With the ever changing regulatory landscape and increased cost of behavioral healthcare, it seems that agencies and funding sources want“more bang for their buck.” Treatment programs are authorized for shorter durations, federal funding is tied to research-based outcomes, and discharge planning has become a prevalent theme in nearly all multi- and trans-disciplinary discussions. Not only do agencies want faster turnarounds, but parents want more help for their child, and service providers want better outcomes for their clientele.
In this climate, how do we ensure that best practices truly are what they claim to be and produce meaningful outcomes for clients, parents, agencies, funding avenues, and service providers? The answer lies in treatment integrity, that is, the degree to which an intervention is implemented as intended
Over the past two decades, monitoring and reporting treatment integrity has become an overlooked variable in both research and the implementation of evidence-based practices. Federal guidelines require strategies and interventions be based on evidence-based practices, and often tie funding security to successful outcomes.
For clients to achieve these successful outcomes, agencies and service providers must have comprehensive improvement plans in place that support monitoring and evaluation of treatment integrity. This can be a daunting challenge without proper infrastructure support (i.e. funding, personnel, training, environmental supports, etc).
Qualified personnel, such as licensed clinicians, are responsible for developing effective, evidence-based interventions that target clientele. However, in a community-based setting, these personnel are often not directly responsible for delivering an intervention and therefore immediately lose accuracy in treatment integrity, which, hypothetically, decreases the rate of success.
Additionally, assigning several support personnel responsibility for the same intervention can affect consistency in delivery, as different personalities are likely to bring different approaches and responses to the same situation. This can decrease treatment integrity, if proper training, modeling, and feedback are not provided to all parties responsible for intervention implementation.
Training is a large component that influences treatment integrity and must be individualized to meet the needs of clients, interventions, and personnel. Training provided by someone with knowledge of all three componentsis also helpful.
Having a support network that provides individualized feedback and training, intervention monitoring, evaluation, and evidence-based intervention development requires a great number of resources from a human resources and financial perspective. Too often, these types of monitoring programs are not accounted for in financial contracts, which can limit skilled and accurate treatment implementation.
If service providers want to ensure that treatment is going to produce better client outcomes in shorter periods of time, they must be willing to commit to the cause and devote the resources necessary to developing and implementing treatment integrity monitoring processes.