2.50
Hdl Handle:
http://hdl.handle.net/10755/157347
Type:
Presentation
Title:
ENHANCING TREATMENT FIDELITY IN AN RCT WITH FAMILIES
Abstract:
ENHANCING TREATMENT FIDELITY IN AN RCT WITH FAMILIES
Conference Sponsor:Western Institute of Nursing
Conference Year:2010
Author:Schepp, Karen G., PhD, PMHNP-BC, FAAN
P.I. Institution Name:University of Washington
Title:Associate Professor
Contact Address:Box 357263, School of Nursing, Seattle, WA, 98195, USA
Co-Authors:HeeYoung Lee
PURPOSE: The purpose of this paper is to present an RCT that involved families and to describe how treatment fidelity was monitored, maintained, and enhanced. Treatment fidelity refers to the strategies used to enhance reliability and validity of behavioral interventions. Maintaining treatment fidelity is a challenge in any behavioral intervention but it is especially challenging when there are multiple families involved, all of whom have an adolescent with a major mental illness and multiple family members with of varying ages, experiences, roles, and educational levels. The complexity increases with cultural variations among and within the families as well. The RCT that will be addressed in this presentation was a psychoeducational program for families with an adolescent with schizophrenia. The aims of the study were to improve the familyÆs level of functioning as well as the functioning of the adolescent. Rationale: As more families become the primary caregivers for their chronically ill family member, we need to know how best to help families care for their family member and support each other in the process. Caregiver burden and the consequences are well known and yet few family studies exist that study the family as a unit of analysis. The theoretical basis for the family component of this family study was Bowen's Family Systems Theory which maintains that illness in one member affects the whole family. Treatment fidelity is especially important to monitor because of the complexity of families and the potential for confounding variables that can interfere with the treatment.
METHODS: The sample for this study was 40 families with an adolescent aged 15-19 with a severe mental illness. The family members included the adolescent, siblings, parents, and any other family members the family defined as having an important role in caring for the adolescent. This trial consisted of two arms to which families were randomly assigned, the treatment group which received the psychoeducation program and the control group that received treatment as usual which was basically medication management from their primary mental health provider in a monthly 15 minute appointment. The intervention consisted of 12 2-hour sessions over the course of 14 months with content on symptom management and stress reduction skills. The strategies included pretesting and simplifying the intervention, detailed manual with checklists, materials prepared for each age group, videotaping and audio taping all sessions, debriefing sessions, evaluations, monitoring participants' ability to process content.
RESULTS: Treatment fidelity was monitored after each session. Estimates were computed through evaluations and interrater agreement resulting in approximately 90% agreement overall.
IMPLICATIONS: Nurses are often hesitant to involve families in their research. RCTs involving multiple family members are challenging but can be done with structure, careful planning and evaluation. Close monitoring of each session provides the opportunity to identify when the intervention is getting off track and needs to be brought back on track. Examples of threats to treatment fidelity and strategies to estimate treatment fidelity will be presented from this RCT.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleENHANCING TREATMENT FIDELITY IN AN RCT WITH FAMILIESen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157347-
dc.description.abstract<table><tr><td colspan="2" class="item-title">ENHANCING TREATMENT FIDELITY IN AN RCT WITH FAMILIES</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Schepp, Karen G., PhD, PMHNP-BC, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Washington</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Associate Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Box 357263, School of Nursing, Seattle, WA, 98195, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">kschepp@u.washington.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">HeeYoung Lee</td></tr><tr><td colspan="2" class="item-abstract">PURPOSE: The purpose of this paper is to present an RCT that involved families and to describe how treatment fidelity was monitored, maintained, and enhanced. Treatment fidelity refers to the strategies used to enhance reliability and validity of behavioral interventions. Maintaining treatment fidelity is a challenge in any behavioral intervention but it is especially challenging when there are multiple families involved, all of whom have an adolescent with a major mental illness and multiple family members with of varying ages, experiences, roles, and educational levels. The complexity increases with cultural variations among and within the families as well. The RCT that will be addressed in this presentation was a psychoeducational program for families with an adolescent with schizophrenia. The aims of the study were to improve the family&AElig;s level of functioning as well as the functioning of the adolescent. Rationale: As more families become the primary caregivers for their chronically ill family member, we need to know how best to help families care for their family member and support each other in the process. Caregiver burden and the consequences are well known and yet few family studies exist that study the family as a unit of analysis. The theoretical basis for the family component of this family study was Bowen's Family Systems Theory which maintains that illness in one member affects the whole family. Treatment fidelity is especially important to monitor because of the complexity of families and the potential for confounding variables that can interfere with the treatment. <br/>METHODS: The sample for this study was 40 families with an adolescent aged 15-19 with a severe mental illness. The family members included the adolescent, siblings, parents, and any other family members the family defined as having an important role in caring for the adolescent. This trial consisted of two arms to which families were randomly assigned, the treatment group which received the psychoeducation program and the control group that received treatment as usual which was basically medication management from their primary mental health provider in a monthly 15 minute appointment. The intervention consisted of 12 2-hour sessions over the course of 14 months with content on symptom management and stress reduction skills. The strategies included pretesting and simplifying the intervention, detailed manual with checklists, materials prepared for each age group, videotaping and audio taping all sessions, debriefing sessions, evaluations, monitoring participants' ability to process content. <br/>RESULTS: Treatment fidelity was monitored after each session. Estimates were computed through evaluations and interrater agreement resulting in approximately 90% agreement overall. <br/>IMPLICATIONS: Nurses are often hesitant to involve families in their research. RCTs involving multiple family members are challenging but can be done with structure, careful planning and evaluation. Close monitoring of each session provides the opportunity to identify when the intervention is getting off track and needs to be brought back on track. Examples of threats to treatment fidelity and strategies to estimate treatment fidelity will be presented from this RCT.<br/></td></tr></table>en_GB
dc.date.available2011-10-26T19:47:27Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:47:27Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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