Treatment integrity also known as procedural integrity, procedural fidelity, and treatment fidelity is the extent to which interventionists implement procedures in a manner consistent with their prescribed protocols e.
This article discusses treatment integrity and the importance thereof, not just in the field of behavior analysis but across disciplines. The search identified articles, which included experimental work, literature reviews, and commentaries. A closer look at the articles that the search identified indicates that treatment integrity is a topic of empirical interest across numerous disciplines, including intellectual and developmental disabilities, dementia care, special education, mental health, addiction and substance abuse, social work, psychotherapy, and cognitive therapy, just to name a few.
The search also indicated that since the year , there has been a sharp increase in the number of articles published on treatment integrity. It is important to provide a rationale for why studying treatment integrity is important, regardless of discipline, since it is a topic to which much recent empirical research has been dedicated. From a research perspective, high levels of treatment integrity are essential in reaching accurate conclusions regarding functional relations between dependent i.
Compromised treatment integrity can lead to erroneous conclusions regarding treatment effectiveness. Either one of these conclusions can have detrimental effects on the development of effective procedures. For example, if a procedure is implemented with the aim of increasing prosocial behavior in a child with autism, and no increases in behavior is shown, it may lead the interventionist to conclude that the procedure was ineffective and that more intensive training is required.
However, without measuring the integrity with which the procedure was administered, it remains unclear whether the procedure itself was ineffective, or whether the procedure would have been effective had prescribed protocols been followed.
If the interventionist concludes that the procedure was ineffective, it becomes less likely that the procedure will be used with other clients in the future. Low levels of treatment integrity also adversely affect external validity i.
Unfortunately, reporting quantifiable measures of treatment integrity within published literature is not the norm. Several literature reviews have been conducted across various disciplines to assess the frequency with which treatment integrity data are reported. The results from these reviews paint a somewhat grim picture and should motivate researchers and journals to pay more attention to the reporting of treatment integrity data. Monchar and Prinz conducted a review involving journals across four disciplines psychiatry, clinical psychology, behavior therapy, and marital and family therapy for articles published between and Despite these numbers, it is encouraging to see that various disciplines have begun the process of self-evaluation with respect to reporting treatment integrity data.
For some related fields, such as gerontology, occupational therapy, and performance management, literature reviews outlining the frequency with which treatment integrity data are reported, to the best of our knowledge, do not exist Bruhn et al.
Treatment integrity literature reviews usually contain recommendations calling for journals and authors to measure and report treatment integrity data as often as possible and with increased frequency. I wish to add my voice to these recommendations. Treatment integrity is also important from a clinical practice perspective. Research investigating the relationship between treatment integrity and client outcomes are either correlational e.
Correlational studies involve recording data on how changes in client behavior coincide with changes in treatment integrity. Experimental studies involve arranging conditions in which treatment integrity is systematically manipulated and assessing how client outcomes are affected under these varying treatment integrity conditions. Experimental studies allow for functional conclusions with respect to how varying levels of treatment integrity affect client behavior, whereas correlational studies do not.
The review included more than articles covering areas such as mental health, alcohol and substance abuse, social skills, and physical health promotion. The review found that procedures implemented with high levels of integrity are more effective compared to procedures that are implemented with lower levels of integrity. Specifically, client outcomes are best when procedures are implemented with perfect treatment integrity.
Although implementing procedures with perfect integrity every time a procedure is carried out in the natural environment may not be feasible, interventionists should strive to implement procedures with high levels of integrity as often as possible.
An interesting finding is that when treatment integrity decreases, client behavior becomes less predictable e. This entry describes the importance of treatment integrity, how it can be measured, influences on treatment integrity, and how it can be improved. Many authors have noted how treatment integrity is complex and multidimensional, thus difficult to adhere to, measure, and report. Social science and specifically teacher-implemented interventions have a high risk of treatment integrity lapses due to the nature and variability of classrooms.
Lack of adherence to treatment integrity during implementation Show page numbers Download PDF. Search form icon-arrow-top icon-arrow-top. Page Site Advanced 7 of Edited by: Bruce B. Disciplines : Education. Buy in print.
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