Monitoring Fidelity to an Evidence-Based Treatment: Practitioner Perspectives

Despite the push to implement evidence-based treatment (EBT) in child and youth mental health service settings, few studies have focused on the optimal processes for adopting and sustaining EBTs in these contexts. There is even less evidence regarding practitioner perspectives on the optimal processes for sustaining fidelity to EBTs in practice, despite unequivocal evidence linking the importance of practitioner fidelity to intervention outcomes. Following the principles of inductive qualitative inquiry, this study examined practitioner perspectives of fidelity monitoring processes within the context of implementing motivational interviewing (MI) in four community-based child and youth mental health organizations. MI is a widely disseminated EBT that supports behavior change among adolescents and adults living with psychological, alcohol, and substance use challenges. Practitioners (n=22) completed semi-structured, qualitative focus groups that elicited their perceptions of the processes and supports provided to support fidelity to MI practice throughout the implementation project. Conventional content analysis revealed a number of important contextual, practitioner, and client factors that have the potential to support or deter the embedding of fidelity processes on the front lines. In addition, practitioners spoke of the importance of using a brief, straightforward fidelity-checking tool to support practitioner learning and practice in relation to MI. Findings have implications for supporting sustained practitioner fidelity to EBTs in settings where MI may constitute one of many possible treatments offered by practitioners in community-based mental health services. Findings also have implications for sustaining practitioner fidelity to EBTs more broadly.