Treatment fidelity is the ability of the clinician to replicate the intervention according to the model.  While clinicians agree that fidelity is important in order to determine the model’s effectiveness in achieving the stated outcomes, pressures exist to adapt treatments to service settings.  It is also unclear to what degree fidelity is evaluated or emphasized in implementation and dissemination (McHugh et al., 2009).

Based on the work of the NIH Behavioral Change Consortium, Borelli (2012) reviews strategies for assessing, monitoring, and enhancing treatment fidelity in each of the five domains—study design, training, delivery, receipt, and enactment—of the treatment fidelity framework.  Included in the article are strategies for enhancing treatment fidelity for each domain as well as a treatment fidelity assessment and implementation plan.  She notes that while the implementation plan may require staff time and funding, the benefits outweigh the resources allocated to the assessment.

In 2012, Teague and his colleagues published an article on four recently developed fidelity measures for community-based interventions for persons with serious mental illness:  Cognitive Therapy for Psychosis Adherence Scale, Strengths Model Fidelity Scale, Illness Management and Recovery Program Fidelity Scale, and Tool for Measurement of ACT.

They found that each measure:

  • Has satisfactory psychometric properties
  • Assesses interventions on critical elements
  • Is related to outcomes
  • Is used for training, quality improvement, or certificationResearchers cautioned that unless evidence is obtained that a treatment element is not necessary, clinicians should continue to use fidelity scales in which all elements are assessed.


Bellg AJ, Borelli B, Resnick B, Hecht J, Minicucci DS, Ory M, Ogedegbe G, Orwig D, Ernst D, Czajkowski S.  Enhancing treatment fidelity in health behavior change studies:  Best practices and recommendations from the NIH Behavior Change Consortium.  Health Psychology.  2004;23(5):443-51.

Borelli B.  The assessment, monitoring, and enhancement of treatment fidelity in public health clinical trials.  Journal of Public Health Dentistry.  2011;71(sl):S52-S63.

Borelli B, Sepinwall D, Ernst D, Bellg AJ, Czajkowski S, Breger R, DeFrancesco C, Levesque C, Sharp DL, Ogedegbe G, Resnick B, Orwig D.  A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research.  Journal of Consulting and Clinical Psychology.  2005;73(5):852-60.

McHugh RK, Murray HW, Barlow DH.  Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions.  Behavioral Research and Therapy.  2009;47(11):946-53.

Teague GB, Mueser KT, Rapp CA.  Advances in fidelity measurement for mental health services research:  Four measures.  Psychiatric Services, 2012;63(8):1-7.