Advances in Treatment Integrity Research: Multidisciplinary Perspectives on the Conceptualization, Measurement, and Enhancement of Treatment Integrity

Article excerpt

Abstract. Documenting treatment integrity is an important issue in research and practice in any discipline concerned with prevention and intervention. However, consensus concerning the dimensions of reatment integrity and how they should be measured has yet to emerge. Advances from three areas in which significant treatment integrity work has taken place--psychotherapy, substance abuse treatment, and prevention science--are summarized and integrated with recent advances in treatment integrity in school psychology. Innovations discussed include broadened models of treatment integrity, generic treatment integrity measures that assess common and unique elements of multiple interventions, and experimentally validated strategies for enhancing treatment integrity. Building on innovations across disciplines is one means for advancing treatment integrity technology in educational settings.

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Treatment integrity refers to the extent to which an intervention, as conceptualized in a theoretical model or manual, is implemented as intended. It is central to two movements: evidence-based practice and response to intervention (RTI), both of which have significant implications for research and practice in school psychology (Sanetti & Kratochwill, 2009).

Despite the importance of treatment integrity, numerous reviews over the past 25 years have documented the low rate at which treatment integrity procedures are incorporated in intervention research and practice (e.g., Borelli et al., 2005; Dane & Schneider, 1998; Gresham, Gansle, Noell, Cohen, & Rosenblum, 1993; Moncher & Prinz, 1991; Peterson, Homer, & Wonderlich, 1982; Weisz, Doss, & Hawley, 2005). This lack of change in treatment integrity practices across time and disciplines leaves the impression that treatment integrity is much like the weather--everyone talks about it, but no one does much about it.

However, this impression is false. Although the extent to which treatment integrity is assessed in research and practice has not changed markedly over the past few decades, there have been significant advances in its conceptualization, measurement, and enhancement, particularly in the areas of psychotherapy, substance abuse treatment, and prevention science. In many cases, these advances have been the result of federally funded, large-scale prevention or intervention trials that include an explicit focus on treatment integrity (e.g., the National Institute of Mental Health Treatment of Depression Collaborative Research Program, Ablon & Jones, 2002; the National Institute of Drug Abuse Cocaine Collaborative Treatment Study, Crits-Cristoph et al., 1997; the National Institutes of Health Behavior Change Consortium, Bellg et al., 2004).

Yet, these advances have tended to be isolated. It may be that the multiple terms used to refer to treatment integrity across disciplines and stages of the research-to-practice cycle (e.g., treatment integrity, treatment fidelity, intervention integrity, implementation fidelity) have made it difficult to accumulate knowledge about treatment integrity across fields, or have impeded consensus building on the key elements of treatment integrity (Mowbray, Holter, Teague, & Bybee, 2003; Sanetti & Kratochwill, 2009).

In the past few years, this situation appears to be changing. There have been several comprehensive reviews of treatment integrity methodology (Durlak & DuPre, 2008; Mowbray et al., 2003; O'Donnell, 2008). In addition, standards for the documentation and measurement of treatment integrity have begun to be included in intervention research guidelines across multiple fields (e.g., Flay et al., 2005; Mayo-Wilson, 2007; Task Force on Evidence-based Interventions, 2008). As diverse fields move toward evidence-based practice, pressure for documenting treatment integrity is likely to increase, both when interventions are developed and as they are put into use. …

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