Increasing parents treatment integrity to a homework interventio

University of Connecticut OpenCommons@UConn Doctoral Dissertations University of Connecticut Graduate School 5-11-2013 Increasing Parents' Treatment Integrity to a Homework Intervention Through Conjoint Behavioral Consultation and Performance Feedback Melissa Collier-Meek University of Connecticut, melissa.edu Follow this and additional works at: https://opencommons.edu/dissertations Recommended Citation Collier-Meek, Melissa, "Increasing Parents' Treatment Integrity to a Homework Intervention Through Conjoint Behavioral Consultation and Performance Feedback" (2013).edu/dissertations/91 Increasing Parents’ Treatment Integrity to a Homework Intervention Through Conjoint Behavioral Consultation and Performance Feedback Melissa Annette Collier-Meek, PhD University of Connecticut, 2013 Assessing treatment integrity is vital to ensure an intervention is implemented as planned and to appropriately evaluate student outcomes. Performance feedback, an empirically supported method to increase low treatment integrity levels, has been evaluated primarily with school personnel. Homework is a widely used and effective school practice, which some students struggle to complete with accuracy. These students may benefit from interventions that necessitate implementation by parents.

To date, no study has systematically assessed (a) parent treatment integrity levels, (b) the delivery of performance feedback to parents, and (c) the agreement between parent self-report and permanent product data. To begin the process of answering these questions, this dissertation assessed parents’ implementation within a randomized multiple baseline design. To improve fifth-grade students’ homework completion and accuracy, parents and teachers participated in Conjoint Behavioral Consultation to individualize a parent-implemented homework intervention. Parents’ treatment integrity was below the criterion, though specific level and variability differed across participants.

Following the receipt of performance feedback, parents’ implementation briefly increased, but attrition issues preclude drawing conclusions about causality. In addition, (a) the effectiveness of the homework intervention, (b) the relationship between the homework intervention and treatment integrity data, and (c) acceptability and social validity of the intervention were evaluated. ! Increasing Parents’ Treatment Integrity to a Homework Intervention Through Conjoint Behavioral Consultation and Performance Feedback Melissa Annette Collier-Meek B., University of Connecticut, 2008 M., University of Connecticut, 2009 A Dissertation Submitted in Partial Fulfillment of the Requirement for the Degree of Doctor of Philosophy at the University of Connecticut 2013 i Copyright by Melissa Annette Collier-Meek 2013 ii ! PARENTS’ TREATMENT INTEGRITY 1 ! Acknowledgements The inspiration, encouragement, and support of several people made this project possible. My advisor, Dr.

Lisa Sanetti, encouraged my research interests, provided me with a platform to actively study treatment integrity, and supported every aspect of this dissertation. Her work proved foundational to my present research and I am grateful for both her expertise and kindness. The support and perspective of Dr. Anne Farrell has helped to shape both this project and my development as a scholar.

Feedback from and discussion with Dr. Sandra Chafouleas and my readers, Dr. Thomas Kratochwill and Dr. Daniel Maggin, was essential for the development of the project.

Justin Byron provided gracious help during the data review process. I am thankful to my cohort who all served as continual sources of joy, inspiration, and support. Finally, I am endlessly grateful to my husband, Andy Meek, whose steadfast support and thoughtful encouragement made it possible for me to pursue this work. ! PARENTS’ TREATMENT INTEGRITY 2 ! Table of Contents Abstract Page ……………………………………………………………………………………… Title Page ………………………………………………………………………………………….ii Approval Page ……………………………………………………………………………….

1 Table of Contents. 2 List of Tables. 4 List of Figures. 5 List of Appendices.

8 Statement of the Problem. 10 Chapter II: Review of the Literature. 41 Conjoint Behavioral Consultation. 48 Purpose of Study.

56 Research Questions and Hypotheses. 57 Chapter III: Methods. 78 Chapter IV: Results. 82 Primary Research Questions.

82 Secondary Research Questions. 85 Exploratory Research Question. 97 Levels of Treatment Integrity. 98 Self-Report Data.

100 ! PARENTS’ TREATMENT INTEGRITY 3 ! Treatment Integrity Dimensions. 111 ! ! PARENTS’ TREATMENT INTEGRITY 4 ! List of Tables Table 1. Parent Participants' Pre- and Post- Ratings of the Homework Problem Checklist……. Participants' Ratings of Consultation and Intervention Social Validity Measures.

