Abstract
This commentary for the special issue on integrity measurement in school mental health research advocates that pragmatism is centralized in implementation and fidelity efforts for evidence-based behavioral interventions (EBIs). Specific recommendations include focusing on augmenting existing practices and core element interventions; developing practitioner self-report fidelity measures; and emphasizing practitioner training in how to use EBI fidelity methods. An exemplar model of practitioner training in fidelity methods, featuring observational coder training and fidelity measurement feedback, is presented.
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Becker-Haimes, E. M., Klein, M. R., McLeod, B. D., Schoenwald, S. K., Dorsey, S., Hogue, A., Fugo, P. B., Phan, M. L., Hoffacker, C., & Beidas, R. S. (2021). The TPOCS-self-reported therapist intervention fidelity for youth (TPOCS-SeRTIFY): A case study of pragmatic measure development. Implementation Research and Practice, 2, 2633489521992553. https://doi.org/10.1177/2633489521992553
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, 1–11.
Brookman-Frazee, L., Stadnick, N. A., Lind, T., Roesch, S., Terrones, L., Barnett, M. L., Regan, J., Kennedy, C. A., Garland, F., & A., & Lau, A. S. (2021). Therapist-observer concordance in ratings of EBP strategy delivery: Challenges and targeted directions in pursuing pragmatic measurement in children’s mental health services. Administration and Policy in Mental Health and Mental Health Services Research. 48(1), 155–170. https://doi.org/10.1007/s10488-020-01054-x
Caron, E. B., & Dozier, M. (2019). Effects of fidelity-focused consultation on clinicians’ implementation: An exploratory multiple baseline design. Administration and Policy in Mental Health and Mental Health Services Research, 46, 445–457.
Chorpita, B. F., Daleiden, E. L., Park, A. L., Ward, A. M., Levy, M. C., Cromley, T., Chiu, A. W., Letamendi, A. M., Tsai, K. H., & Krull, J. L. (2017). Child STEPs in California: A cluster randomized effectiveness trial comparing modular treatment with community implemented treatment for youth with anxiety, depression, conduct problems, or traumatic stress. Journal of Consulting and Clinical Psychology, 85, 13–25.
Chorpita, B. F., Park, A., Tsai, K., Korathu-Larson, P., Higa-McMillan, C. K., Nakamura, B. J., Weisz, J. R., & Krull, J. (2015). Balancing effectiveness with responsiveness: Therapist satisfaction across different treatment designs in the Child STEPs randomized effectiveness trial. Journal of Consulting and Clinical Psychology, 83, 709–718.
Chorpita, B. F., Weisz, J. R., Daleiden, E. L., Schoenwald, S. K., Palinkas, L. A., Miranda, J., Higa-McMillan, C. K., Nakamura, B. J., Austin, A. A., Borntrager, C. F., & Research Network on Youth Mental Health. (2013). Long-term outcomes for the Child STEPs randomized effectiveness trial: A comparison of modular and standard treatment designs with usual care. Journal of Consulting and Clinical Psychology, 81, 999–1009.
Frank, H. E., Becker-Haimes, E. M., & Kendall, P. C. (2020). Therapist training in evidence-based interventions for mental health: A systematic review of training approaches and outcomes. Clinical Psychology: Science and Practice, 27(3), e12330.
Gallo, K. P., & Barlow, D. H. (2012). Factors involved in clinician adoption and nonadoption of evidence-based interventions in mental health. Clinical Psychology: Science and Practice, 19, 93–106.
Glasgow, R. E., Fisher, L., Strycker, L. A., Hessler, D., Toobert, D. J., King, D. K., & Jacobs, T. (2014). Minimal intervention needed for change: Definition, use, and value for improving health and health research. Translational Behavioral Medicine, 4, 26–33.
Glasgow, R. E., & Riley, W. T. (2013). Pragmatic measures: What they are and why we need them. American Journal of Preventive Medicine, 45(2), 237–243. https://doi.org/10.1016/j.amepre.2013.03.010
Gonder, J., Metlay, W., & Shapiro, T. (2018). Testing assumptions: Can performance rating feedback result in objective performance improvements? Journal of Management and Innovation, 4(2), 1–31.
Herschell, A. D., Quetsch, L. B., & Kolko, D. J. (2020). Measuring adherence to key teaching techniques in an evidence-based treatment: A comparison of caregiver, therapist, and behavior observation ratings. Journal of Emotional and Behavioral Disorders, 28(2), 92–103. https://doi.org/10.1177/1063426618821901
Hogue, A., Bobek, M., Porter, N., MacLean, A., Bruynesteyn, L., Jensen-Doss, A., Dauber, S., & Henderson, C. E. (2021). Therapist self-report of fidelity core elements of family therapy for adolescent behavior problems: Psychometrics of a pragmatic quality indicator tool. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-021-01164-0
Hogue, A., Dauber, S., & Henderson, C. E. (2017). Benchmarking family therapy for adolescent behavior problems in usual care: Fidelity, outcomes, and therapist performance differences. Administration and Policy in Mental Health and Mental Health Services Research, 44, 626–641. https://doi.org/10.1007/s10488-016-0769-7
Hogue, A., Ozechowski, T. J., Robbins, M. S., & Waldron, H. B. (2013). Making fidelity an intramural game: Localizing quality assurance procedures to promote sustainability of evidence-based practices in usual care. Clinical Psychology: Science and Practice, 20, 60–77.
