Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011;6(1):18-33.
doi: 10.5042/jcs.2011.0123.

Examining implementer fidelity: Conceptualizing and measuring adherence and competence

Wendi F Cross  1 , Jennifer C West
Affiliations

Examining implementer fidelity: Conceptualizing and measuring adherence and competence

Wendi F Cross et al. J Child Serv. 2011.

Abstract

The large gap between intervention outcomes demonstrated in efficacy trials and the apparent ineffectiveness of these same programs in community settings has prompted investigators and practitioners to look closely at implementation fidelity. Critically important, but often overlooked, are the implementers who deliver evidence-based programs -- the effectiveness of programs cannot surpass skill levels of the people implementing them. This article distinguishes fidelity at the programmatic level from implementer fidelity. Two components of implementer fidelity are defined. Implementer adherence and competence are proposed to be related but unique constructs that can be reliably measured for training¸ monitoring, and outcomes research. Observational measures from a school-based preventive intervention are provided and the unique contributions of implementer adherence and competence are illustrated. Distinguishing implementer adherence to the manual and competence in program delivery is a critical next step in child mental health program implementation research.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Resilience Project Adherence raw scores and range for two implementers* Key: C-I= Check-in; Rev = Review of previous meeting; Int = Introduction to new skill; Tch = Teach new skill; AL = Active Learning & Practice new skill; R & G = Review of new skill and Generalization to daily context; T= time/duration *Session 9
Figure 2
Figure 2
Resilience Project Competence raw scores and range for two implementers* Key: Emot-Resp = Emotional responsiveness; Bound = Boundaries; Lang = Language; Pacing/focus = Pacing of delivery and focus on skill; Practice = Practice and rehearsal engagement; Tailoring = Individualizing material; In-vivo = spontaneous teaching/reinforcing *Session 9
See this image and copyright information in PMC

References

    1. Backer TE. The failure of success: Challenges of disseminating effective substance abuse prevention programs. Journal of Community Psychology. 2000;28(3):363–373.
    1. Backer TE. Finding the Balance: Program fidelity and adaptation in substance abuse prevention: A state-of-the-art review. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration (DHHS/PHS); Rockville, MD: 2002.
    1. Barber JP, Crits-Cristoph P, Luborsky L. Effects of therapist adherence and competence on patient outcome in brief dynamic therapy. Journal of Consulting and Clinical Psychology. 1996;64(3):619–622. - PubMed
    1. Brekke JS, Wolkon GH. Monitoring program implementation in community mental health settings. Evaluation and the Health Professions. 1988;11(4):425–440. - PubMed
    1. Bumbarger BK, Perkins DF. After randomized trials: issues related to dissemination of evidence-based interventions. Journal of Children’s Services. 2008;3(2):53–61.

LinkOut - more resources