Elah Sunde

Date Approved


Degree Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department or School


Committee Member

Adam Briggs, PhD, BCBA-D, LBA, Co-Chair

Committee Member

James Todd, PhD, Co-Chair

Committee Member

Hannah Ham, PhD, LP

Committee Member

Alexandros Maragakis, PhD

Committee Member

Timothy Moore, PhD, LP, BCBA-D


Caregiver-mediated behavioral interventions are a critical and evidence-based treatment of childhood behavioral concerns. However, caregivers face many barriers to adherence that can reduce the effectiveness of these interventions. The purpose of this study was to evaluate the effectiveness of a training protocol delivered over telehealth within an integrated behavioral health setting, evaluate the reliability and validity of an assessment tool (i.e., the Performance Diagnostic Checklist - Parent), and examine patterns of engagement (e.g., missed sessions, dropout rates) that caregivers experienced. Eight caregivers enrolled in the study and received a child-directed interaction protocol, which included instruction, a video model and skill rehearsal with feedback provided on their performance. Participants’ performance was examined across training components and of the four participants who completed Study 1, two (50%) met mastery criteria on the protocol with their child. The other two participants were invited to participate in the intervention portion of Study 2. Five participants completed the PDC-P interview, and interrater reliability of the PDC-P was high (92.2%). One participant participated in an intervention that was not indicated by their PDC-P results as an area in need of support, and two interventions that their PDC-P results indicated were from domain that contained barriers. Consistent with the authors’ hypotheses, the participant’s performance during the non-indicated intervention remained the same or lower than previous performance. Average performance during the indicated intervention increased to 70.6% of steps completed, however performance subsequently decreased. The participant then engaged in an enhanced indicated intervention and met mastery criteria. This provides preliminary evidence for the validity of the PDC-P in predicting ineffective and effective adherence supports, however replication and extension of the PDC-P across caregivers, domains and protocols is warranted. Difficulties in recruitment and retention of participants hindered data collection. Five of the eight participants who enrolled in the study dropped out, all participants experienced disruptions in study visits, and overall participants missed 48.1% of scheduled research visits. These results reflect a need to support caregiver’s continued engagement in treatment as a precursor to treatment adherence.