What are the factors that affect treatment integrity?
Multiple considerations may affect how treatment integrity is addressed, including available funding, study design, setting, and the level of risk of treatment inaccuracies. The degree to which each treatment integrity procedure is implemented may also be dictated by the nature of an intervention.
Is treatment integrity important in psychology?
Furthermore, few behavioral studies have assessed treatment integrity even though it is one of the most important components in the scientific process of studying behavior change (Gresham, 1989) and has been demonstrated to be correlated with more positive outcomes (Noell et al., 2005).
What is the appropriate level of treatment integrity for a prompt?
Wilder, Atwell, and Wine (2006)evaluated different levels of treatment integrity (100%, 50%, and 0%) of a three-step prompting procedure on the compliance of two typically developing children. A multielement design was used to evaluate the effects of integrity level on child compliance.
What is treatment integrity in nursing?
In this context, Hagermoser Sanetti and Kratochwill (2009) defined treatment integrity as “the extent to which essential intervention components are delivered in a comprehensive and consistent manner by an interventionist trained to deliver the intervention” (p. 448).
Why is treatment integrity so important?
Treatment integrity, also known as treatment fidelity, is integral for empirical testing of intervention efficacy as it allows for unambiguous interpretations of the obtained results. Assuring treatment integrity is also important for dissemination of evidence-based practices and quality improvement of services.
What does treatment integrity mean?
Treatment integrity is the extent to which an intervention is im- plemented as planned. Basically, reviewing treatment integrity data will tell you how much of an intervention is being implemented and what—if any—intervention steps are being missed.
Why is treatment fidelity important?
Treatment fidelity means assuring that the treatment in a research study is conducted consistently and reliably. That is very important is because the outcomes of treatment research ends up affecting patient care and the quality of care that patients receive.
How can I improve my treatment of integrity?
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How do you monitor treatment integrity?
The most frequently reported methods of treatment integrity measurement include direct observation, self-report, and permanent product recording.
What is treatment integrity in research?
Treatment integrity (or fidelity) refers to. the extent to which an intervention is implemented as intended (or planned). Although its importance has. been acknowledged in the literature, this construct has largely been neglected in consultation research and. practice.
What are the two components of treatment fidelity?
Treatment fidelity consists of two general components: 1) treatment integrity, the degree to which a treatment is implemented as intended, and 2) treatment differentiation, the degree to which two or more study arms differ along critical dimensions (2, 3, 4, 5).
What is treatment fidelity in therapy?
Purpose: Treatment fidelity is a measure of the reliability of the administration of an intervention in a treatment study. It is an important aspect of the validity of a research study, and it has implications for the ultimate implementation of evidence-supported interventions in typical clinical settings.
How do you evaluate treatment fidelity?
In clinical research treatment fidelity is typically attained by intensive training and supervision techniques and demonstrated by measuring therapist adherence and competence to the protocol using external raters.
What is the most effective method for improving treatment integrity?
Recent literature suggests that performance feedback is the most effective method for improving treatment integrity (DiGennaro Reed and Codding 2011; DiGennaro Reed et al. 2013).
What is the percentage of treatment integrity?
Wilder, Atwell, and Wine (2006)evaluated different levels of treatment integrity (100%, 50%, and 0%) of a three-step prompting procedure on the compliance of two typically developing children. A multielement design was used to evaluate the effects of integrity level on child compliance. Compliance systematically varied according to the level of treatment integrity. That is, 100% integrity was associated with the most compliance, 50% with moderate compliance, and 0% with very little compliance.
Can teachers implement an intervention with low integrity?
As the authors not ed, this finding suggests that teachers and caregivers can implement an intervention with low integrity and still maintain treatment outcomes if they initially implement the intervention with high levels of integrity. This is an important possibility that requires further experimental evaluation.
Does integrity affect effectiveness?
Although integrity levels were correlated positively with treatment effectiveness in both of the above-mentioned studies, neither manipulated integrity levels in a controlled manner to measure their effects on treatment outcomes. A complete understanding of the effects of integrity failures on treatment effectiveness can be understood only by experimental evaluation. The following studies involved such experiments.
Does intermittent reinforcement strengthen behavior?
Indeed, it is well known that intermittent reinforcement has the effect of strengthening behavior; thus, researchers should consider the possibility that integrity failures might result in the long-term strengthening of problem behavior or, conversely, in the further strengthening of appropriate behavior.
Is treatment integrity failure detrimental?
As both of the aforementioned studies discovered, it is possible that treatment integrity failures are less detrimental if they are preceded by a history of high integrity levels. Thus, it is possible that treatment integrity is most critical during the early stages of treatment and becomes less critical over time.
Why is treatment integrity important?
