Measuring Teachers’ Intervention Fidelity

Abstract

School personnel implementing interventions new or unfamiliar to them need to know how to implement the intervention with fidelity. A five-step process is described that can be used to design and implement fidelity procedures with teachers using new or unfamiliar interventions.

Keywords

Fidelity of treatment interventions integrity of implementation

Fidelity of treatment, or integrity of implementation for interventions, means interventions are used according to predetermined criteria detailing activities, materials, and behaviors so the intervention has the desired effect on students’ behaviors (Smith, Daunic, & Taylor, 2007). Fidelity means the intervention is used true to the way it was originally designed. Kaderavek and Justice (2010) noted that fidelity should be determined hand in hand with targeting evidence-based practices because whether an intervention works as expected can be dependent on whether the intervention was implemented as intended. Correspondingly, students are more likely to benefit from interventions used as intended, although researchers find many evidence-based practices are not implemented as originally planned (Stahmer et al., 2015). When an intervention is not used as planned, students’ performance declines (Duhon, Mesmer, Gregerson, & Witt, 2009). When considering that school teams target specific interventions for teachers to use (e.g., within the frameworks of response to intervention [RTI], schoolwide positive behavior intervention and supports, behavior support plans [BSP]), it may be erroneous to assume that teachers are experts with all aspects of every intervention. Consequently, interventions should be accompanied by a fidelity plan that supports teachers’ implementation, which in turn supports students with or without disabilities. Yet focusing on fidelity plans is not yet the norm when teachers are asked to use new interventions (Fogarty et al., 2014; Gresham, 2009). This article describes a five-step process that school personnel can use for guidance when developing and implementing a behavior or academic intervention fidelity plan.

Fidelity is not only about using the correct steps in an intervention, but also about how well the steps are implemented (Harn, Parisi, & Stoolmiller, 2013). For example, Burke, Howard, Peterson, Peterson, and Allen (2012) prepared educators to record the frequency of high-quality behavior-praise statements (i.e., verbalized as intended) used by paraprofessionals they supervised, and then graphed the data for paraprofessionals to view. Using the graphs as visual performance feedback about the quantity of behavior-specific statements yielded increased use of statements, indicating increased fidelity. In addition to high fidelity for the intervention, the quality of how the praise statements were spoken was also important, such as tone of voice and enthusiasm (Gresham, 2009). As such, it is not just the adherence to steps in an intervention being used, but also the quality of how steps are implemented (Schulte, Easton, & Parker, 2009).

The Importance of High Fidelity

Similar to Burke et al. (2012), Duhon et al. (2009) prepared educators to implement interventions with students in the context of RTI team meetings. Teachers received a fidelity protocol detailing intervention steps. During the professional development, teachers practiced using the interventions and attained high degrees of fidelity prior to implementation in their classrooms. Once implementation began, teachers continued using the fidelity protocol to remain aligned with accurate implementation. Some teachers started out well with regard to fidelity, but soon dropped to unacceptable levels by skipping implementation steps. During the next RTI team meeting, performance feedback was provided to teachers via graphs of the percentage of intervention steps completed. After performance feedback, fidelity of implementation increased. When fidelity was high, students’ performance also increased to desirable levels.

Other researchers have also found correlations between high fidelity of intervention implementation and student progress (Crawford, Carpenter, Wilson, Schmeister, & McDonald, 2012; Reinke, Stormont, Herman, & Newcomer, 2014; Sanetti & Kratochwill, 2011). For example, Gabriel and Davis (2015) found that students with learning disabilities learned significantly more on a writing strategy when their teachers’ instruction exhibited high fidelity. Posttest scores for students whose teachers adhered to the writing strategy components were almost double those of students whose teachers had low fidelity. Some teachers may not realize the critical connection between high fidelity and desired impact on students’ outcomes. When fidelity is low, students reap fewer benefits. In addition, school personnel should use caution when making decisions based on low fidelity, or even lack of fidelity data. Low fidelity may lead to beliefs that the intervention did not work. However, when fidelity is low, it is not the intervention that should change, but rather how the intervention is implemented. This article describes a five-step process for designing and implementing fidelity instruments that can guide teams, individual teachers, and other school personnel when implementing unfamiliar or innovative intervention methods that are identified for use in response to a student’s behavior of concern.

