title: Adherence and Dosage Contributions to Parenting Program Quality.
abstract: OBJECTIVE
  The 3 most frequently examined elements of treatment fidelity are adherence, dosage, and quality. The relationships between these fidelity elements are complex, and additional research is needed to provide clarity. Improving clarity may be especially relevant to parenting programs, which tend to include direct explicit instruction (DEI) elements (i.e., instruction, modeling, and practice). The adherence to and dosage of these DEI elements are frequently assumed to improve program quality; however, little information is available to determine if such adherence and dosage affect program quality. This study examines whether adherence to and dosage of DEI elements predict quality ratings for a widely disseminated, manualized parenting program.
  
  
  METHODS
  Adherence is defined as the percentage of intervention tasks completed for each DEI element. Dosage is defined as the number of minutes and seconds spent in each intervention DEI element. Treatment fidelity is assessed for 36 of 144 sessions across 10 program facilitators. A hierarchical linear regression analysis examines the contributions of adherence and dosage in the prediction of session quality ratings.
  
  
  RESULTS
  The analysis indicates that adherence accounts for a significant proportion of the variance (26%), whereas dosage contributes a nonsignificant proportion of variance (11%). Adherence to skill practice was the strongest individual predictor (β = .445,p< .01).
  
  
  CONCLUSIONS
  Findings suggest that ensuring a high degree of adherence can contribute to quality program delivery. However, more exploration is needed to better understand the ways in which adherence and dosage of DEI elements affect program quality.
authors.affiliation: The Center for Child and Family Well Being, University of Nebraska-Lincoln.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Gross
authors.affiliation: National Research Institute for Child and Family Studies, Father Flanagan's Boys' Home, Boys Town, Nebraska.
authors.forename: W Alex
authors.initials: WA
authors.lastname: Mason
authors.affiliation: National Research Institute for Child and Family Studies, National Research Institute for Child and Family Studies, Father Flanagan's Boys' Home, Boys Town, Nebraska.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Parra
authors.affiliation: National Research Institute for Child and Family Studies, Father Flanagan's Boys' Home, Boys Town, Nebraska.
authors.forename: Robert
authors.initials: R
authors.lastname: Oats
authors.affiliation: National Research Institute for Child and Family Studies, Father Flanagan's Boys' Home, Boys Town, Nebraska.
authors.forename: Jay
authors.initials: J
authors.lastname: Ringle
authors.affiliation: School of Social Work, University of Washington, Seattle, Washington.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Haggerty
keywords: Direct explicit instruction; Parenting programs; Treatment fidelity