Characterizing Fidelity Monitoring Practices in Community Behavioral Health Care

Area of Science:

• Behavioral Health
• Implementation Science
• Healthcare Quality Improvement

Background:

• Evidence-based practices (EBPs) require high fidelity for maximum effectiveness.
• Clinician deviation from intended EBP delivery necessitates ongoing fidelity monitoring.
• Current fidelity monitoring practices in community behavioral health care are not well understood.

Purpose of the Study:

• To characterize current fidelity monitoring practices in community behavioral health agencies.
• To identify barriers and facilitators to fidelity monitoring.
• To explore needs for scalable and sustainable fidelity monitoring methods.

Main Methods:

• A mixed-methods approach combining surveys and qualitative interviews.
• Surveys administered to 191 clinicians, supervisors, and leaders in Midwestern agencies.
• Interviews conducted with 10 agency personnel and 11 intermediary organization leaders nationwide.

Main Results:

• Most agencies monitor delivered practices, primarily using self-report and chart reviews.
• Session recordings and role-play assessments were least frequently endorsed.
• Common barriers and facilitators were identified at clinician, agency, and system levels.

Conclusions:

• There is a need for scalable and sustainable methods to monitor EBP fidelity.
• Multi-level approaches are essential to support fidelity monitoring in community behavioral health.
• Findings inform strategies to improve EBP implementation and outcomes.