What question did this study set out to answer?

To explore how the fidelity of motivational interviewing affects parenting practices and child outcomes in an early intervention program.

March 28, 2026Open Access

The family check-up: Relations between motivational interviewing fidelity and intervention outcomes in early elementary school.

Key Points

To explore how the fidelity of motivational interviewing affects parenting practices and child outcomes in an early intervention program.
Examined a subsample of 136 parents and 36 teachers from a randomized controlled trial of the Family Check-Up intervention.
Measured MI fidelity using the Motivational Interviewing Treatment Integrity Code 4.2.1 during feedback sessions.
Used binomial regression and multiple linear regression to analyze relationships between MI fidelity and intervention outcomes.
FCU therapists showed fair to good levels of MI fidelity during sessions.
Higher proportions of parent change talk related to Technical Global MI fidelity scores.
Higher parent-reported limit setting was associated with Percent Complex Reflections scores.
Total MI Nonadherent correlated with increased teacher-reported behavioral concerns in children.
Unexpectedly, Total MI Adherent was linked to lower parent change talk.

Abstract

The Family Check-Up (FCU) is a family-centered intervention that uses motivational interviewing (MI) to enhance parents' motivation for goal-directed change in parenting practices. The present study examined relations between FCU therapists' MI fidelity and (a) the proportion of parent change talk, (b) parent-reported positive parenting practices (proactive parenting and limit setting), and (c) parent- and teacher-reported child social, emotional, and behavioral concerns. Participants were a subsample of parents (n = 136) and teachers (n = 36) of children from the FCU intervention condition of a randomized controlled trial implemented at kindergarten entry. MI fidelity was measured in FCU feedback sessions with parents using the Motivational Interviewing Treatment Integrity Code 4.2.1. Binomial regression analysis and multiple linear regression analysis were performed to examine relations between MI fidelity and intervention outcomes. Results suggest that FCU therapists implemented MI with fair to good levels of fidelity. Several Motivational Interviewing Treatment Integrity summary scores were related to intervention outcomes. As hypothesized, Technical Global was associated with a higher proportion of parent change talk, Percent Complex Reflections was associated with higher parent-reported limit setting in first grade, and Total MI Nonadherent was associated with higher teacher-reported social, emotional, and behavioral concerns in first grade. Unexpectedly, Total MI Adherent was associated with a lower proportion of parent change talk. Taken together, findings suggest areas of MI fidelity that may be helpful to emphasize to maximize FCU efficacy. Implications for school psychology, study limitations, and future directions are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

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