Internet-based Fidelity Enhancement of MTFC

DESCRIPTION (provided by applicant): The fields of mental health, child welfare, and juvenile justice are jointly faced with the challenge of reducing the prevalence of antisocial behavior among adolescents. In the last 20 years, conduct disorders have moved from being considered intractable difficulties to having difficult but available solutions. Empirically-validated interventions are now being widely disseminated, but the replication of the results from clinical trials in community settings remains problematic. The systems, which produced impressive effects in a research-context, are difficult to replicate without intensive monitoring of fidelity by the intervention developers. Intensive monitoring is a barrier toward adoption, in particular, as the distance between the adopter and developer increases so does cost. At the same time, states, communities, and agencies are under increasing pressure to implement those intervention services that have been shown to be most effective. One possible solution to this problem is to develop feedback mechanisms for supervisors and interventionists as part of the data collection and reporting functions with an Internet-based system. Such a system could link local clinical programs and nationally-based dissemination teams through direct, immediate to high quality data, and would make it more likely that local service organizations are able to implement services at the highest possible fidelity. As fidelity of these empirically-validated treatments has been shown to be related to the quality of their outcomes, it is of critical importance to develop innovative service delivery systems that increase fidelity in the dissemination of these proven treatment approaches. This project would develop and test the feasibility and satisfaction with an enhanced Internet-based supervision/fidelity system among agencies delivering Multidimensional Treatment Foster Care (MTFC). Our proposed system will include: (a) a secure website with multiple levels of access restrictions for data storage, display of reports (both graphical and tabular) and observations for dynamic feedback; (b) computer-mediated forms of clinical (e.g. daily reporting of child behavior) and supervisory ratings and activities (e.g., program tasks such as therapy appointments and clinical meetings) tailored to the participating program with both Internet-based and automated-phone-based response formats; and (c) computer-mediated video observation (clinical meetings & individual sessions). This proposed system would record (via computer digital video camera) essential clinical staff and foster parent meetings, compress and encrypt the video data for transmission via the Internet, and the secure transmission of the video data over the Internet for coding and reporting.