Intervention Implementation Integrity Within Conjoint Behavioral Consultation: Strategies for Working with Families

Mental health services in school systems can take many forms. Behavioral consultation is one efficacious and commonly used form of indirect service delivery. Indirect service delivery models are unique in that an intermediate person, the consultee, provides treatment directly to a client. The effectiveness of the intervention depends in large part on the degree to which the consultee implements the intervention as designed. Families of children at-risk for school failure may experience challenges implementing an intervention developed through a consultation model. Some researchers have noted that the implementation of treatment plans is influenced by “events in the real world” including stress and limited economic and social resources (Cordray and Pion (in: R. R. Bootzin & P. E. McKnight (eds.) Strengthening research methodology: Psychological measurement and evaluation, 2006); Watson et al. (in: Levensky and O’Donohue (eds.) Promoting treatment adherence: A practical handbook for health care providers, 2006). The purpose of this paper is to present descriptive findings from a large-scale consultation study that introduced unique strategies to promote intervention implementation integrity for children experiencing behavioral difficulties. Participants were separated into two groups, a general, mainstream group and a diverse, at-risk group (i.e., participants who were of low-income status, racially diverse, linguistically diverse, living in a single parent home, or who had less than a high school diploma). Consultants used general strategies (e.g., training and education) for maximizing intervention implementation integrity with all families and additional support strategies (e.g., regular contacts and additional home visits) with families at-risk. Reports via self-report and permanent product measures indicated families in both groups adhered to intervention plans with high integrity when participating in CBC. These strategies were illustrated in a case study format.