Improve Treatment Integrity Research Articles

Provider Adherence to Modular Cognitive Behavioral Therapy for Children and Adolescents.

This study explored predictors of community-based providers' adherence to MATCH, a modular cognitive behavioral therapy for children and adolescents. Provider-reported adherence to MATCH was measured using three increasingly strict criteria: (1) session content (whether the session covered MATCH content consistent with the client's target problem), (2) session content and sequencing (whether the session covered MATCH content in the expected sequence for the client's target problem), and (3) session content, sequencing, and participant (whether the session covered MATCH content in the expected sequence and with the expected participant(s) for the client's target problem). Session, client, provider, and organizational predictors of adherence to MATCH were assessed using multilevel modeling. Results revealed that nearly all providers delivered MATCH content that corresponded to the target problem, but only one-third of providers delivered MATCH content in the expected sequence and with the expected participant for the client's target problem. This difference underscores the need for nuanced adherence measurement to capture important implementation information that broad operationalizations of adherence miss. Regardless of the criteria used providers were most adherent to MATCH during sessions when clients presented with interfering comorbid mental health symptoms. This suggests that the design of MATCH, which offers flexibility and structured guidance to address comorbid mental health problems, may allow providers to personalize treatment to address interfering comorbidity symptoms while remaining adherent to evidence-based practices. Additional guidance for providers on managing other types of session interference (e.g., unexpected events) may improve treatment integrity in community settings.

Effects of Acceptance and Commitment Training on Treatment Integrity Amongst Behavioral Technicians.

Behavioral technicians (BT) within the field of applied behavior analysis may be at greater risk for experiencing burnout and stress due to the nature of their clients, job demands, and work environments. Burnout and stress may negatively impact BT's work performances, more specifically, their treatment integrity. Acceptance and Commitment Training (ACT) may be a useful tool to address the private events as well as the covert and overt behaviors associated with burnout and stress. The purpose of this study was to investigate the effects of an ACT intervention on improving treatment integrity and reducing work-related burnout and stress amongst BTs. Four BTs participated in an ACT workshop, and their treatment integrity as well as their burnout and stress levels were measured prior to and following the ACT workshop. Treatment integrity increased for all participants, suggesting that ACT-based interventions may be an effective approach to improving work performance (i.e., treatment integrity) amongst BTs who may experience workplace burnout and stress.

Guidelines, guidelines and more guidelines for haemorrhoid treatment: A review to sort the wheat from the chaff.

AimGuidelines benefit patients and clinicians by distilling evidence into easy‐to‐read recommendations. The literature around the management of haemorrhoids is immense and guidelines are invaluable to improve treatment integrity and patient outcomes. We identified current haemorrhoid guidelines and assessed them for quality and consistency.MethodsA systematic search of the literature from January 2011 to October 2021 was carried out. Guidelines identified were assessed for quality using the AGREE II instrument and for consistency in terms of tabulated treatment recommendations.ResultsDuring this period nine guidelines were identified worldwide. The general quality was poor with only one guideline considered of high enough quality for use. In general, expert selection criteria for guideline development groups were vaguely defined. There were inconsistencies in the interpretation of the published evidence leading to variation in treatment recommendations.DiscussionFewer, higher quality guidelines, with more consistent results, are needed. Particular attention should be given to defining the selection of experts involved.

Treatment integrity in psychotherapy research and implications for the delivery of quality mental health services.

Treatment integrity, or the degree to which an intervention is delivered as intended, serves a crucial function as an independent variable check in treatment outcome research. Implementation science focuses on understanding and improving the processes (e.g., training, supervision, monitoring) that establish and support treatment integrity in community settings. This review assessed the adequacy of treatment integrity procedures (i.e., establishing, assessing, evaluating, and reporting integrity) implemented in treatment outcome research with the goals of updating the review by Perepletchikova, Treat, and Kazdin (2007) and connecting findings to implementation science goals. Using the Implementation of Treatment Integrity Procedures Scale (Perepletchikova et al., 2007), 2 trained raters coded the treatment integrity procedures described by randomized controlled trials of psychosocial interventions published in 6 high-impact-factor journals from 2011 to 2015 (N = 188 studies describing 270 treatments). Compared with Perepletchikova et al., current findings indicate significant improvement, but the frequency of adequate treatment integrity implementation remains low (10.7%). Recommendations for future work include focus on conceptualization of treatment integrity, establishment of treatment integrity standards, and use of findings from implementation science to improve treatment integrity procedures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A SYSTEMATIC FRAMEWORK FOR ADDRESSING TREATMENT INTEGRITY IN SCHOOL SETTINGS

School psychologists are tasked with ensuring treatment integrity because the level of intervention implementation affects decisions about student progress. Treatment integrity includes multiple dimensions that may impact the effectiveness of an intervention including adherence, dosage, quality, and engagement. Unfortunately, treatment integrity is not routinely monitored in consultation. A systematic framework is needed to better prepare practitioners to assess, analyze, and intervene when there are treatment integrity failures. A framework for monitoring and improving multiple dimensions of treatment integrity in natural settings is proposed to provide guidance to practitioners through two phases. The first phase focuses on improving initial treatment integrity and the second phase outlines a problem‐solving process for improving treatment integrity.

