The 6 Ts of Treatment Fidelity

“Plan your work and work your plan” is an oft repeated bit of wisdom.  “Fidelity” means loyalty or faithfulness.  In the context of treatment, it refers to the degree to which your actions match your plans.  All of us can give examples of programs we have established with the best of intentions, only to find out later that what is actually being delivered barely resembles the intended plan.  In simple terms, designing a treatment program is based on the wise saying, “Plan your work.”  Faithfulness to that design is based on the “Work your plan” part.

Measuring fidelity is time consuming and difficult.  However, failure to do so essentially equates to another wise saying:  Fail to Plan = Plan to Fail.  Fidelity WILL NOT just happen because you have motivated clients and quality staff.  Without consistent follow up, measurement and feedback, “treatment drift” WILL OCCUR. 

Theory:  Is the intervention based on evidence based principles?

 If the treatment is not focused, behavioral, and measured, it is likely based on something other than sound offender intervention theory.

Text:  Is there a written manual? 

All practices in which fidelity is considered important (e.g., religion) are based on writings that express the theory and rules of engagement.  The same principles are often discussed in a variety of different methods (e.g., metaphors, real life examples, standards of behavior, rules, etc.).

Train: Has the provider been trained in the delivery of the intervention?

Training in delivery does not mean “familiar with the theory” and does not mean “has read the manual.”  It does mean training that includes observing, role playing and feedback to the performance.

Treat:  Has the treatment provider actually delivered the treatment intervention? 

Role playing with colleagues is quite different than actually delivering an intervention with offenders, particularly when some of those offenders are resistant or disruptive.  Early in the process, the newly trained treatment provider must be observed actually providing the treatment.

Track:  Are the key ingredients of the treatment program manual actually being practiced in the real world? 

While the quality of interactions with offenders is subjective at times, whether key performance indicators (KPIs) are present or absent is an objective issue.  Supervisors must observe, measure and track actual performance.  Consistent tracking must continue in order to prevent “treatment drift.”

Tell:  Is timely meaningful feedback shared with the treatment provider? 

Much like an offender’s initial assessment that is filed and ignored, tracking performance only makes a difference if the results are shared with the treatment provider.  Feedback is vital to honing new skills.