Parent Participants' Pre- and Post- Ratings of the Parental Self-Efficacy in Helping the Child Succeed in School. Participant Responsiveness as Measured by Motivation and Cooperation Across Phases. Program Differentiation Across Phases.96 ! PARENTS’ TREATMENT INTEGRITY 5 ! List of Figures Figure 1. CONSORT diagram illustrating recruitment, screening, and implementation.

Parents' Percent Adherence to Homework Intervention Across Sessions ……………. Students' Percent Homework Completion and Accuracy Across Sessions ………. Students' Minutes of Exposure to Homework Intervention Across Sessions ………. Students' Percent Participant Adherence to Homework Intervention Across Sessions .…93 ! PARENTS’ TREATMENT INTEGRITY 6 ! List of Appendices Appendix A Sample Daily Homework Sheet….……135 Appendix B Sample Homework Steps Graph .……136 Appendix C Sample Homework Accuracy Graph ………….……137 Appendix D Sample Weekly Reward System ….……138 Appendix E Adherence Checklist ….……139 Appendix F Treatment Integrity Record ….……140 Appendix G Sample Modified Daily Homework Sheet ….……141 Appendix H Teacher Adherence Checklist.……142 Appendix I Sample Homework Report….……143 Appendix J Homework Problem Checklist…………………………………….……144 Appendix K Parental Self-Efficacy in Helping the Child Succeed in School.……145 Appendix L Consultant Evaluation Form…….………146 Appendix M Behavior Intervention Rating Scale ….147 Appendix N Children's Intervention Rating Profile ….……149 Appendix 0 Introductory Email to Principal and Teachers ….……150 Appendix P Consent Form for Teachers ….……151 Appendix Q Phone Script: Teacher Initial Call to Parents …….…155 Appendix R Consent From for Parents ….……157 Appendix S Parental Permission ….…161 Appendix T Student Assent ….………………165 Appendix U Screening Criteria Notice ….……166 Appendix V CBC Treatment Integrity Checklists ….……168 ! PARENTS’ TREATMENT INTEGRITY 7 ! Appendix W Homework Completion and Accuracy Form ….…171 Appendix X Sample Training ….……172 Appendix Y Check In Meeting Script ….……178 Appendix X Performance Feedback Script….……179 ! PARENTS’ TREATMENT INTEGRITY 8 ! Chapter I: Introduction Implementation of evidence-based practice requires adequate treatment integrity (Kratochwill et al., 2010; Peterson, Homer, & Wonderlich, 1982; Sanetti & Kratochwill, 2009a).

Treatment integrity is conceptualized as a multidimensional construct (e., Power et al., 2005), but simply defined, it is the degree to which an intervention is implemented as planned (Gresham, 1989; Sanetti & Kratochwill, 2009a). In general, low levels of treatment integrity have been associated with poorer intervention outcomes (e. High levels of treatment integrity typically sustain for only a brief period following intervention training, and support is often required to increase these levels (Noell, Witt, Gilbertson, Ranier, & Freeland, 1997; Noell et al. Performance feedback, an empirically supported method of promoting high levels of treatment integrity for school-based interventions, involves a brief meeting during which the intervention and implementation data are reviewed (Burns, Peter, & Noell, 2008; Noell, 2010; Sanetti, Luiselli, & Handler, 2007).

For evidence-based practice to be fully realized in the field of education, educators must assess treatment integrity and apply strategies, such as performance feedback, to promote high levels of treatment integrity. Homework, a widely used task assigned by school personnel intended to be completed during non-school hours, is considered to be an effective academic practice (Cooper, 1989; Cooper, Civey Robinson, & Patall, 2006). Some students struggle with homework completion and accuracy, which may decrease the potential benefits of homework such as increased retention, understanding of content, and study skills (Bryan & Burnstein, 2004; Cooper & Valentine, 2001). Typical interventions to increase homework completion or accuracy may include school, parent, and self-management components (Jenson et al.

Such ! PARENTS’ TREATMENT INTEGRITY 9 ! interventions, implemented by parents, have been effective in increasing students’ homework completion and accuracy (e., Weiner, Sheridan, & Jenson, 1998). Indeed, the proper administration of many student interventions requires implementation by parents, in addition to school staff. Further, research has demonstrated the importance and positive outcomes associated with family-school partnerships (Hoover-Dempsey & Sandler, 1995; Hoover-Dempsey et al. To facilitate and structure this collaboration, Conjoint Behavioral Consultation (CBC) was developed (Sheridan, 1997; Sheridan, Kratochwill, & Bergan, 1996).

