1. Program Fidelity Influencing Training Program Functioning and Effectiveness Cheryl J. Woods, CSW

2. Program Fidelity The degree to which a program or intervention is delivered as was intended, What a program or intervention consists of in practice, And how well the program or intervention functions according to its specific design

3. Who determines program fidelity? Top Down Consensus

4. Outcomes and Processes Outcomes are what we hope to accomplish through implementation of the program or intervention Processes refer to what the program or intervention will do to achieve the anticipated outcomes and the way it will be done

5. Why be concerned with fidelity? It may be difficult to know what actually happened during the program or intervention – What took place – The quality of the program delivered – Whether the target audience was reached

6. What are the benefits of knowing? Information about program fidelity – Helps explain differences in observed changes in the outcomes – Helps strengthen conclusions that the program or intervention is effective

7. Attention to fidelity Helps us understand the internal dynamics and operations of the program or intervention – How the pieces of the program fit together – How the users (e.g. trainers, providers, and trainees) interact – The obstacles faced and resolved

8. Attention to fidelity Lets us see the – The strengths and weaknesses of a program or intervention – Anticipated and unanticipated consequences

9. Attention to fidelity Helps us learn more about “Best Practices” for: – Replicating – Maintaining – Diffusing programs or interventions

10. Without attention to fidelity It is difficult to know whether to ascribe program outcomes to the full effect of the program as originally intended or to imperfect implementation of the program

11. For instance the same program at three different sites – Site A – every one just gets together – Site B – the content of the program is delivered with little attention to how much or how it is delivered – Site C – The program is implemented as designed

12. Promotes Fidelity

13. Preparation – Theory of how the program or intervention produces change – Specification of major components or the active ingredients – Manual – Training

14. Supervision Ongoing supervision that includes – Continuous monitoring of implementation – Provisions for corrective action

15. Threats to Program Fidelity

16. Cultural Issues Cultural Issues Language differences between trainers and trainees Lack of respect for and/or knowledge about the culture and worldview of trainees from diverse cultural backgrounds Lack of consideration for the values and integrity of the community being served

17. Issues related to the trainee Pattern of attachment and internal working model Level of active participation Developmental issues Emotional state or history of trauma

18. Learning skills Attitude of the trainee Trainee expectations and assumptions

19. Issues related to the characteristics of the intervention Attrition Mismatch between trainee and training Scheduling problems Conflict in the goals of the training by trainees, trainers, administration, and community

20. More issues related to the characteristics of the intervention Program intake timing Physical setting of training Attitude of the trainer Trainer expectations and assumptions Trainer adherence to program specifications

21. Verification Documentation that all aspects are delivered as described and for measuring fidelity across sessions, implementers and sites

22. Verification of program fidelity Documentation of Delivery – Are the essential components actually being delivered? – Quality (e.g. usefulness, affective quality, responsiveness)

23. Documentation of Delivery (continued) – Content – Unusual events – Problem solving

24. Adaptation Modifications can be deliberate or accidental Balance between fidelity and adaptation Rigidity also threatens fidelity by not allowing for innovation

25. Intentional Modifications May included – Enhancements of program components – Adjustments in the nature of the components – Changes in the manner or intensity of delivery – Cultural and other modifications required by local circumstances

26. Assessment Tools Used to verify program fidelity Trainee forms (trainee perceptions) – What they received – Trainee satisfaction

27. Measures Tapes can be reviewed and rated – Audio – Video

28. Other measures – Environmental rating forms – Process notes – Attendance sheets – Adherence measures – Structured observations and interviews

29. Benefits Documented compliance to State mandates Greater willingness to assume outcomes of training Trainer competency can be evaluated independently of trainee performance Higher level of training transferred to the work environment