A Five-Step Process

When teachers are asked to use something new, adequate preparation, technical assistance, and support are needed (Couvillon, Bullock, & Gable, 2009). School teams composed of personnel at a single school or including individuals who provide consultation services (e.g., behavior specialist) who recommend interventions should not simply identify or describe interventions. Even something as seemingly simplistic as using specific praise statements requires a change in teacher behavior. Teachers need clear parameters about what the intervention is, what it looks like, how to use it, and how to ensure implementation as intended. To that end, someone who serves in the role as a fidelity coach can be designated. This coach may be a fellow teacher who has expertise about the intervention, an administrator familiar with the method, or other school system personnel. A fidelity coach could be a special educator, behavior specialist, general educator, or another professional (e.g., occupational or speech language therapist). A fidelity coach is not an evaluator or in a specific position; the primary qualifier is the person’s expertise relative to how the intervention should be implemented.

The fidelity coach determines what the intervention looks like and sounds like when implemented by a teacher. Those actions and audible cues then become transferred in writing to the document considered the fidelity protocol. This protocol lists the steps and sequence of the intervention, specific or special materials used with the intervention, and how and how often steps and materials are used. The fidelity protocol for implementing a token economy intervention would look quite different from the fidelity protocol for implementing reading comprehension methods. Similarly, the fidelity coach for token economy could be a behavior specialist, whereas the fidelity coach for reading comprehension might be the reading specialist. Regardless of who the fidelity coach is or what the intervention is, there are generic steps each coach uses when preparing another teacher to use the corresponding intervention. This article focuses on those generic steps so that school personnel can use one fidelity process, no matter what the intervention is.

Some school teams may not yet be accustomed to pairing interventions with fidelity measures, much less designating someone as a fidelity coach. When that is the case, the first behavior change begins with school teams or individual educators who need to incorporate fidelity protocols, processes, and personnel into procedures. High fidelity for teachers’ use of interventions can be dependent on how well school personnel translate fidelity from research to practice. These five steps are designed for that translation. See Table 1 for examples of how each step fits for designing and using fidelity. Therefore, the design of the fidelity process impacts the interventions’ use. The five-step process focuses on how school teams, via the fidelity coach, can work with teachers for high fidelity. Practitioners learning the interventions can be proactive in asking the school team about who the fidelity coach will be. Because each intervention’s fidelity varies dependent on unique features of that intervention, practitioners can learn what steps compose the fidelity sequence, and fidelity coaches can use the steps for guidance in teaching, monitoring, and reflecting with the practitioners. That is, materials, sequences, and checklists vary per intervention. Fidelity itself is not “one size fits all,” albeit there is a universal expectation of adherence to fidelity. The five-step fidelity process includes:

Model the intervention

Share the intervention’s fidelity protocol

Coach the practitioner prior to implementation

Observe for fidelity during implementation

Reflect with practitioner using fidelity data

Table 1.

The Five-Step Process for Designing and Using Fidelity Protocols.

Considerations When Designing and Implementing Fidelity Protocols

Model intervention
• I show. I do. I tell.
• Talk as if with students.
• Model (talk aloud about thinking process) what is being done and how decisions about what to do are made.
• Know what steps will be featured in the fidelity protocol; model each step.
• Sequence steps during modeling the same as will be shown on the fidelity protocol, if sequence makes a difference.
• Attend to nuances of an intervention when modeling, such as tone of voice, nonverbal behaviors, or other verbal behaviors.
Share fidelity protocol
• Emphasize rationale for specific parts.
• Ensure all on fidelity protocol are the essential parts that must be done.
• Be clear if fidelity parts are yes/no responses about what behaviors = yes and what behaviors = no.
• Be clear if fidelity parts are ratings about what specific behaviors = which rating.
Coach
• Role play with practitioner prior to use in real situation.
• Coach until practitioner is doing / saying things (+ using materials, etc.) with high degree of fidelity (e.g., 80%, 100%).
• Consider rationale for needing high fidelity: If low fidelity prior to using in real situation, then why would one expect higher fidelity in real situation?
Observe for fidelity
• Use fidelity protocol when observing.
• Calculate for fidelity.
Reflect with practitioner; fade to self-reflection
• Share results per fidelity protocol, including the calculations (e.g., 85% fidelity for that observation; 60% fidelity for that observation).
• Discuss what to maintain; what needs to improve.
• Begin the five-step process again if low fidelity emerges.
• Continue to observe and reflect, even when high fidelity occurs.
• Fade fidelity sessions, but caution on eliminating fidelity altogether. Shift responsibility to practitioner for self-reflections (when possible—depends on intervention and corresponding fidelity).
• Retain a focus on the intervention’s impact on the desired student’s behavior.

