Development and Validation of Fidelity Monitoring and Enhancement in an Evidence-Based Parenting Program
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ence to Carmen S. Spry, PhD, Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia. Matthew R. Sanders, PhD, Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, QLD, Australia. Cassandra L. Tellegen, PhD, Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, QLD, Australia. James N. Kirby, PhD, Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, QLD, Australia. Carol M. Metzler, PhD, Oregon Research Institute, Eugene, OR, USA. Ronald J. Prinz, PhD, University of South Carolina, Columbia, SC, USA.
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Journal of Behavioral Health Services & Research, 2020. 1–11. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09713-5
Development and Validation of Fidelity Monitoring and Enhancement
SANDERS ET AL.
Treatment fidelity, which is critical to both rigorous research design and cogent community implementation, refers to the extent to which an intervention is delivered as intended.1 Beyond design rigor, this construct has become increasingly important with the shift of funding priorities from treatment development to dissemination, and corresponding research on delivery in realworld settings.2 Documenting fidelity is crucial in determining the validity of the conclusions drawn about whether a treatment is effective. Fidelity for psychosocial interventions needs to address adherence to content as well as delivery process.3 Adherence to content fidelity refers to the degree to which the practitioner uses prescribed procedures, covers manualized content, and avoids deviating from the treatment protocol, while process fidelity focuses on the degree to which the content is delivered consistent with the manner, communication, and cross-cutting principles specified in the protocol’s delivery process.4 The relationship between content and process fidelity has been somewhat unclear, with results ranging from no association (indicating they are different constructs)5 to high correlations (indicating they are similar constructs),6,7 but both aspects of treatment fidelity are considered to be important. Recent years have seen greater sophistication regarding the development of fidelity measures and monitoring procedures with increasing recognition of the importance of fidelity in treatment. Historically, fidelity in the delivery of psychosocial treatments has been under-evaluated, while adherence rates when reported have varied considerably. A cutoff criterion of 80% to represent high treatment fidelity proposed by Borrelli et al.8 has been widely adopted. A review of 147 randomized controlled trials (RCTs) of psychosocial treatment studies found that only 3.5% adequately measured treatment integrity.4 A review focused specifically on outcome studies for evidence-based parent training programs published before 2012 found that the mean adherence to best practices in fidelity promotion and evaluation was 73%.2 Garbacz et al.2 a
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