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The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model

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Abstract

This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents’ competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.

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Funding

Support was provided by R01DA026874 (Sandler), R01DA033991 (Berkel & Mauricio), and competitive funding from the Center for Prevention Implementation Methodology (Ce-PIM), P30-DA027828 (Brown/Berkel), and Diversity Supplement R01DA033991-03S1 (Berkel/Gallo).

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Authors and Affiliations

  1. REACH Institute, Department of Psychology, Arizona State University, 900 S McAllister Ave, Tempe, AZ, 85287, USA

    Cady Berkel, Anne M. Mauricio, Irwin N. Sandler & Sharlene A. Wolchik

  2. Center for Prevention Implementation Metholodogy (Ce-PIM), Northwestern University, Chicago, IL, USA

    Carlos G. Gallo & C. Hendricks Brown

Authors
  1. Cady Berkel
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  2. Anne M. Mauricio
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  3. Irwin N. Sandler
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  4. Sharlene A. Wolchik
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  5. Carlos G. Gallo
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  6. C. Hendricks Brown
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Corresponding author

Correspondence to Cady Berkel.

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Conflict of Interest

Sandler and Wolchik are the developers of the NBP and have an LLC that trains providers to deliver the program. The remaining authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Arizona State University’s IRB and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Berkel, C., Mauricio, A.M., Sandler, I.N. et al. The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model. Prev Sci 19, 782–794 (2018). https://doi.org/10.1007/s11121-017-0855-4

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  • DOI: https://doi.org/10.1007/s11121-017-0855-4

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