Stopping after Step 1 is insufficient because components of an intervention are not a “pick-and-choose” process. That is, there are not parts of the intervention that can be eliminated once what constitutes fidelity of treatment is established in the corresponding protocol. Each of the five steps addresses important aspects of intervention fidelity.

When Fidelity Begins

Fidelity begins after the school team or individual educator (hereafter referred to as school team) has targeted an intervention. Intentionally, this article does not detail the process by which a school team (e.g., RTI, Functional Behavior Assessment to Behavior Intervention Plan) comes to the decision of specifying the intervention, whether focused on behavior or academics. It is only at the point after the intervention is identified that fidelity comes into play. Regardless of why or how an intervention is determined, the fidelity process begins when the details, materials, plans, and people who will be using the intervention are known. For purposes of this article, the person who knows the intervention is called the fidelity coach, and the person who is learning how to implement the intervention with fidelity is the teacher or practitioner.

Consider the following scenario (see Note 1). After a school team conducts a comprehensive functional behavior assessment for Joshua, a sixth grader with learning disabilities, the school team determines the BSP is a behavior contract for Joshua, primarily supported by his general educator, Mrs. Rodriquez. The targeted behaviors for Joshua are for him to increase both the quantity and accuracy of independent work during math class. The school team has already established that Joshua understands how to do the math. However, he talks to peers, wanders around the classroom, and rearranges items around his desk instead of completing independent tasks. For Joshua’s behavior contract to work as intended, the school team needs to ensure that Mrs. Rodriquez knows key features of behavior contracts. She needs to know how to accomplish the following.

Explain the contract’s purpose and acquire buy in from Joshua

Work with Joshua to develop the contract’s terms

Develop a schedule of reinforcement that is more frequent initially, then fades as Joshua’s behaviors improve

Monitor Joshua’s performance to determine the effectiveness of the behavior contract

Ensure she is using the behavior contract as the school team intends it to be used

Mrs. Rodriquez also needs to know how often (e.g., Is it daily?) and how long (e.g., Is it for 15 minutes per day?) the intervention takes place. Frequency and duration of the intervention are important fidelity details (Dane & Schneider, 1998). These details are subsumed in the five-step process, which includes key components for fidelity noted by other researchers: preparing the teacher, ongoing coaching, and evaluating the performance of the teacher (Fixsen, Naoom, Blasé, Friedman, & Wallace, 2005).

The Five-Step Process

Adhering to the five-step fidelity process can increase the probability that teachers have a clear understanding of the intervention and how to use it. Consider if Mrs. Rodriquez had one interpretation of what a behavior contract was and how to use it, whereas other school team members had a different interpretation. When teachers actually implementing the intervention believe they have an accurate understanding about what the intervention should be, they self-assess high because they believe they already know how to implement the intervention. However, if school team members had different interpretations about what constituted the intervention, the fidelity may have actually been low. If school team members are not clear about what the intervention looks and sounds like, then clarification is the first step toward achieving high fidelity.

Fixsen et al. (2005) defined implementation as “a specified set of activities designed to put into practice an activity or program of known dimensions” (p. 5). They further noted that descriptions of interventions, such as the activities or programs, needed to be specific with clear details so that “independent observers can detect the presence and strength of the ‘specific set of activities’” (p. 5). The specific, clear details for the activity or program are described when the teacher is preparing for implementation, and thus the first of the five steps begins.