Hogue, A., Porter, N., Bobek, M., MacLean, A., Bruynesteyn, L., Jensen-Doss, A., Dauber, S., & Henderson, C. E. (2022). Online training of community therapists in observational coding of family therapy techniques: Reliability and accuracy. Administration and Policy in Mental Health and Mental Health Services Research. 49, 139–151. https://doi.org/10.1007/s10488-021-01152-4
Hurlburt, M. S., Garland, A. F., Nguyen, K., & Brookman-Frazee, L. (2010). Child and family therapy process: Concordance of therapist and observational perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 37, 230–244. https://doi.org/10.1007/s10488-009-0251-x
Institute of Medicine. (2015). Psychosocial interventons for mental and substance use disorders: A framework for establishing evidence-based standards. National Academies Press.
Kerns, S. E., Perrine, C. M., Sedlar, G., Peterson, R., & Monroe-DeVita, M. (2021). Keeping the faith while keeping it real: practical, empirical approaches to evaluating treatment fidelity. Global Implementation Research and Applications, 1(2), 1–12.
LeBreton, J. M., & Senter, J. L. (2008). Answers to 20 questions about interrater reliability and interrater agreement. Organizational Research Methods, 11(4), 815–852.
Lyon, A. R., Stanick, C., & Pullmann, M. D. (2018). Toward high-fidelity treatment as usual: Evidence-based intervention structures to improve usual care psychotherapy. Clinical Psychology: Science and Practice, 25, e12265.
Mastroleo, N. R., Humm, L., Williams, C. M., Kiluk, B. D., Hoadley, A., & Magill, M. (2020). Initial testing of a computer-based simulation training module to support clinicians’ acquisition of CBT skills for substance use disorder treatment. Journal of Substance Abuse Treatment, 114, 108014.
McLeod, B. D., Cook, C. R., Sutherland, K. S., Lyon, A. R., Dopp, A., Broda, M., & Beidas, R. S. (2021). A theory-informed approach to locally managed learning school systems: Integrating treatment integrity and youth mental health outcome data to promote youth mental health. School Mental Health.
McLeod, B. D., Cox, J. R., Jensen-Doss, A., Herschell, A., Ehrenreich-May, J., & Wood, J. J. (2018). Proposing a mechanistic model of clinician training and consultation. Clinical Psychology: Science and Practice, 25(3), e12260.
Park, A. L., Tsai, K. H., Guan, K., & Chorpita, B. F. (2018). Unintended consequences of evidence-based treatment policy reform: Is implementation the goal or the strategy for higher quality care? Administration and Policy in Mental Health and Mental Health Services Research, 45(4), 649–660.
Regan, J., Daleiden, E. L., & Chorpita, B. F. (2013). Integrity in mental health systems: An expanded framework for managing uncertainty in clinical care. Clinical Psychology: Science and Practice, 20(1), 78.
Schleider, J. L., & Weisz, J. R. (2017). Little treatments, promising effects? Meta-Analysis of single-session interventions for youth psychiatric problems. Journal of the American Academy of Child & Adolescent Psychiatry, 56, 107–115.
Shimokawa, K., Lambert, M. J., & Smart, D. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78(3), 298.
Stirman, S. W. (2020). Commentary: Challenges and opportunites in the assessment of fidelity and related constructs. Administration and Policy in Mental Health and Mental Health Services Research, 47(6), 932–934.
Sutherland, K. S., & McLeod, B. D. (2021). Advancing the science of integrity measurement in school mental health research. School Mental Health.
Walton, H., Spector, A., Tombor, I., & Michie, S. (2017). Measures of fidelity of delivery of, and engagement with, complex, face-to-face health behaviour change interventions: A systematic review of measure quality. British Journal of Health Psychology, 22(4), 872–903.
Weisz, J., Bearman, S. K., Santucci, L. C., & Jensen-Doss, A. (2017). Initial test of a principle-guided approach to transdiagnostic psychotherapy with children and adolescents. Journal of Clinical Child & Adolescent Psychology, 46, 44–58.
Weisz, J. R., Krumholz, L. S., Santucci, L., Thomassin, K., & Ng, M. Y. (2015). Shrinking the gap between research and practice: Tailoring and testing youth psychotherapies in clinical care contexts. Annual Review of Clinical Psychology, 11, 139–163.
Acknowledgments
The author gratefully acknowledges the contributions of esteemed colleagues Molly Bobek, Sarah Dauber, Amanda Jensen-Doss, Alexandra MacLean, Bryce McLeod, Nicole Porter, and Michael Southam-Gerow to the ideas presented herein.
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Hogue, A. Behavioral Intervention Fidelity in Routine Practice: Pragmatism Moves to Head of the Class. School Mental Health 14, 103–109 (2022). https://doi.org/10.1007/s12310-021-09488-w
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DOI: https://doi.org/10.1007/s12310-021-09488-w