The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model

Cady Berkel, Anne Mauricio, Irwin Sandler, Sharlene Wolchik, Carlos G. Gallo, C. Hendricks Brown

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents’ competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.

Original languageEnglish (US)
Pages (from-to)782-794
Number of pages13
JournalPrevention Science
Issue number6
StatePublished - Aug 1 2018


  • Behavioral observation
  • Externalizing
  • Fidelity
  • Home practice
  • Internalizing
  • Parenting
  • Program implementation
  • Quality
  • Responsiveness

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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