Category: Dissemination & Implementation Science
Beidas, R. S., Cross, W., & Dorsey, S. (2014). Show Me, Don’t Tell Me: Behavioral Rehearsal as a Training and Analogue Fidelity Tool. Cognitive and Behavioral Practice, 21(1), 1–11. https://doi.org/10.1016/j.cbpra.2013.04.002
,Schoenwald, S. K., & Garland, A. F. (2013). A review of treatment adherence measurement methods. Psychological Assessment, 25(1), 146–156. https://doi.org/10.1037/a0029715
, ,Brigid Marriott, Ph.D. (she/her/hers)
Postdoctoral Fellow
Indiana University School of Medicine
Indianapolis, Indiana
Alyssa Ward, Ph.D. (she/her/hers)
Carelon Behavioral Health
RIchmond, Virginia
Alexandra Rose, M.S. (she/her/hers)
Doctoral Student
University of Maryland- College Park
College Park, Maryland
Brigid Marriott, Ph.D. (she/her/hers)
Postdoctoral Fellow
Indiana University School of Medicine
Indianapolis, Indiana
Simone Schriger, M.A. (she/her/hers)
Doctoral Candidate
University of Pennsylvania
Los Angeles, California
Decades of research have demonstrated the efficacy and effectiveness of treatments for a range of behavioral health problems. Nevertheless, these evidence-based practices (EBPs) are not always available and when they are, may not be implemented with fidelity or as intended (Kilbourne et al., 2007). This may in turn lead to decreased effectiveness and less than optimal clinical outcomes (e.g., Hogue et al., 2008; Schoenwald et al., 2008). Monitoring EBP fidelity (which includes both competence and adherence), is crucial to promoting high-fidelity implementation over time and to understanding when additional provider training, technical assistance, and/or supports are needed. However, the current gold standard for measuring fidelity - observational coding of therapy sessions - is both time- and resource-intensive, and often impractical for low-resource settings (Perepletchikova et al., 2009). Moreover, little is known about the current challenges in assessing fidelity among non-specialists delivering EBPs and in low-resource health systems. Further, there is limited research characterizing the type of fidelity monitoring taking place routinely that could be leveraged and built upon to further advance fidelity monitoring efforts. The present symposium includes three studies focused on addressing these gaps and exploring the continuum of fidelity measurement, including selecting, conducting, and evaluating fidelity measurement.
Our first presentation focuses on the selection of competence measures in low-resource health systems. This presentation will discuss findings from individual interviews conducted with research staff and community health workers from a non-governmental organization participating in task-shared mental health training in Cape Town, South Africa. These interviews focused on what competencies are used to select non-specialists for training in psychological interventions and are perceived to be important to intervention delivery. The second presentation will focus on conducting fidelity measurement across behavioral health settings. This presentation will describe findings from a mixed methods assessment of therapists, supervisors, recovery coaches, and agency leaders characterizing current fidelity monitoring practices in community behavioral health care in Indiana as well as acceptable and feasible fidelity monitoring methods and strategies for facilitating fidelity monitoring. Finally, with a focus on evaluating pragmatic methods of fidelity measurement, the third presentation will present on a study comparing three lower-intensity alternatives (self-report, chart stimulated recall, behavioral rehearsal) to the gold-standard method of adherence measurement to evaluate whether any of these lower-intensity methods can accurately measure adherence to specific CBT components. The discussant will discuss the implications of these studies for quality management in large systems and measuring and monitoring fidelity in low-resource settings, noting lessons that may be bidirectional between domestic and international contexts.