In CBC, a consultant leads a series of meetings during which parents and teachers (a) discuss a student problem, (b) collect baseline data, (c) design an intervention, (d) implement the intervention with continued data collection, and (e) discuss intervention effectiveness. Research consistently supports CBC as an effective method of collaboration and improving student outcomes (e., Garbacz et al., 2008; Weiner et al. Recent studies have begun to examine treatment integrity in reference to CBC (Sheridan et al., 2009; Swanger- Gagne, Garbacz, & Sheridan, 2009). As treatment integrity begins to be assessed in relation to CBC, researchers will have to grapple with (a) how to systematically assess parental treatment integrity, and (b) what appropriate and evidence-based strategies can be used when parents’ levels of treatment integrity are low.

As of yet, no such strategies have been identified. Although performance feedback has consistently been shown to increase the treatment integrity of school staff (e., Noell et al., 1997, 2005), only two studies have attempted to examine the effect of performance feedback on parents’ treatment integrity, and varying design flaws preclude drawing conclusions (Bonar, 2007; Connell, 2009). As such, this dissertation was designed and implemented to ! PARENTS’ TREATMENT INTEGRITY 10 ! systematically examine parents’ treatment integrity and assesses the effectiveness of performance feedback on low parent treatment integrity. Statement of the Problem To promote student outcomes, evidence-based interventions should be implemented with a high degree of treatment integrity (Sanetti & Kratochwill, 2009a).

However, school personnel’s treatment integrity levels typically decrease following implementation training, and support is needed to sustain acceptable levels of treatment integrity (e., Noell et al. Performance feedback is an empirically based method to increase school personnel’s treatment integrity (e., Noell et al., 1997, 2005; Solomon, Klein, & Politylo, 2012). Homework is a widely used and effective educational practice (Cooper et al., 2006), which many student struggle to complete with accuracy (Bryan & Burnstein, 2004). Interventions to improve homework completion and accuracy often include parent involvement (Jenson et al.

Furthermore, family-school collaboration has been shown to be beneficial for student outcomes (Christenson & Reschly, 2010; Sheridan et al. CBC is an evidence-based framework for designing and implementing interventions with teachers and parents (Sheridan et al., 1996), but supporting research does not typically include systematic treatment integrity data (Collier-Meek & Sanetti, 2012; Sheridan et al., 2009; Swanger-Gange et al. In fact, appropriate methods for assessing and increasing parent treatment integrity have not been identified, despite the need for acceptable levels of treatment integrity during student intervention implementation, regardless of treatment agents (e. This dissertation was developed to address these gaps in the literature through the application of assessment and promotion methods successfully used in the school setting to parents’ treatment integrity.

! PARENTS’ TREATMENT INTEGRITY 11 ! Chapter II: Review of the Literature Recent education movements have highlighted the importance of utilizing evidence- based practice to promote improved student outcomes (Kazdin, 2004; Kratochwill, 2007; Kratochwill, Albers, & Steele-Shernoff, 2004). Evidence-based practice involves employing scientific methods within school practice, utilizing high-quality research to inform intervention choice and implementation decisions, and evaluating the effectiveness of implemented interventions (Drake, Latimer, Leff, McHugo, Burns, 2004; Kratochwill et al. Evidence- based interventions must be implemented with a high level of treatment integrity to optimize positive student outcomes (Kratochwill et al., 2010; Sanetti & Kratochwill, 2009a, Walker, 2004). Therefore, as evidence-based practices are promoted in schools, strategies to increase the treatment integrity of diverse treatment agents (e., school personnel, parents) must be considered and assessed.

Treatment Integrity Treatment integrity (also known as treatment fidelity, procedural reliability, or intervention implementation) can be considered the degree to which an intervention is implemented as planned (Gresham, 1989; Sanetti & Kratochwill, 2009a). Though a critical construct in intervention research, adequate levels of treatment integrity are often assumed, rather than assessed (Dane & Schneider, 1998; Dusenbury, Brannigan, Falco, & Hansen, 2003; Gresham, Gansle, Noell, Cohen, & Rosenblum, 2003; Hill, King, Lemons, & Partanen, 2012; McIntyre, Gresham, DiGennaro, & Reed, 2007; Naleppa & Cagle, 2010; Peterson et al., 1982; Sanetti, Gritter, & Dobey, 2009). However, without implementation data, experimental validity may be affected and study conclusions may be flawed. Only more recently has psychological and ! PARENTS’ TREATMENT INTEGRITY 12 ! educational research attended to treatment integrity, including studies that evaluate the relationship to student outcomes (e.