Assessing the Fidelity of Evidence-Based Practices: History and Current Status of a Standardized Measurement Methodology
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ORIGINAL PAPER
Assessing the Fidelity of Evidence‑Based Practices: History and Current Status of a Standardized Measurement Methodology Gary R. Bond1 · Robert E. Drake1
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Evidence-based practices are effective only when implemented faithfully. This paper explicates the history, standardization, and methods for developing and validating measures of fidelity. We overviewed the past 20 years of developing fidelity measures, summarized standardization of the development procedures, and described needed psychometric assessments. Fidelity assessment has become the sine qua non of implementation, technical assistance, and research on evidence-based practices. Researchers have established standardized procedures for scale development and psychometric testing. Widescale use of fidelity measurement remains challenging. The implementation of evidence-based practice and the development and validation of fidelity measures are interdependent. International improvements of mental health care will require attention to both. Keywords Fidelity · Evidence-based practice · Measurement · Scale development
Introduction Evidence-based practices (EBPs) are interventions that consistently improve valued outcomes. The EBP movement for adults with serious mental illness has aimed to spread effective interventions to routine practice settings. The movement coalesced in the US in a 1998 meeting of policy makers, administrators, clinicians, and patients sponsored by the Robert Wood Johnson Foundation (Drake et al. 2001). Subsequently, federal, state, and local efforts have endorsed and disseminated the spread of EBPs. Implementation of EBPs requires specification, and all stakeholders have recognized the need for rigorous methods for defining and monitoring quality of implementation. Thus, the development of measures that assess the quality of implementation and adherence to EBP standards has been a natural outgrowth of the increased emphasis on EBPs. Fidelity is defined as the degree to which a program implementing an EBP adheres to specific model standards (Bond et al. 2000a). EBP developers typically describe criteria for fidelity in practice manuals or protocols, though some fidelity scale developers have used more formal * Gary R. Bond [email protected] 1
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methodologies to define critical ingredients (Mowbray et al. 2003). Fidelity measures are tools to assess the adequacy of implementation of an EBP. When a program uses the label of assertive community treatment, for example, does the label depict the actual practice, and does the intervention differ in expected ways from standard case management? Fidelity measures answer these questions and thus are essential features of EBP implementations. This paper describes the history, development, uses, and current methodological and logistical challenges of measuring EBP fidelity. This paper is not a systematic review,
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