# Characterizing Fidelity Monitoring Practices in Community Behavioral Health Care

## TL;DR

This study explores how community behavioral health agencies monitor the fidelity of evidence-based practices and identifies barriers and facilitators to effective monitoring.

## Contribution

The study provides new insights into current fidelity monitoring practices and strategies in community behavioral health care settings.

## Key findings

- Self-report and chart review are the most commonly used fidelity monitoring methods in agencies.
- Session recordings and role-play assessments are rarely used for fidelity monitoring.
- Barriers and facilitators to fidelity monitoring exist at clinician, agency, and system levels.

## Abstract

Evidence-based practices (EBPs) are most effective when they are delivered with a high degree of fidelity, or as they are intended to be delivered. Because clinicians often deviate from fidelity, it is important to monitor EBP fidelity over time to guide corrective actions. However, little is known about current fidelity monitoring practices in community behavioral health care. The current study used a mixed methods approach to characterize current fidelity monitoring practices, as well as barriers and facilitators to fidelity monitoring, in community behavioral health care agencies. Therapists, supervisors, recovery coaches, executive leaders, and agency leaders (N = 191) from multiple agencies in a Midwestern state completed a survey measuring current fidelity monitoring methods at their agency and perceived acceptability and feasibility of potential fidelity monitoring methods and strategies. Additionally, agency leaders, supervisors, and therapists (N = 10) within the state and leaders of intermediary organizations (N = 11) across the United States participated in individual qualitative interviews asking about facilitators, barriers, and priorities related to ongoing fidelity monitoring. Most respondents indicated their agency currently monitors what practices are being delivered, with self-report and chart review the most frequently reported methods used and session recordings and role-play assessment the least-frequently endorsed. Mixed methods results revealed common barriers to and potential strategies for facilitating fidelity monitoring efforts at the clinician-, agency-, and system-level. Findings highlight the need for scalable and sustainable methods for monitoring fidelity and the need for multi-level approaches to support EBP fidelity monitoring in community behavioral health settings.