ERIC Number: EJ867979
Record Type: Journal
Publication Date: 2009
Reference Count: 29
Evolution of the Treatment Integrity Concept: Current Status and Future Directions
Gresham, Frank M.
School Psychology Review, v38 n4 p533-540 2009
The concept of treatment integrity cuts across a diversity of fields involved with providing treatments or interventions to individuals. In medical treatments, the concept of "treatment compliance" or "treatment adherence" is an important and problematic issue. In the field of nutrition, the concept of "dietary adherence" is important for successful outcomes. In the fields of rehabilitation and substance abuse, the term "program implementation" captures the concept of treatment integrity. In clinical psychology, a common term for this concept is "treatment fidelity." Finally, in the field of applied behavior analysis, the concept of "procedural reliability" is commonly used to refer to treatment integrity. Despite variations in terminology across these diverse fields, the concern that treatments or interventions are delivered as prescribed or intended is of utmost importance to document that changes in individuals' functioning (medical, nutritional, psychological, or behavioral) are from those treatments and from extraneous variables. Treatment integrity is usually conceptualized as involving three dimensions: (1) "treatment adherence," or the degree to which an intervention is implemented as planned or intended; (2) "interventionist competence," or the interventionist's skill and experience in implementing a particular treatment; and (3) "treatment differentiation," or the extent to which interventions differ on critical dimensions. Conceptually, treatment adherence represents a quantitative dimension of treatment integrity in that it can be measured in terms of the number of critical treatment components that are implemented. Therapist competence might be conceptualized as more of a qualitative dimension of treatment integrity because it reflects how well treatment procedures are delivered. Finally, treatment differentiation represents theoretical distinctions between different aspects of two or more treatments. This commentary summarizes and expands the concepts on treatment integrity. The comments are organized around five broad categories: (1) conceptual issues; (2) psychometric/measurement issues; (3) flexibility considerations; (4) facilitation of treatment integrity; and (5) policy issues.
Descriptors: Program Implementation, Psychometrics, Definitions, Intellectual Disciplines, Medical Services, Behavior Modification, Mental Health, Behavior Change, Theories, Intervention, Research Methodology, Models, Validity, Reliability, Educational Research, Evaluation Methods, Educational Policy, Research Needs, Educational Assessment, Outcomes of Treatment, School Psychology, Special Education, Program Effectiveness, Program Evaluation, Research Problems, Evaluation Problems, Measurement, Measurement Techniques, Interdisciplinary Approach, Evidence, Predictor Variables
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Publication Type: Journal Articles; Opinion Papers
Education Level: Elementary Secondary Education
Authoring Institution: N/A