Fidelity Scale: From Black Box to Holy Grail

Abstract

Fidelity scales are indispensable in the pursuit of evidence-based mental healthcare. Without fidelity checks, treatment remains a mysterious black box. The aim of this article is to comment on the studies in this special section, and to discuss some general issues with regard to fidelity assessment. Despite all of their supposed benefits, resistance to fidelity scales persists among mental health practitioners. One way to overcome this resistance is to conduct fidelity assessments in the context of a well-guided learning community. The predictive validity of fidelity scales is considered the single most valuable attribute of these instruments. Research on predictive validity requires large sample sizes, which is difficult to achieve. It should nevertheless not prevent us from rigorously searching for this Holy Grail of fidelity assessment. In addition, fidelity assessment should be placed in a broader perspective. The quality of care for people with severe mental illness cannot be assessed conclusively according to the extent to which separate interventions have been applied with good fidelity. These individuals need access to high-quality treatment and support systems within the community, which can enable them to live their lives as valued citizens. In conclusion, fidelity assessment, both at the level of interventions and systems, contributes to a highly desirable transparency in practice variations within the field of mental healthcare.

Fidelity and Clinical Competence in Providing Illness Management and Recovery: An Explorative Study

“…Finally, realization of organizational conditions is critical to successful IMR implementation (Egeland, Hauge, et al, 2019 ; Heiervang et al, 2020 ; Teague et al, 2012 ; van Weeghel, 2020 ). In this study, however, we chose to focus on adherence to the IMR model and the fidelity of the competencies of IMR trainers.…”

Supporting psychosis research, implementation, and training through an academic intermediary–purveyor organization.

“…Interventions and programs that are administered with high fidelity are more likely to yield better program and patient outcomes, yet publicly funded health care settings experience significant hardships in monitoring fidelity or using fidelity metrics to guide program or professional development (McLeod et al, 2018). van Weeghel (2020) asserts that “without fidelity checks … it is not possible to distinguish failure of the intervention from failure to implement the intervention” (p. 927). As public sector health care organizations increasingly look to implement cognitive behavioral skills training and therapies, options to enhance and monitor the quality of CBTp interventions are sorely needed, particularly in light of an increasing reliance on a workforce not formally educated or trained in ESTs.…”

Measuring Fidelity to Evidence-Based Practices: Psychometrics

“…In his comments van Weeghel ( 2020 ) discusses some of the challenges and limitations in the fidelity scales reported in this section, overcoming resistance to fidelity measures, fidelity assessments in mental healthcare systems, and the importance of predictive validity. He also gives an international perspective by describing some developments in Europe, including in the Netherlands.…”