Effects of Fidelity-Focused Consultation on Clinicians’ Implementation: An Exploratory Multiple Baseline Design

  • EB CaronEmail author
  • Mary Dozier
Original Article


Identification of effective consultation models could inform implementation efforts. This study examined the effects of a fidelity-focused consultation model among community-based clinicians implementing Attachment and Biobehavioral Catch-up. Fidelity data from 1217 sessions from 7 clinicians were examined in a multiple baseline design. In fidelity-focused consultation, clinicians received feedback from consultants’ fidelity coding, and also coded their own fidelity. Clinicians’ fidelity increased after fidelity-focused consultation began, but did not increase during other training periods. Fidelity was sustained for 30 months after consultation ended. Findings suggest that consultation procedures involving fidelity coding feedback and self-monitoring of fidelity may promote implementation outcomes.


Implementation Fidelity Consultation Self-monitoring 



We would like to thank the parent coaches and ABC fidelity coders and consultants who participated in this study. We also thank Patria Weston-Lee and the Consuelo Foundation for leading the implementation effort in Hawaii.


This study was supported by the National Institutes of Health under Grants R01 MH052135, R01 MH074374, and R01 MH084135.

Compliance with Ethical Standards

Conflict of interest

EB Caron declares that she has no conflict of interest. Mary Dozier declares that she has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


