Using branching simulations in treatment fidelity plans

Area of Science:

• Health Professions
• Medical Education
• Clinical Psychology

Background:

• Treatment fidelity is crucial for the internal validity of intervention studies.
• Traditional methods for assessing fidelity may not adequately capture complex clinical decision-making processes.
• Ensuring adherence to multicomponent intervention protocols is challenging.

Purpose of the Study:

• To introduce and evaluate a new approach to treatment fidelity assessment using branching simulations.
• To determine the effectiveness of branching simulations in identifying interventionists' adherence to protocols.

Main Methods:

• Branching simulations were developed as case scenarios requiring step-by-step user decisions and actions.
• Users received immediate feedback on the consequences of their choices.
• Interventionists' performance was tested against an 80% criterion for full retraining.

Main Results:

• Out of 67 interventionists, 15 (22%) scored below the 80% criterion, requiring full retraining.
• A significant proportion, 30 (45%), needed partial retraining in specific intervention components.
• Branching simulations effectively identified areas of inadequate adherence.

Conclusions:

• Branching simulations represent a valuable tool for enhancing treatment fidelity assessment.
• This method can decrease threats to internal validity caused by poor adherence to intervention protocols.
• The approach is particularly suitable for interventions involving critical thinking and sequential action steps.