2 - (SYM 47) Fidelity Monitoring as Usual: Characterizing Fidelity Monitoring Practices in Community Behavioral Health Care

Evidence-based practices (EBPs) are most effective when they are delivered with a high degree of fidelity, or as they are intended to be delivered. It is therefore important to monitor EBP fidelity over time to ensure providers are delivering EBPs as intended and minimize “drift” from best practices, thereby increasing the likelihood patients will receive high quality care and experience optimal outcomes. However, little is known about current fidelity monitoring practices in community behavioral health care. The current study used a mixed methods approach to characterize current fidelity monitoring practices in community behavioral health care in Indiana. Therapists, supervisors, recovery coaches, executive leaders, and agency leaders (N=205) completed a survey measuring current fidelity monitoring methods at their agency, fidelity monitoring methods perceived as acceptable and feasible, and strategies for facilitating fidelity monitoring. In addition, agency leaders, supervisors, and therapists (N = 10) participated in individual qualitative interviews asking about facilitators, barriers, and priorities related to ongoing fidelity monitoring. Initial quantitative results revealed that approximately 65% of respondents indicated their agency currently monitors what practices are being delivered, with role-play assessments (4.7%) and live supervision or observation (1.6%) the least frequently used methods and self-report (38.7%) and review of patient charts or treatment plans the most commonly used methods (38.7%). These latter two methods were also the most frequently endorsed as being acceptable and feasible methods for monitoring fidelity at their agency (review of patient charts/treatment plans: 55.5%; self-report: 53.4%), followed by patient report (30.4%), role-play assessments (24.6%), review of billing codes (18.8%), submitting session recordings (15.7%), and live supervision or observation (1%). Qualitative content analysis of interviews will be conducted to provide greater understanding of and expand on the survey results. Findings will describe fidelity monitoring as usual in community behavioral health care as well as what fidelity monitoring methods are considered to be acceptable and feasible. Implications for monitoring fidelity and strategies for facilitating fidelity monitoring will be discussed.