Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation.
Rianne Verschuur, Bibi Huskens, Hubert Korzilius and 3 others
PMID 31538812WHAT IT FOUND
Certified PRT therapists showed low fidelity (30.2%).
Only two factors predicted better implementation: therapists' openness to trying new interventions and their months of experience delivering PRT. Personality, relationship quality, and child age or severity did not predict fidelity.
Key findings
01Average fidelity of PRT implementation was 30.2%, with only one therapist exceeding 80% across sessions, despite all participants being certified.
02Therapists' openness to innovation and their experience with PRT were the only significant predictors of fidelity, accounting for 36% of the variance.
03Therapist personality, therapist-child relationship, attitude toward evidence-based practices in general, and child characteristics were not significantly related to fidelity.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Interobserver agreement was insufficient for 34% of videotapes, which may affect the accuracy of the fidelity scores. The sample was small (41 therapists), limiting the ability to detect smaller effects. The study was cross-sectional, so it cannot determine if openness to innovation causes higher fidelity or if higher fidelity leads to more openness. The fidelity coding system used differed from standard measures, and participants were highly certified therapists, so results may not generalize to community settings. The therapist-child relationship was measured by self-report, which can be biased.
Declared interests
The authors declared no potential conflicts of interest and received no financial support.
The easy way to misread this
Do not assume that personality traits or a good relationship with the child will lead to high fidelity in PRT implementation. This study found that only openness to innovation and experience with PRT predicted fidelity, and even certified therapists showed low overall fidelity.