Program FidelityProgram Fidelity

Influencing Training Program Functioning and Effectiveness

Cheryl J. Woods, CSW

Program FidelityProgram Fidelity• The degree to which a program or

intervention is delivered as was intended,• What a program or intervention consists of

in practice,• And how well the program or intervention

functions according to its specific design

Who determines program fidelity?

•Top Down

•Consensus

Outcomes and ProcessesOutcomes and ProcessesOutcomes are what we hope to accomplish

through implementation of the program or intervention

Processes refer to what the program or intervention will do to achieve the anticipated outcomes and the way it will be done

Why be concerned with Why be concerned with fidelity?fidelity?

It may be difficult to know what actually happened during the program or intervention– What took place– The quality of the program delivered– Whether the target audience was reached

What are the benefits of What are the benefits of knowing?knowing?

Information about program fidelity– Helps explain differences in observed changes

in the outcomes– Helps strengthen conclusions that the program

or intervention is effective

Attention to fidelity Attention to fidelity Helps us understand the internal dynamics and

operations of the program or intervention– How the pieces of the program fit together– How the users (e.g. trainers, providers, and

trainees) interact– The obstacles faced and resolved

Attention to fidelityAttention to fidelityLets us see the – The strengths and weaknesses of a program or

intervention– Anticipated and unanticipated consequences

Attention to fidelityAttention to fidelityHelps us learn more about “Best Practices”

for:– Replicating– Maintaining – Diffusing programs or interventions

Without attention to fidelityWithout attention to fidelity

It is difficult to know whether to ascribe program outcomes to the full effect of the program as originally intended or to imperfect implementation of the program

For instanceFor instancethe same program at three different sites

– Site A – every one just gets together – Site B – the content of the program is delivered

with little attention to how much or how it is delivered

– Site C – The program is implemented as designed

Promotes FidelityPromotes Fidelity

PreparationPreparation

– Theory of how the program or intervention produces change

– Specification of major components or the active ingredients

– Manual– Training

SupervisionSupervision

Ongoing supervision that includes– Continuous monitoring of implementation– Provisions for corrective action

Threats to Program Threats to Program FidelityFidelity

Cultural IssuesCultural Issues          

       Language differences between trainers and trainees    

Lack of respect for and/or knowledge about the culture and worldview of trainees from diverse cultural backgrounds

          Lack of consideration for the values and integrity of the community being served

Issues related to the trainee Issues related to the trainee Pattern of attachment and internal working model Level of active participation Developmental issues Emotional state or history of trauma

Learning skillsAttitude of the traineeTrainee expectations and assumptions

Issues related to the Issues related to the characteristics of the interventioncharacteristics of the intervention

Attrition Mismatch between trainee and trainingScheduling problems Conflict in the goals of the training by trainees, trainers, administration, and community

More issues related to More issues related to the the characteristics of the interventioncharacteristics of the intervention

Program intake timingPhysical setting of training Attitude of the trainer Trainer expectations and assumptions Trainer adherence to program specifications

Verification Verification

Documentation that all aspects are delivered as described and for measuring fidelity across sessions, implementers and sites

Verification of program fidelityVerification of program fidelity

Documentation of Delivery– Are the essential components actually being

delivered? – Quality (e.g. usefulness, affective quality,

responsiveness)

Documentation of Delivery (continued)– Content– Unusual events– Problem solving

AdaptationAdaptation

Modifications can be deliberate or accidental

Balance between fidelity and adaptationRigidity also threatens fidelity by not

allowing for innovation

Intentional ModificationsIntentional Modifications

May included– Enhancements of program components– Adjustments in the nature of the components– Changes in the manner or intensity of delivery– Cultural and other modifications required by

local circumstances

Assessment ToolsAssessment ToolsUsed to verify program fidelityTrainee forms (trainee perceptions)

– What they received– Trainee satisfaction

MeasuresMeasuresTapes can be reviewed and rated

– Audio– Video

Other measuresOther measures– Environmental rating forms– Process notes– Attendance sheets– Adherence measures– Structured observations and interviews

Benefits Benefits Documented compliance to State mandates

Greater willingness to assume outcomes of training

Trainer competency can be evaluated independently of trainee performance

Higher level of training transferred to the work environment