Toward equitable fidelity measurement of evidence-based psychosocial interventions

Accurately measuring clinician fidelity to psychosocial evidence-based interventions (EBIs) is essential to advance equitable EBI implementation. Observational measures of live or recorded therapy sessions are widely considered the most reliable and valid metrics for indexing fidelity. However, they are costly, time and resource intensive, and rarely used in underresourced clinical settings; this makes it challenging to assess the quality of care delivered to underserved populations. Further, many fidelity coding schemes originated from clinical trials testing relatively structured clinical protocols with primarily White, middle-class individuals. This raises equity considerations for their use and interpretation in settings serving individuals with diverse identities and adverse social determinants of health, where flexible EBI application is often required to meet needs. For example, fidelity coding schemes do not always consider patient cultural and contextual factors that may lead clinicians to "stray" from fidelity standards. Guided by the health equity implementation framework, we outline key equity considerations related to observational fidelity measurement and interpretation in mental health. We describe several ongoing efforts to equitably assess fidelity to psychosocial EBIs in underresourced community settings using a variety of strategies including standardized patient paradigms codeveloped with community partners, snapshot coding of session recordings, artificial intelligence models that automate fidelity score generations, and leveraging expert consultation encounters to generate actionable fidelity data. We conclude by discussing implications for future research. (PsycInfo Database Record (c) 2026 APA, all rights reserved).