Attention to Treatment Fidelity in Social Work Outcomes: A Review of the Literature from the 1990s

Effective social work research on psychosocial outcomes is likely to depend not only on quality of research designs, but also on treatment fidelity. Treatment fidelity refers to whether a specific treatment or intervention is implemented as planned (Gresham, 1996; Hogue, Liddle, & Rowe, 1996). Components of treatment fidelity include treatment adherence and competence. Adherence refers to the degree to which a practitioner uses techniques and approaches prescribed by an intervention, whereas competence refers to the level of skill with which a practitioner delivers the intervention (Waltz, Addis, Koerner, & Jacobson, 1993). Strategies to enhance treatment fidelity might include developing treatment manuals, protocols, or both for practitioners who deliver the intervention, training practitioners in the intervention methods, supervising practitioners as they deliver the intervention, and making observational checks (in vivo, audio, or video) to ensure that the intervention is being implemented as intended (Moncher & Prinz, 1991). Bellig and his colleagues (2004) noted that many of these strategies are well-known but are not consistently used in intervention research on health behaviors. Rosen and his colleagues (1999) stressed that in order for social work research to inform practice and add to the social work knowledge base, interventions must be "empirically denotable" and sufficiently detailed to ensure the integrity of implementation and future replication. For that reason, enhancing and verifying treatment fidelity as part of research has the potential to increase strong and valid comparisons of replicable treatments. In addition, it has been argued that a critical reason for assessing and enhancing treatment fidelity is to increase the internal validity or confidence that observed differences or lack thereof in outcome studies are due to the intervention and not other variables (Barber, Foltz, Crits-Christoph, & Chittams, 2004; Moncher & Prinz, 1991). Because of its importance, treatment fidelity, according to experts in other fields, should be a standard part of any evaluation (Bellig et al., 2004; Perepletchikova & Kazdin, 2005); however, little attention has been given to treatment fidelity in social work research. In the past, treatment fidelity in studies of school-based behavioral interventions (Gresham, Gansle, Noell, Cohen, & Rosenblum, 1993); clinical psychology, behavioral therapy, psychiatry, marital and family therapy (Moncher & Prinz, 1991); and child treatment (Gresham, Gansle, & Noell, 1993) spanning a decade have been examined. In general, the findings suggest the trend that outcome studies were more likely to use strategies to enhance treatment fidelity than to measure the extent of treatment fidelity. For example, Gresham, Gansle, and Noell (1993) found that only 16% of 168 articles reviewed specifically measured and reported treatment fidelity, whereas as little as 6% of the 359 studies reviewed by Moncher and Prinz (1991) did the same. In addition, conflicting information has been found on the relationship between treatment fidelity and outcomes. In their review of studies addressing treatment fidelity, Perepletchikova and Kazdin (2005) noted that although some research indicates that decreased fidelity is related to a decrease in the likelihood of significant change in the dependent variables, other research partially supports this or indicates therapeutic change without therapeutic fidelity. Unlike the mentioned psychology and education literature, little attention has been given to treatment fidelity in social work research on psychosocial outcomes. In an effort of fill this gap, this study reviews a decade of social work research on psychosocial outcomes to see how treatment fidelity is addressed and to understand the relationship of treatment fidelity to outcomes. METHOD Six prominent social work journals were selected for this review for two reasons. …