Assessing the Fidelity of an Affirmative Cognitive Behavioural Group Intervention

Canada
Written By INQYR

Craig, S. L., Pascoe, R. V., Iacono, G., Pang, N., & Pearson, A. (2022). Assessing the fidelity of an affirmative cognitive behavioural group intervention. Research on Social Work Practice, 0(0), 1–15. https://doi.org/10.1177/10497315221110865

Highlights

Background

  • Despite an increase in interventions designed for LGBTQ+ populations, there is a paucity of social work research that systematically describes the implementation fidelity of affirmative practice (i.e., the reliability and validity of affirmative interventions by assessing adherence to the treatment protocol) 

  • The purpose of this study is to explore the implementation fidelity of an affirmative CBT group intervention designed to improve coping and reduce depression among LGBTQ+ youth and young adults 

Study Description

  • As part of a clinical trial, the AFFIRM fidelity checklist was designed to assess clinician adherence. A total of 151 audio-recorded group sessions were coded by four trained raters 

  • AFFIRM implementation fidelity followed the processes outlined by Breitenstein et al. (2010), detailed in Figure 1. This study has systematically addressed three key aspects of implementation fidelity: adherence, competence, and differentiation  

  • Adherence was high with a mean fidelity score of 84.13 (SD = 12.50). Inter-rater reliability was 81%, suggesting substantial agreement 

  • Qualitative thematic analysis of low-rated sessions identified deviations from the manual and difficulties in group facilitation, while high-rated sessions specified affirmative and effective clinical responses 

Key Findings

  • The results of this research suggest that clinicians highly adhered to the AFFIRM intervention protocol, with good treatment fidelity and inter-rater reliability. The AFFIRM fidelity score (M=84.13) is relatively consistent with other intervention research 

  • Qualitative findings suggest clinician readiness is best addressed through the recruitment of qualified clinicians that have experience delivering EBPs in addition to knowledge of the LGBTQ+ community, comprehensive training and intensive supervision and coaching throughout intervention delivery 

  • The AFFIRM Fidelity Checklist is a relatively simple tool that captures the critical elements of affirmative group CBT implementation. Such a checklist may enhance monitoring during a clinical trial or may help improve clinical training, and supervision, and generate specific implementation strategies to enhance program materials 

 
INQYR
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