Treatment integrity, also known as treatment fidelity, is integral for empirical testing of intervention efficacy as it allows for unambiguous interpretations of the obtained results. Assuring treatment integrity is also important for dissemination of evidence-based practices and quality improvement of services. However, in the examination of the relationship between treatment integrity and treatment outcome it is important to consider that treatment integrity may be a proxy variable for other variables impacting therapeutic change (e.g., characteristics of intervention, clients, setting, and therapist). Considerations on examining the association between integrity and outcome are discussed. Further, recommendations on the level to which treatment integrity needs to be addressed in psychotherapy research and clinical practice are provided.
How does treatment integrity relate to outcomes?
Treatment integrity is not conceptually related to treatment outcome, and may be just a proxy variable for other influences that account for therapeutic change. Associated variables (e.g., characteristics of treatment, setting, patients, and therapists) may function as moderating or mediating variables in the relationship, or may just be the confounding influences that may serve as alternative explanations of the obtained outcome. It may be difficult to formulate a question on the relationship between integrity and outcome to obtain information that incrementally adds to data collected on other variables. Indeed, a question of whether high treatment integrity relates to improved outcomes basically translates into a question of whether a particular intervention implemented as designed is effective in addressing a particular problem in a particular population. When an intervention is found efficacious and treatment integrity levels are high, an additional examination of the association between integrity and outcomes may be redundant. In a situation when changes on the dependent measures are in an expected direction but treatment integrity levels are low, data on the association between integrity and outcomes may not offer much insight. Instead, it may be advisable to evaluate all available information (e.g., sessions tapes, therapist's self-reports, clinical notes, written homework assignments, data collection sheets) to establish what was actually done by therapists. Information on the employed procedures may provide clues for developing a more promising treatment. Similarly, when a treatment validated in one setting fails to demonstrate efficacy in a different setting even when implemented with high integrity, examination of the relationship between integrity levels and outcome may not be informative. In such cases, variability that contributed to discrepant findings most likely rests in characteristics of a setting, patients and therapists, rather than intervention implementation.
What is indirect assessment in therapy?
Indirect assessment: therapists fill out therapy checklists after each session to indicate procedures that were or were not implemented as prescribed in a manual (checklists should allow for explanations on any protocol deviations)
What is treatment integrity?
Treatment integrity is essential for empirical testing of intervention efficacy, as it allows for unambiguous interpretations of the obtained results. Indeed, obtained results may be related to the implementedintervention (i.e., treatment as delivered) and not to the intendedintervention (i.e., treatment as designed). Therapists may implement all, some or none of the procedures specified in a treatment protocol, or may supplement prescribed tasks with procedures not in a manual. Having information on treatment integrity allows for judgments regarding how closely the implemented intervention approximates the intended intervention.
Why is it difficult to draw inferences on the association between treatment integrity and treatment outcome?
It may be difficult to draw inferences on the association between treatment integrity and treatment outcome due to multiple influences that normally occur in the context of clinical trials and clinical services. When approaching on this line of investigation, researchers may need to consider how the obtained data may be informative, as well as take into account other variables at play and affecting this association.
What is indirect training?
Indirect training procedures: didactic instructions about the intervention and written materials describing the rationale, scripts, tasks, and activities
What is a specific treatment manual?
Specific treatment manual provides information about a theoretical basis of the intervention, specifies rationales for adherence, spells statements to be made by treatment agents, describes characteristics of the treatment process and sequencing the techniques, provides examples of treatment operations, and procedures for handling deviations
How to improve treatment integrity?
As indicated earlier, performance feedback is an effective way to improve and maintain treatment integrity. Performance feedback can be provided during a consultant–consultee interaction (Noell, Duhon, Gatti, & Connel, 2002) or in the public forum of a school team meeting (Duhon, Mesmer, Gregerson, & Witt, 2009). Duhon et al. (2009) explained that if there are problems with treatment integrity or if there are concerns about possible implementation fall-off, school teams can discuss ways to improve intervention integrity in team meetings. Data-analysis team meetings (Kovaleski & Pedersen, 2008) or professional learning communities (Dufour & Eaker, 1998) would appear to be ideal venues for these types of discussions. It is important in these venues to ensure that the analysis of treatment integrity be carried out as a problem-solving activity rather than a procedure to evaluate a particular teacher or interventionist. It seems reasonable to conclude that the provision of performance feedback should lead to increased and stable levels of implementation, which in turn should result in improved intervention outcomes (Noell, Duhon, et al., 2002, 2005).
What is treatment integrity?
