Implementation Science: Fidelity in a Statewide Implementation of an Evidence-Based Practice.

摘要

A great deal of pressure has been applied to the mental health field to provide efficacious research-driven treatment, or evidence-based practices, in an environment of dwindling resources. Although the mental health field has been provided with ample evidence of effective practices, how to provide these practices with fidelity, as the original researched model intended, has received less attention. Through the lens of the diffusion of innovations theory, the purpose of this study was to examine whether the use of an evidence-informed tool, one that provides technical assistance with the tool and supportive feedback, increased fidelity to an evidence-based practice. Using an ex post facto quantitative pretest-posttest within-subjects design, the research questions examined whether the intervention would affect a pre and post examination of proxy measures of model adherence, a validated measure of symptom distress (the Youth Outcome Questionnaire), and a measure of fidelity. These dependent variables were analyzed using a t test with Bonferroni correction at alpha = .007. Results indicated that the statewide implementation of the intervention did not affect various measures of adherence, fidelity, and outcome. Although design flaws such as a lack of researcher control over archival data may have contributed to the nonsignificant findings, these results may also be due to the difficulty with increasing fidelity after one-year post implementation of an evidence-based practice. The results of this study suggest that resources may be more efficiently utilized in first-year implementation, given that it may be resource-intensive after one year. As mental health agencies and administrators grapple with decreasing resources, this study contributes to their efficient use and suggests means for greater impact to model fidelity.