Step 1: Model the Intervention

The first step is for the fidelity coach who knows what the intervention looks and sounds like to demonstrate the intervention for the teacher who will be implementing the intervention. Ideally, the fidelity coach has previously used the intervention, so the background expertise to demonstrate how to use the intervention is well developed. The aspects of the intervention that are key to its effectiveness must be known in advance (Fixsen et al., 2005), so those activities, materials, or actions are intentionally demonstrated and modeled. It is also important to know what is flexible. For example, a behavior contract can look many different ways, so there is flexibility to individualize for students’ varied ages, interests, and preferences. In this scenario Mr. Sherman, the special educator, is the fidelity coach who will be preparing Mrs. Rodriquez to use a behavior contract with Joshua. Within an explicit instructional sequence, a demonstration consists of the fidelity coach taking the lead by showing, doing, and telling. Similarly, in the model step, Mr. Sherman will be doing those same behaviors:

I show Mrs. Rodriquez how to use a behavior contract.

I do what Mrs. Rodriquez will do when she is using a behavior contract with Joshua.

I tell Mrs. Rodriquez what materials to use, how to use them, when to use them, and how to make decisions about how well the implementation is going.

An effective way to model is to role play, in which Mr. Sherman acts as the teacher and Mrs. Rodriquez acts as Joshua. That way, Mrs. Rodriquez hears what she should sound like when working with Joshua. When demonstrating the intervention for Mrs. Rodriquez, Mr. Sherman also needs to use modeling, or talking aloud, about what he is doing, why he is doing it that way, and how he is making decisions about the behavior contract. Mr. Sherman makes his inner thoughts external by verbalizing them so Mrs. Rodriquez can hear his decision making, and he can also model making a mistake then self-correcting for her to hear. By the time Mr. Sherman has modeled using a behavior contract with Joshua, Mrs. Rodriquez has a clear idea of what the intervention is, how to use it, when to use it, what it sounds like (e.g., tone of voice), and why it is important to use all the steps modeled by Mr. Sherman.

Step 2: Share the Fidelity Protocol

The fidelity protocol includes a written description of the essential steps and delineates whether or not a specific order, or sequence, is necessary. For some interventions, there are sequences of what and when to do things which would be written down so the steps and order are clear to the person implementing the intervention. Those sequences or steps should be evident when the intervention is modeled. As such, the fidelity protocol is established prior to the modeling by the fidelity coach. But, it is after the modeling that the fidelity protocol is shared with the teacher. Modeling occurs first so the focus can more clearly be on the intervention instead of what is written on the fidelity protocol. If there are seven steps to using a behavior contract, those seven steps should be written down for Mrs. Rodriquez to use when implementing the intervention.

During Step 2, the sequences or steps are developed into a checklist or organized into a listing that is easy to reference and can be used as the intervention’s fidelity protocol. If reinforcement for a student must occur on a specific schedule, it is written on the fidelity protocol for the teacher to reference. Using this example, Joshua’s behavior contract is in effect whenever his assignment is to complete independent math work, which is usually a daily 20-minute session. During that time, he typically has two or three tasks to complete, so he has the opportunity to earn two or three coupons each day. The terms on his behavior contract describe what can be earned (e.g., coupons), with what frequency and conditions (e.g., for each assignment completed with 90% or higher accuracy), who delivers the coupons (i.e., Mrs. Rodriquez), how immediately the coupons are delivered (e.g., right after independent work time), for what items or privileges the coupons can be exchanged (i.e., reinforcers previously established for Joshua), and when the coupons can be exchanged (e.g., end of day or end of period). These details are quite important for knowing what needs to be done when, for what reason, and by whom. Content on the protocol clearly (a) alerts Mrs. Rodriquez about exactly what needs to be done, (b) states Joshua’s behavioral expectations put forth by his behavior contract, and (c) provides Mr. Sherman with criteria so he knows what to observe when visiting the classroom to determine the fidelity of the intervention.

