Fidelity Scale: From Black Box to Holy Grail
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ORIGINAL ARTICLE
Fidelity Scale: From Black Box to Holy Grail Jaap van Weeghel1,2,3
© The Author(s) 2020
Abstract Fidelity scales are indispensable in the pursuit of evidence-based mental healthcare. Without fidelity checks, treatment remains a mysterious black box. The aim of this article is to comment on the studies in this special section, and to discuss some general issues with regard to fidelity assessment. Despite all of their supposed benefits, resistance to fidelity scales persists among mental health practitioners. One way to overcome this resistance is to conduct fidelity assessments in the context of a well-guided learning community. The predictive validity of fidelity scales is considered the single most valuable attribute of these instruments. Research on predictive validity requires large sample sizes, which is difficult to achieve. It should nevertheless not prevent us from rigorously searching for this Holy Grail of fidelity assessment. In addition, fidelity assessment should be placed in a broader perspective. The quality of care for people with severe mental illness cannot be assessed conclusively according to the extent to which separate interventions have been applied with good fidelity. These individuals need access to high-quality treatment and support systems within the community, which can enable them to live their lives as valued citizens. In conclusion, fidelity assessment, both at the level of interventions and systems, contributes to a highly desirable transparency in practice variations within the field of mental healthcare.
Introduction Treatment fidelity is indispensable in the pursuit of evidence-based mental healthcare. In most cases, fidelity scales reflect the consensus reached amongst experts with regard to the characteristics and requirements of specific interventions. Fidelity scales also facilitate research aimed at identifying, measuring and improving the components and effects of interventions (Bond and Drake 2019). Without fidelity checks, treatment outcomes are subject to either overestimation or underestimation (Moncher and Prinz 1991), and it is not possible to distinguish failure of the intervention from failure to implement the intervention (Mowbray et al. 2003). Without fidelity checks, treatment remains a mysterious black box. We do not know exactly what an intervention is, how to implement it, with which level of quality it is * Jaap van Weeghel [email protected] 1
Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
2
Parnassia Psychiatric Institute, The Hague, The Netherlands
3
Phrenos Center of Expertise, Da Costakade 45, 3521 VS Utrecht, The Netherlands
delivered or how it differs from other interventions (Bond and Drake 2019). During the first decade of this century, Bob Drake, Greg McHugo, Will Torrey and colleagues conducted the National Implementing Evidence-Based Practices Project in 53 sites in 8 states of the United States (Drake et al. 2001). Fide
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