Treatment Integrity Dimensions

Strategies designed to increase treatment integrity fall into two categories: antecedent-based strategies and consequence-based strategies.

Historically, treatment integrity has been defined as implementation of an intervention as planned (Gresham, 1989). More recently, treatment integrity has been reimagined as multidimensional (Dane & Schneider, 1998). In this conceptualization of treatment integrity are four dimensions relevant to practice: (a) exposure (dosage), (b) adherence, (c) quality of delivery, and (d) student responsiveness.  It is important to understand that these dimensions do not stand alone but rather interact to impact the ultimate effectiveness of an intervention. It is important for educators to assess all dimensions of treatment integrity to assure that it is being implemented as intended.

Schools are often expected to implement innovative instructional programs.  Most often these initiatives fail because what we know from implementation science is not considered as part of implementing the initiative.  This chapter reviews the contributions implementation science can make for improving outcomes for students.

This paper discusses common elements of successfully sustaining effective practices across a variety of disciplines.

The usual approach to determining if an intervention is effective for a student is to review student outcome data; however, this is only part of the task. Student data can only be understood if we know something about how well the intervention was implemented. Student data without treatment integrity data are largely meaningless because without knowing how well an intervention has been implemented, no judgments can be made about the effectiveness of the intervention. Poor outcomes can be a function of an ineffective intervention or poor implementation of the intervention. Without treatment integrity data, the is a risk that an intervention will be judged as ineffective when, in fact, the quality of implementation was so inadequate that it would be unreasonable to expect positive outcomes.

Treatment integrity is a core component of data-based decision making (Detrich, 2013). The usual approach is to consider student data when making decisions about an intervention; however, if there are no data about how well the intervention was implemented, then meaningful judgments cannot be made about effectiveness.

Student achievement scores in the United States remain stagnant despite repeated attempts to reform the education system. New initiatives promising hope arise, only to disappoint after being adopted, implemented, and quickly found wanting. The cycle of reform followed by failure has had a demoralizing effect on schools, making new reform efforts problematic. These efforts frequently fail because implementing new practices is far more challenging than expected and require that greater attention be paid to how initiatives are implemented. Treatment integrity is increasingly recognized as an essential component of effective implementation in an evidence-based education model that produces results, and inattention to treatment integrity is seen as a primary reason new initiatives fail. The question remains, what strategies can educators employ to increase the likelihood that practices are implemented as designed? The Wing Institute overview on the topic of Treatment Integrity Strategies examines the essential practice elements indispensable for maximizing treatment integrity.

Reform efforts tend to come and go very quickly in education. This paper makes the argument that the sustainability of programs is closely related to how well those programs are implemented.

To produce better outcomes for students two things are necessary: (1) effective, scientifically supported interventions (2) those interventions implemented with high integrity.  Typically, much greater attention has been given to identifying effective practices.  This review focuses on features of high quality implementation.

This paper examines a range of education failures: common mistakes in how new practices are selected, implemented, and monitored. The goal is not a comprehensive listing of all education failures but rather to provide education stakeholders with an understanding of the importance of vigilance when implementing new practices.