During Step 2, Mr. Sherman, as the fidelity coach, establishes and reviews the fidelity protocol with Mrs. Rodriquez. Actions on the fidelity protocol align with what Mr. Sherman demonstrated and modeled for Mrs. Rodriquez. Equally important is that concurrent with implementing the intervention, Mrs. Rodriquez monitors Joshua’s target behaviors, increasing the quantity and accuracy of assignments during independent work time in math. Mrs. Rodriquez estimates that there are two or three independent math assignments each day, so she works with Mr. Sherman to determine how to efficiently monitor Joshua’s performance. In addition to the intervention’s fidelity being monitored, the student’s behavior (i.e., quantity and accuracy of assignments) should also be monitored. However, fidelity protocol content varies, because it is not essential that the fidelity protocol include how the student’s progress is monitored. Whether or not the student’s behavior is directly on the fidelity protocol varies. In short, (a) student progress needs to be watched, (b) student progress may or may not be on the fidelity protocol itself, and (c) even if not on protocol, student progress needs to be monitored.

Step 3: Coach the Practitioner

Before using the intervention in the classroom setting with the student, the teacher practices the intervention and receives performance feedback from the fidelity coach, relative to the fidelity protocol. In some situations, the teacher may want to physically hold the protocol checklist for guidance on what to do, in what order, and/or how many times.

Reinke et al. (2014) found that teachers who received professional development on proactive classroom management interventions and were provided ongoing coaching with performance feedback had higher levels of implementation fidelity. Conversely, teachers who received less coaching decreased their fidelity levels of implementing proactive classroom management interventions over time. Including coaching in the fidelity process prior to use of an intervention in the classroom provides the teacher opportunities to practice and perform the intervention with “safety nets” in place, namely, the nonevaluative feedback provided by two sources. The first source is the fidelity coach (in this scenario, Mr. Sherman). The second source is through examining the established fidelity protocol. Data such as anecdotal notes, checklists, or other criteria noted on the fidelity protocol are the basis for collaboration between the fidelity coach and teacher, and serve to bolster the teacher’s comfort and confidence when implementing the intervention (Joyce & Showers, 2002; King-Sears, Janney, & Snell, 2015).

Inherent to implementing a new intervention (and during coaching), teachers will be asked to change their behaviors. Because of this, multiple opportunities to practice prior to implementation in the classroom provide a safe and risk-free environment to make mistakes, receive feedback, and try out the intervention. It is only after the fidelity coach and teacher agree that the teacher has acquired competence and comfort implementing the technique/intervention in the practice setting that the teacher transitions to its use into the classroom.

Step 4: Observe for Fidelity

When Mrs. Rodriquez begins teaching Joshua how to use the behavior contract and begins its use, she uses the fidelity protocol to self-monitor her implementation. Mr. Sherman can use the same fidelity protocol to observe her performance. Both are also attuned to the effect the intervention is having on Joshua’s assignment completion and accuracy.

Kaderavek and Justice (2010) stated that direct observation is the most methodical way to determine fidelity of implementation for interventions. Initially, it may seem awkward to have another person (i.e., the fidelity coach) in the intervention setting observing for fidelity, yet this is a straightforward way to know how the intervention is implemented. However, if the fidelity coach cannot physically be in the classroom or setting where the intervention is being carried out, video-taping or audio-taping can be used. Regardless of how observation occurs, the clarity and thoroughness of predeveloped fidelity steps are critical so data from observations yield valid information.

Although direct observations are ideal, additional personnel, like a fidelity coach, may not be available. Alternative fidelity methods of indirect observations consist of teachers’ self-report and self-evaluation using the fidelity protocol. While the self-report data are more subjective (Kaderavek & Justice, 2010), the clarity and thoroughness of predetermined fidelity actions are just as critical as when direct observations are used. Importantly, self-report fidelity data are misleading when confusing or vague protocols are used; therefore, explicit and clear protocols yield more informative and valid fidelity data.

As mentioned previously, in addition to the intervention’s fidelity being monitored, the student’s performance must also be measured. For example, if a self-monitoring intervention is intended to produce an increase in the number of assignments completed, these data also are collected. For Joshua, his scores on math assignments should also increase if the intervention is having the intended effect. If this is the case, Mrs. Rodriquez and Joshua may decide that he uses an answer key to check his work. This shifts ownership of accurate performance to Joshua self-correcting, rather than waiting for Mrs. Rodriquez to correct his work.

