30 / 64
Fresh science and pioneering practice
140
JCPSLP
Volume 17, Number 3 2015
Journal of Clinical Practice in Speech-Language Pathology
Maryanne
O’Hare (top) and
Elizabeth Doell
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
KEYWORDS
COACHING
EVIDENCE-
BASED
PRACTICE
SUPERVISION
TREATMENT
FIDELITY
concomitant requirements for clinicians to demonstrate
that their implementation of evidence-based interventions is
effective and efficient. Speech-language pathologists have
been encouraged to consider the treatment fidelity of their
implementation of evidence-based programs as this has a
significant impact on effectiveness of the intervention and
subsequent outcomes (Kaderavek & Justice, 2010).
What is treatment fidelity?
In this article, treatment fidelity refers to the extent to which
an intervention relates to the prototype intervention or the
effectiveness research carried out on the intervention
(Hulleman & Cordray, 2009; Kaderavek & Justice, 2010).
Treatment fidelity is reported in published studies to
establish the consistency and integrity of the application of
the intervention, to strengthen the internal validity of the
study. Just as demonstrating fidelity assists researchers to
establish underlying reasons for the success of an
intervention in research, it is highly likely that the degree of
fidelity in the implementation of clinical interventions will
impact client outcomes (Kaderavek & Justice, 2010).
Implementing a range of treatment fidelity measures
as part of service delivery is important for monitoring
the outcomes of an intervention. As more validated
interventions are developed, monitoring treatment fidelity
will become more important for implementing successful
interventions for clients (Kaderavek & Justice, 2010). When
there is low fidelity to the original intervention, clinical
decision-making regarding the success of an intervention
can be difficult because it is unclear if a treatment is
effective (or not) due to the actual intervention or factors
related to how the intervention was delivered. Implementing
interventions with high treatment fidelity requires integration
of two of the evidence-based practice components: the
findings from published research and the clinician’s skills
and knowledge. It is important that SLPs apply treatment
fidelity measures both in their own clinical practice and at
the service delivery level.
Treatment fidelity measures
There is a range of suggested treatment fidelity measures.
Distinctions are made between context, compliance, and
competence measures (Fixsen, Naoom, Blase Friedman, &
Wallace, 2005). Context measures refer to the prerequisite
required supports for an intervention, from the completion
of training to the clinician’s caseload capacity to deliver the
intervention. Compliance measures are utilised to monitor a
clinician’s application of the intervention process and
One of the challenges for speech-language
pathologists implementing evidence-based
interventions is the need to consider
treatment fidelity. This paper reviews the
treatment fidelity guidance provided in three
evidence-based interventions utilised in
Australia and New Zealand practice for
children with communication difficulties. The
challenges in measuring and monitoring
treatment fidelity within real-world practice
contexts are identified along with
recommendations for ways of supporting
speech-language pathologists (SLPs) to
develop and monitor treatment fidelity
procedures. The paper proposes an
organisational perspective for supporting
speech-language pathologists to implement
evidence-based interventions for children
with communication difficulties.
E
vidence-based practice is the combination of
three equally important components: high-quality
published research, clinician skills and knowledge,
and client preferences and values (Reilly, 2004). Although
speech-language pathologists (SLPs) understand the
value of evidence-based practice and have an ethical
requirement to provide clients with best practice (SPA,
2010), they experience difficulties applying evidence to their
everyday practice contexts (Hoffman, Ireland, Hall-Mills &
Flynn, 2013; Roulstone, 2015). Accessing and translating
evidence into practice is a complex task requiring skills
in reading and analysing research combined with clinical
expertise and the ability to access and integrate clients’
and caregivers’ values and preferences. Kenny and Block
(2014) discussed ethical challenges related to translating
research knowledge to practice and the need to adapt
knowledge to the “culture and worldview of consumers so
they may benefit from new approaches” (p. 38). Clinicians
may be faced with a dilemma when considering how to
make program adaptations in response to stakeholder
preferences that do not compromise the requirements for
maintaining treatment fidelity.
An organisational priority is the need to ensure that
allocated resources result in optimal outcomes, with
What supports speech-
language pathologists to
implement treatments
with fidelity?
Maryanne O’Hare and Elizabeth Doell