For the sake of simplicity, we use treatment integrity in this article. Treatment integrity has been defined as the degree to which an intervention or treatment is implemented as planned, intended, or originally designed (Gresham, 1989, 2004; Gresham, MacMillan, Beebe-Frankenberger, & Bocian, 2000; Lane, Bocian, MacMillan, & Gresham, 2004). Treatment integrity has been an important topic in the research literature because it is critical to ascertain whether the treatment being investigated was implemented reliably if a causal relationship with the dependent variable is to be supported. Charters and Jones (1974), in an early paper on this topic, argued for the necessity of measuring treatment integrity in pursuing empirical research and noted that many studies failed to account for the extent to which treatment integrity is in place. By failing to consider the level of implementation of an experimental treatment, threats to internal and external validity make it impossible to reach accurate conclusions about the effectiveness of the treatment or to replicate a research study with the hopes of gaining the same results (Bellg et al., 2004). The goal of research is to determine if changes in the dependent variable (outcomes) are due to changes in the independent variable (intervention). The impact that the intervention has on outcomes can only be determined when researchers demonstrate that the intervention was implemented as intended without modifications (Gresham et al., 2000). Clearly, practitioners seeking to implement research-based interventions need to be cautious in adopting practices that are not supported by research studies in which treatment integrity is meaningfully measured.
How does the implementation of interventions affect the classroom?
When interventions are implemented in the field, rather than in a controlled empirical study, a variety of confounding factors may have an impact on the integrity with which they are implemented. The transition of an intervention from the lab to the classroom may be accompanied by a decrease in intervention effectiveness because of the decreases in treatment integrity associated with this transition (Hulleman & Cordray, 2009). Variables that affect treatment integrity in the classroom include the characteristics of the child, because teachers are more likely to be responsive to students who are more skilled (Detrich, 1999); the resources required for the intervention, because implementation will not occur if resources put a strain on the classroom (Detrich, 1999; Gresham 1989; Gresham et al., 2000); the similarity of the intervention to the current classroom practices (Detrich, 1999); the complexity of the treatments (Gresham, 1989; Gresham et al., 2000); the time required to implement interventions (Gresham, 1989; Gresham et al., 2000); the number of staff required to implement interventions (Gresham, 1989); the motivation of the staff to implement interventions (Gresham, 1989); and the perceived and actual effectiveness of the interventions (Gresham 1989; Gresham et al., 2000).
What is RTI in education?
Response to intervention (RtI) has been conceptualized as having two meanings. First, RtI has served as a synonym for a multi-tier system of support (MTSS); as such, it includes those assessment and instruction/intervention procedures that have as a goal the attainment of proficiency in basic academic skills. Alternatively, RtI describes the use of assessment data that are collected on students during the course of instruction and/or intervention for the purpose of making both low- and high-stakes decisions about those students. In either usage, it is presupposed that the student’s response can be validly and reliably measured and that an intervention has been used that is reasonably calculated to facilitate student learning. This latter determination depends on the extent to which the intervention used is based in scientific research (i.e., has been shown to work with students under appropriately controlled conditions) and whether the intervention has been implemented with fidelity. The extent to which an intervention is delivered in adherence to its design features has been termed treatment integrity and has been identified as a critical element of RtI programs (Zirkel & Thomas, 2010). How treatment integrity is defined, operationalized, and evaluated within an MTSS is the topic of this article.
Why is RTI important?
If treatment integrity is not ensured, practitioners are unable to determine if the student’s progress is traceable to the intervention used. More important, if a student fails to make progress in response to a scientifically validated intervention, it is critical to ascertain whether the intervention, which has been established as effective for other students with similar needs, was implemented with sufficient integrity . Failure to check the fidelity of the treatment can lead to a potentially erroneous conclusion that the student’s academic deficiencies are the result of a disabling condition, such as a specific learning disability (Kovaleski, VanDerHeyden, & Shapiro, 2013).
Why do clinicians modify treatment protocols?
Clinicians may use their judgment to modify an intervention in order to better meet the needs of a client. Very strict adherence to the treatment protocol may limit useful adaptations to the intervention that may be more effective or meaningful to the individual, particularly for more complex interventions (Schulte et al., 2009). Modifying interventions can be an acceptable practice because manipulations to the intervention may result in the introduction of a more successful strategy, but simple interventionist drift that results in modifications that do not take into account the client’s needs are not justifiable (Hagermoser Sanetti & Kratochwill, 2009).
How to know if an intervention is implemented with integrity?
Some signs that intervention integrity is interfering with the effectiveness of the intervention, and therefore needs to be assessed, include the following: lack of data regarding implementation, lack of progress-monitoring data of outcomes, data indicat ing the intervention is rarely implemented with integrity, training has not been provided regarding correct implementation, or support has been provided to teachers but the intervention rarely continues to be implemented correctly (Witt, VanDerHeyden, & Gilbertson, 2004).