Multidimensional fidelity evaluation in a residential program for adolescent substance abuse

Leyla Jean Faw, Fordham University


Adolescent substance abuse is a major public health concern. Residential treatment is one of the most commonly provided as well as one of the most costly to address this problem. Little is known about the implementation programs or their adherence to the principles of intervention models. The current study developed and implemented a multidimensional method to measure fidelity of treatment in a residential treatment center for adolescents with substance abuse problems. Subjects were 43 adolescents enrolled in a residential treatment center that represented one condition in a large randomized clinical trial comparing family-based treatment to residential treatment for adolescent substance abuse. In developing the fidelity measurement model, the study drew upon common methods from program evaluation and mental health treatment research, as well as the innovative theory and methods of Orwin (1998), Holland (1986), and Melnick and DeLeon (1997). The final model measured three main elements: (a) program strength as defined by Yeaton and Sechrest (1981), (b) program adherence to the required parameters of service provision, and (c) program maintenance of a therapeutic milieu. For the latter two elements, the study examined not only the overall level of implementation, but also the variance in implementation across participants, using statistical process control procedures. Finally, the study examined five important pre-treatment client variables (Externalizing, Internalizing, Motivation for Treatment, Cooperation, and Empathy) as predictors of adolescent ratings of therapeutic milieu. Findings were somewhat divergent for the three fidelity variables. The program demonstrated high strength, moderate adherence to service parameters, and high ratings of therapeutic milieu. Statistical process control analyses showed that both adherence to service parameters and therapeutic milieu ratings were, on the whole, consistent across program participants. Contrary to expectations, adherence to service parameters was not significantly related to therapeutic milieu in the program. Finally, a significant relation emerged between Externalizing scores at intake and adolescent ratings of therapeutic milieu during treatment. Implications for future fidelity and outcome studies are discussed, as are the developmental implications of the findings.

Subject Area

Developmental psychology|Psychotherapy

Recommended Citation

Faw, Leyla Jean, "Multidimensional fidelity evaluation in a residential program for adolescent substance abuse" (2003). ETD Collection for Fordham University. AAI3098129.