Although frequent observations during initial intervention implementation are important, it is not simply a matter of establishing high fidelity once an intervention is implemented and then walking away. Implementation drift occurs more often than not, which may include teachers dropping off elements of the intervention that were newest for them, dropping elements with which they had the most discomfort, or simply forgetting steps. Reminders to use the established fidelity protocol are important to avoid implementation drift. As noted earlier, if direct observation is not possible, then whatever fidelity format is put in place should be used frequently (e.g., self-check). While monitoring may move to an intermittent schedule, to assume initial acquisition of high fidelity equates to ongoing high fidelity is erroneous; researchers find teachers drift away from high fidelity if continued monitoring of fidelity does not occur (Burke et al., 2012; Duhon et al., 2009; Reinke et al., 2014).

Step 5: Reflect With the Practitioner

After each session in which Mr. Sherman observes and collects fidelity data on Mrs. Rodriquez’s behavior contract implementation with Joshua, they schedule time to reflect on the fidelity data (see Figure 1 where fidelity data would be recorded). It is important that someone like Mr. Sherman is not in an evaluative role when talking with Mrs. Rodriquez, but rather a collaborative one. Trust is essential for authentic, open, and honest reflections to occur (King-Sears et al., 2015). If Mrs. Rodriquez feels she is being evaluated or criticized, she may shut down, and resistance versus reflection may prevail.

Figure 1.

Fidelity protocol for behavior contract.

When examining fidelity data, remember that some steps may be more important than others. In addition to looking at the percentage of steps that were executed correctly during the intervention, the data should be analyzed to determine which steps were missed or which steps had low scores. In Joshua’s example, the availability of the answer key for him to check his work affects other steps for fidelity, so that would be a key step to always execute on the fidelity checklist. Mr. Sherman and Mrs. Rodriquez want to reflect on not only what went well, but also which responses were “no,” and determine how to change those responses to a “yes.” There may be times when the fidelity protocol is tweaked; however, the goal is to ensure that a set of realistic and practical steps is developed initially and sufficient practice occurs prior to Step 3 for observations.

Consistently low fidelity may indicate some steps of the intervention are being omitted, which undoubtedly compromises the effectiveness of the intervention. Examine which steps are being omitted, and discuss why. If low fidelity continues, consider beginning the Step 1 process again by modeling the intervention. Ledford and Wolery (2013) recommended booster sessions focused on specific components yielding low fidelity. It may be that more of Step 3, coaching, is needed to implement with high fidelity. When fidelity is consistently high, continue with Steps 4 and 5 to observe and reflect. Observe more frequently when the intervention is initially being used, and then fade to intermittent observations. As teachers are able to maintain high fidelity and use self-reflection, the role of the fidelity coach can be systematically reduced.

Finally, reflection in Step 5 can include examining the student’s performance to determine the impact of the intervention on the initial concerns. For instance, in Joshua’s example, the fidelity protocol does indicate Mrs. Rodriquez is to maintain a list of each assignment’s percentage score. These data will indicate that even in the presence of high fidelity, if Joshua is not completing assignments with greater accuracy, then Mr. Sherman and Mrs. Rodriquez need to discuss why the behavior contract is not having the desired effect. Step 5’s reflection sessions are designed to support discussions and corresponding decisions about both fidelity and the intervention’s success.

Closure

There are many evidence-based practices that are not implemented as intended (Stahmer et al., 2015), and the focus on fidelity of treatment is a relatively new focus in education (Fogarty et al., 2014; Gresham, 2009; Harn et al., 2013). Interestingly, even in high-quality general and special education research journals, although fidelity procedures were reported by authors of about two thirds of the intervention articles, fewer than half reported data on fidelity implementation (Swanson, Wanzek, Haring, Ciullo, & McCulley, 2013). As such, extrapolating from the research can be helpful for developing fidelity procedures, but calculations for fidelity may be less clear. Even so, researchers and school personnel are keenly aware of the necessity to achieve high fidelity; this five-step process can be used as a guide.

Systemic change within organizations and administrative support is essential to promoting and supporting the implementation of evidence-based practices (King-Sears et al., 2015). Moreover, providing support and technical assistance to teachers using new practices is critical to bring about desired outcomes for students with disabilities (Duhon et al., 2009). The five-step fidelity process can assist school-based teams and teachers to achieve high fidelity when implementing new interventions for students with and without disabilities.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Notes

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