Program Fidelity Influencing Training Program Functioning and Effectiveness Cheryl J. Woods, CSW

Program 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 Processes Outcomes 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 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 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 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 fidelity Lets us see the – The strengths and weaknesses of a program or intervention – Anticipated and unanticipated consequences

Attention to fidelity Helps us learn more about “Best Practices” for: – Replicating – Maintaining – Diffusing programs or interventions

Without 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 instance the 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 Fidelity

Preparation – Theory of how the program or intervention produces change – Specification of major components or the active ingredients – Manual – Training

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

Threats to Program Fidelity

Cultural Issues Cultural 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 Pattern of attachment and internal working model Level of active participation Developmental issues Emotional state or history of trauma

Learning skills Attitude of the trainee Trainee expectations and assumptions

Issues related to the characteristics of the intervention Attrition Mismatch between trainee and training Scheduling problems Conflict in the goals of the training by trainees, trainers, administration, and community

More issues related to the characteristics of the intervention Program intake timing Physical setting of training Attitude of the trainer Trainer expectations and assumptions Trainer adherence to program specifications

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

Verification 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

Adaptation Modifications can be deliberate or accidental Balance between fidelity and adaptation Rigidity also threatens fidelity by not allowing for innovation

Intentional 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 Tools Used to verify program fidelity Trainee forms (trainee perceptions) – What they received – Trainee satisfaction

Measures Tapes can be reviewed and rated – Audio – Video

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

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