Evolution of the Treatment Integrity Concept: Current Status and Future Directions by ProQuest


[...] in the field of applied behavior analysis, the concept of procedural reliability is commonly used to refer to treatment integrity. [...] in terms of practice, Sanetti and Kratochwill (2009) note that treatment integrity assessment is not a consistent practice in applied settings.

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									                                                                            School Psychology Review,
                                                                  2009, Volume 38, No. 4, pp. 533–540


  Evolution of the Treatment Integrity Concept: Current
               Status and Future Directions

                                     Frank M. Gresham
                                   Louisiana State University

       This special series on treatment integrity    accurate independent variable application (i.e.,
is a timely and salient contribution to the fields    treatment integrity), incontrovertible conclu-
of intervention science in general and school        sions regarding the relation between a treat-
psychology in particular. Theoretical and em-        ment and behavior change are not possible
pirical developments regarding the concept of        (Gresham, 1989; McIntyre, Gresham, Di-
treatment integrity have lagged behind ad-           Gennaro, & Reed, 2007: Moncher & Prinz,
vances in the development, delivery, and val-        1991).
idation of evidence-based interventions. The                The concept of treatment integrity cuts
guest editors, Lisa Sanetti and Tom Kratoch-         across a diversity of fields involved with pro-
will, have done the field a valuable service by       viding treatments or interventions to individ-
providing a set of outstanding articles detail-      uals. In medical treatments, the concept of
ing major conceptual and empirical issues,           treatment compliance or treatment adherence
some resolved and many unresolved, in the            is an important and problematic issue. In the
area of treatment integrity.                         field of nutrition, the concept of dietary ad-
       At the heart of the importance of treat-      herence is important for successful outcomes.
ment integrity to intervention science is that       In the fields of rehabilitation and substance
empirical demonstration of measurable                abuse, the term program implementation cap-
changes in a dependant variable (e.g., behav-        tures the concept of treatment integrity. In
ior or academic achievement) must be attrib-         clinical psychology, a common term for this
utable to systematic and controlled manipula-        concept is treatment fidelity. Finally, in the
tions in the independent variable (i.e., the         field of applied behavior analysis, the concept
“treatment”). In the absence of objective and        of procedural reliability is commonly used to
documented specification of an independent            refer to treatment integrity. Despite variations
variable (i.e., operationally defined), as well as    in terminology across these diverse fields, the

This work was supported in part by grants from the Institute of Educational Sciences (R324A090098 and
Correspondence regarding this article should be addressed to Frank M. Gresham, Department of Psychol-
ogy, Louisiana State University, Baton Rouge, LA 70803; E-mail: gresham@lsu.edu
Copyright 2009 by the National Association of School Psychologists, ISSN 0279-6015, which has
nonexclusive ownership in accordance with Division G, Title II, Section 518 of P.L. Law 110-161 and NIH
Public Access Policy

School Psychology Review, 2009, Volume 38, No. 4

concern that treatments or interventions are       reported that less than 4% of randomized clin-
delivered as prescribed or intended is of ut-      ical trials in psychotherapy research reported
most importance to document that changes in        treatment integrity data. In the area of autism
individuals’ functioning (medical, nutritional,    interventions, only 18% (11 studies) of 60
psychological, or behavioral) are from those       studies reported data on treatment integrity
treatments and from extraneous variables.          (Wheeler, Baggett, Fox, & Blevins, 2006).
      Treatment integrity is usually conceptu-     McIntyre et al. (2007) found that 30% (46
alized as involving three di
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