Findings suggest the importance of including skill set enhancement components in practitioner training; such components may be particular critical for ensuring treatment fidelity among more experienced clinicians. It is well known that treatment is most effective when implemented with fidelity. Thus, ensuring treatment fidelity is incumbent upon federal, state, and private agencies charged with providing treatment. Through this lens, the applied and scholarly implications of the study’s findings are explored.