Contextual Influences on the Implementation of a Schoolwide Intervention to Promote Students’ Social, Emotional, and Academic Learning

Schoolwide interventions are among the most effective approaches for improving students’ behavioral and academic outcomes. However, researchers have documented consistent challenges with implementation fidelity and have argued that school social workers should be engaged in efforts to improve treatment integrity. This study examines contextual influences on the implementation of a whole-school intervention called Responsive Classroom (RC) in one urban K–8 public school serving a diverse student body. RC improves social, emotional, literacy, and math outcomes for disadvantaged students with behavior problems by building on the assets of teachers to intervene with misbehaving students in the classroom setting or school environment. Yet little is understood regarding the factors that constrain or enable implementation of RC in noncontrolled research conditions. Results from a mixedmethods convergent analysis of focus group, observation, and survey data indicate the influence of the following three contextual factors on implementation fidelity: (1) intervention characteristics such as compatibility with staff members’ beliefs about behavior change and management, (2) organizational capacity such as principal and teacher buy-in, and (3) the intervention support system such as training and technical assistance. Implications for future school social work research and practice with respect to the implementation of schoolwide programs are discussed.

Improving Treatment Integrity through a Functional Approach to Intervention Support

A functional approach to intervention planning has been shown to be effective in reducing problem behaviors and promoting appropriate behaviors in children and youth with behavior disorders. When function-based intervention plans are not successful, it is often due to issues of treatment integrity in which teachers omit or do not sufficiently engage in intervention behaviors. The purpose of this article is to conceptually explore how function-based intervention concepts and practices used to support student behavior might be applied to improve treatment integrity through a functional approach to teacher intervention support.

Contextual Intervention for Caregiver Non-Adherence With Behavioral Intervention Plans

The extent to which parents and other caregivers implement behavioral interventions with integrity has an important impact on treatment effectiveness. This article considers popular interventions that train caregivers and improve treatment integrity in applied behavior analysis. After considering these interventions a contextual approach is described, whereby the function of caregiver non-adherence is considered. In particular, interventions aimed at manipulating setting factors are reviewed. The examples of respite and social support groups are provided as function-based interventions to improve caregiver adherence to behavioral recommendations. Implications for more contextual, coordinated, and comprehensive function-based behavioral services are provided.

Social Validity Assessment of Training Methods to Improve Treatment Integrity of Special Education Service Providers

We report the results of a social validity assessment that was administered to special education service providers (N = 44) to document the acceptability and effectiveness ratings of several treatment integrity training methods. The participants judged performance feedback as the most likely method to improve their treatment integrity, followed by avoidance (negative reinforcement) of supervision meetings, online training, and financial incentive. Performance feedback was also rank-ordered as most effective among the four training methods. We discuss the merits of social validity assessment in designing programs for enhancing treatment integrity among practitioners within educational and clinical settings.

Improving Treatment Integrity in a Human Service Setting Using Lottery-Based Incentives

The present study was conducted to improve implementation fidelity of discrete trial training procedures. Three participants were selected from a special education school providing services for students with intellectual disabilities. Staff behaviors measured included the correct implementation of a prompt hierarchy, the accuracy of data recorded, the correct delivery of prompts, and whether procedures were correctly set up for the following day's activities. Intervention consisted of daily verbal and graphic feedback and a lottery-based incentive system in which staff had to perform at a set goal level for the week in order to be eligible for entry into a drawing. A multiple-baseline-across-participants design was utilized to evaluate the effects of the intervention package, and integrity improved consistently for all participants during the intervention.

An Experimental Examination of the Impact of Choice of Treatment Components on Treatment Integrity

Although there is a growing body of research on the use of performance feedback to improve treatment integrity, antecedent interventions have received little attention. Antecedent interventions are simple to use and have a strong research base. This study examined the effects of offering teachers choice of treatment components. A choice condition was compared with a no-choice condition in which an expert-derived treatment was used. An A/B/C/A/C/B design with counterbalancing was combined with a simultaneous-treatments design to examine treatment integrity and student problem behavior for 3 teacher–student dyads. The results indicated that, although both treatments improved student behavior, higher levels of treatment integrity and better behavioral outcomes were associated with the choice condition. The results are discussed in terms of the merits of simple antecedent strategies for improving treatment integrity and the benefit of adding experimental design elements that provide a more direct measure of teacher preference.