  1. Beckman, M., Bohman, B., Forsberg, L., Rasmussen, F., & Ghaderi, A. (2017). Supervision in motivational interviewing: An exploratory study. Behavioural and Cognitive Psychotherapy, 45, 351–365. Scholar
  2. Beidas, R. S., Edmunds, J. M., Marcus, S. C., & Kendall, P. C. (2012). Training and consultation to promote implementation of an empirically supported treatment: A randomized trial. Psychiatric Services, 63, 660–665. Scholar
  3. Bernard, K., Dozier, M., Bick, J., Lewis-Morrarty, E., Lindheim, O., & Carlson, E. (2012). Enhancing attachment organization among maltreated children: Results of a randomized clinical trial. Child Development, 83, 623–636. Scholar
  4. Bernard, K., Hostinar, C. E., & Dozier, M. (2015a). Intervention effects on diurnal cortisol rhythms of child protective services-referred infants in early childhood: Preschool follow-up results of a randomized clinical trial. JAMA Pediatrics, 169, 112–119. Scholar
  5. Bernard, K., Simons, R., & Dozier, M. (2015b). Effects of an attachment-based intervention on child protective services-referred mothers’ event-related potentials to children’s emotions. Child Development, 86, 1673–1684. Scholar
  6. Caron, E., Bernard, K., & Dozier, M. (2018). In vivo feedback predicts parent behavior change in the Attachment and Biobehavioral Catch-up intervention. Journal of Clinical Child and Adolescent Psychology, 47, S35–S46. Scholar
  7. Caron, E., Weston-Lee, P., Haggerty, D., & Dozier, M. (2016). Community implementation outcomes of Attachment and Biobehavioral Catch-up. Child Abuse and Neglect, 53, 128–137. Scholar
  8. Cicchetti, D. V., & Sparrow, S. A. (1981). Developing criteria for establishing interrater reliability of specific items: Applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86, 127–137.Google Scholar
  9. Darnell, D., Dunn, C., Atkins, D., Ingraham, L., & Zatzick, D. (2016). A randomized evaluation of motivational interviewing training for mandated implementation of alcohol screening and brief intervention in trauma centers. Journal of Substance Abuse Treatment, 60, 36–44. Scholar
  10. Dennin, M. K., & Ellis, M. V. (2003). Effects of a method of self-supervision for counselor trainees. Journal of Counseling Psychology, 50, 69–83. Scholar
  11. Dunn, C., Darnell, D., Atkins, D. C., Hallgren, K. A., Imel, Z. E., Bumgardner, K., et al. (2016). Within-provider variability in motivational interviewing integrity for three years after MI training: Does time heal? Journal of Substance Abuse Treatment, 65, 74–82. Scholar
  12. Edmunds, J. M., Beidas, R. S., & Kendall, P. C. (2013). Dissemination and implementation of evidence-based practices: Training and consultation as implementation strategies. Clinical Psychology: Science and Practice, 20, 152–165. Scholar
  13. Eiraldi, R., Mautone, J. A., Khanna, M. S., Power, T. J., Orapallo, A., Cacia, J., et al. (2018). Group CBT for externalizing disorders in urban schools: Effect of training strategy on treatment fidelity and child outcomes. Behavior Therapy, 49, 538–550. Scholar
  14. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. FMHI Publication No. 231. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network.
  15. Funderburk, B., Chaffin, M., Bard, E., Shanley, J., Bard, D., & Berliner, L. (2015). Comparing client outcomes for two evidence-based treatment consultation strategies. Journal of Clinical Child and Adolescent Psychology, 44, 730–741. Scholar
  16. Garcia, I., James, R. W., Bischof, P., & Baroffio, A. (2017). Self-observation and peer feedback as a faculty development approach for problem-based learning tutors: A program evaluation. Teaching and Learning in Medicine, 29, 313–325. Scholar
  17. Henggeler, S. W., Chapman, J. E., Rowland, M. D., Halliday-Boykins, C. A., Randall, J., Shackelford, J., & Schoenwald, S. K. (2008). Statewide adoption and initial implementation of contingency management for substance-abusing adolescents. Journal of Consulting and Clinical Psychology, 76, 556–567. Scholar
  18. Hulleman, C. S., & Cordray, D. S. (2009). Moving from the lab to the field: The role of fidelity and achieved relative intervention strength. Journal of Research on Educational Effectiveness, 2, 88–110. Scholar
  19. Isenhart, C., Dieperink, E., Thuras, P., Fuller, B., Stull, L., Koets, N., & Lenox, R. (2014). Training and maintaining motivational interviewing skills in a clinical trial. Journal of Substance Use, 19, 164–170. Scholar
  20. Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O’Brien, M. A., & Oxman, A. D. (2006). Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. BMJ Quality and Safety, 15, 433–436. Scholar
  21. Lind, T., Raby, K. L., Caron, E. B., Roben, C. K., & Dozier, M. (2017). Enhancing executive functioning among toddlers in foster care with an attachment-based intervention. Development and Psychopathology, 29, 575–586. Scholar
  22. Lyon, A. R., Pullmann, M. D., Whitaker, K., Ludwig, K., Wasse, J. K., & McCauley, E. (2017). A digital feedback system to support implementation of measurement-based care by school-based mental health clinicians. Journal of Clinical Child and Adolescent Psychology. Scholar
  23. Meade, E. B., Dozier, M., & Bernard, K. (2014). Using video feedback as a tool in training parent coaches: promising results from a single-subject design. Attachment and Human Development, 16, 356–370. Scholar
  24. Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72, 1050–1062. Scholar
  25. Murray, H. (2017). Evaluation of a trauma-focused CBT training programme for IAPT services. Behavioural and Cognitive Psychotherapy, 45, 467–482. Scholar
  26. Nadeem, E., Gleacher, A., & Beidas, R. S. (2013). Consultation as an implementation strategy for evidence-based practices across multiple contexts: Unpacking the black box. Administration and Policy in Mental Health and Mental Health Services Research, 40, 439–450. Scholar
  27. National Advisory Mental Health Council. (2001). Blueprint for change: Research on child and adolescent mental health. A report by the National Advisory Mental Health Council’s Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment. Bethesda, MD: National Institutes of Health, National Institute of Mental Health.
  28. Persson, J. E., Bohman, B., Forsberg, L., Beckman, M., Tynelius, P., Rasmussen, F., & Ghaderi, A. (2016). Proficiency in motivational interviewing among nurses in child health services following workshop and supervision with systematic feedback. PLoS ONE, 11, e0163624. Scholar
  29. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods. Thousand Oaks, CA: Sage.Google Scholar
  30. Riemer, M., Rosof-Williams, J., & Bickman, L. (2005). Theories related to changing clinician practice. Child and Adolescent Psychiatric Clinics of North America, 14, 241–254. Scholar
  31. Roben, C. K., Dozier, M., Caron, E., & Bernard, K. (2017). Moving an evidence-based parenting program into the community. Child Development, 88, 1447–1452. Scholar
  32. Schoenwald, S. K., Sheidow, A. J., & Letourneau, E. J. (2004). Toward effective quality assurance in evidence-based practice: Links between expert consultation, therapist fidelity, and child outcomes. Journal of Clinical Child and Adolescent Psychology, 33, 94–104. Scholar
  33. Schwalbe, C. S., Oh, H. Y., & Zweben, A. (2014). Sustaining motivational interviewing: A meta-analysis of training studies. Addiction, 109, 1287–1294. Scholar
  34. Snijders, T. A. B. (2005). Fixed and random effects. In B. S. Everitt & D. C. Howell (Eds.), Encyclopedia of statistics in behavioral science (pp. 664–665). Chichester: Wiley.Google Scholar
  35. Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012). Bridging research and practice: models for dissemination and implementation research. American Journal of Preventive Medicine, 43, 337–350. Scholar
  36. Warren, J. S., Nelson, P. L., Mondragon, S. A., Baldwin, S. A., & Burlingame, G. M. (2010). Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings. Journal of Consulting and Clinical Psychology, 78, 144–155. Scholar
  37. Webster-Stratton, C. H., Reid, M. J., & Marsenich, L. (2014). Improving therapist fidelity during implementation of evidence-based practices: Incredible Years Program. Psychiatric Services, 65, 789–795. Scholar
  38. Weck, F., Kaufmann, Y. M., & Höfling, V. (2017). Competence feedback improves CBT competence in trainee therapists: A randomized controlled pilot study. Psychotherapy Research, 27, 501–509. Scholar
  39. Weisz, J. R., Ugueto, A. M., Herren, J., Afienko, S. R., & Rutt, C. (2011). Kernels vs. ears, and other questions for a science of treatment dissemination. Clinical Psychology: Science and Practice, 18, 41–46. Scholar
  40. Yarger, H. A., Bernard, K., Caron, E., Wallin, A., & Dozier, M. (2019). Enhancing parenting quality for young children adopted internationally: Results of a randomized controlled trial. Journal of Clinical Child and Adolescent Psychology. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of Connecticut Health CenterWest HartfordUSA
  2. 2.Department of Psychological and Brain SciencesUniversity of DelawareNewarkUSA

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