Years ago my wife and I owned a Ford Escort. We really liked this practical car for our young family. Unfortunately the electrical system started to short out. Fortunately it was still under warrantee. We took it in over and over again and it continued to short out. Finally someone discovered that we left a spare set of keys in the ash tray. As the car would move and the keys would jostle, a connection would be made and the car would short out. Once the keys were removed, the problem was over.
A fairly recent study by J. Smith et al demonstrated that , when closely observed, a majority of providers missed a key element of the intervention. Unfortunately this can only be assessed by either close observation over a period of time {more than can practically be accomplished} by someone who thoroughly understands the intervention, or by looking for outcomes. We need to look more to objective outcomes to assure the right intervention was provided to the child and that the key elements were included.
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