Effects of Verbal and Written Performance Feedback on Treatment Adherence: Practical Application of Two Delivery Formats

Verbal and written performance feedback for improving preschool and kindergarten teachers' treatment integrity of behavior plans was compared using a combined multiple-baseline and multiple-treatment design across teacher–student dyads with order counterbalanced as within-series conditions. Supplemental generalized least square regression analyses were included to evaluate significance. Maintenance of treatment integrity following termination of performance feedback was included and correspondence between treatment integrity and student behavior change was examined. Results suggested that both forms of feedback were effective for improving treatment integrity but that verbal performance feedback resulted in immediate and sustained improvements with moderate to strong correspondence with student behavior change.

An Evaluation of the Observer Effect on Treatment Integrity in a Day Treatment Center for Children

Treatment integrity is an important concern in treatment centers but is often overlooked. Performance feedback is a well-established approach to improving treatment integrity, but is underused and undervalued. One way to increase its value to treatment centers may be to expose unrealized benefits on the observer who collects the performance feedback data. This "observer effect" could increase the value of performance feedback and promote more consistent evaluation of treatment integrity. The purpose of this investigation was to evaluate the observer effect on treatment integrity. Five supervisors who worked in a day treatment center were asked to collect performance feedback data on staff members' integrity in following a standard treatment protocol that supervisors were also expected to follow. Results showed an immediate and marked improvement in treatment integrity in three supervisors who collected but never received performance feedback. For two supervisors, this effect was reversed and replicated. Implications are discussed.

Gaps, bridges, and the bumpy road to improving clinic‐based therapy for youth.

It has been proposed that one way of strengthening the effects of evidence-based treatments for youth in service clinics is to improve treatment integrity in these settings. Four assumptions related to this recommendation are evaluated in light of findings from effectiveness studies. The absence of evidence on links between treatment integrity and treatment outcome in effectiveness trials makes it difficult to estimate the potential benefits of many of the proposed quality control strategies. Incremental changes in methods to improve treatment integrity in service clinics must be considered in the context of structural barriers to implementation.

Consultation to Improve Treatment Integrity

Consultation to Improve Treatment Integrity

Effects of public feedback during RTI team meetings on teacher implementation integrity and student academic performance

As a result of the new revision of IDEA (2004), models of early intervention and response-to-intervention (RTI) have received a great deal of attention in the literature. Although various tiered models have been described in detail, one aspect of RTI that has received little empirical attention is the need to ensure integrity of intervention as part of a team decision making process. One method that has good support for improving treatment integrity is performance feedback (PFB); however, the utilization of PFB within a team context has received very little attention in the literature. Experiment 1 evaluated the effect of PFB delivered within the context of an RTI team on treatment integrity after fidelity had fallen to unacceptable levels. Experiment 2 evaluated the effects of PFB on the maintenance of treatment integrity prior to integrity fall off. Results indicate that PFB can be used as an efficient means of improving or maintaining treatment integrity when applied within a team model.

Effects of Verbal and Graphic Performance Feedback on Behavior Support Plan Implementation in a Public Elementary School

Previous research suggests that performance feedback improves treatment integrity. This study compared the effects of verbal performance feedback and verbal plus graphic performance feedback on implementation of a student-specific behavior support plan (BSP) by members of a second-grade teaching team at a public elementary school. A consultant to the school delivered feedback following regularly scheduled classroom observations. Results indicated that combining verbal and graphic performance feedback was more effective than verbal performance feedback alone in improving treatment integrity. Informal data collected on student performance also suggested that appropriate behavior increased with better implementation of the BSP. Clinical and research issues are discussed.

Demythifying Behavioral Consultation

Since behavioral consultation was first described 20 years ago, a number of assumptions have emerged in the literature and gained legendary status despite being based either on weak or non-existent data. Noell and Witt (1996) initially identified five assumptions underlying behavioral consultation including: (a) consultative services are more cost efficient than direct intervention, (b) collaborative consultation are more effective than expert consultation, (c) verbal interactions with teachers result in significant behavior change, (d) skills learned during the consultation interaction will generalize across subjects and behaviors, and (e) direct contact with the client are unnecessary for behavior change to occur. Because these assumptions do not have a solid empirical basis, we prefer to call them “myths.” In an attempt to “demythtify” behavioral consultation, we present four additional myths not previously discussed to further emphasize that what many practitioners have been taught about how to conduct consultation may not be the most effective means for teaching consultees new skills, improving treatment integrity, and improving client outcome. We also hope to provide an impetus for new research directions to enhance the effectiveness of consultation practice.

Strategies for Improving Treatment Integrity in Organizational Consultation

Strategies for Improving Treatment Integrity in Organizational Consultation