Education Drivers

Staff Treatment Integrity

For the best chance of a positive impact on educational outcomes, two conditions must be met: (a) Effective interventions must be adopted, and (b) those interventions must be executed with sufficient quality (treatment integrity) to ensure the intervention is implemented as designed. Treatment integrity research finds that integrity scores are very low and, in practice, implementation is rarely assessed. If an intervention with a strong research base is not implemented with a high level of treatment integrity, then the students do not actually experience the intervention and there is no reason to assume they will benefit from it. Under these circumstances, it is impossible to know if poor outcomes are the result of an ineffective intervention or poor implementation of that intervention. Treatment integrity is defined as consistently implementing the essential components of an intervention as planned, intended, and originally designed. Studies find degradation of fidelity begins shortly after training. To ensure consistent levels of treatment integrity, teachers require ongoing monitoring and feedback of implementation. To date, research has not identified what threshold of treatment integrity is required to ensure the optimum benefit of an evidence-based practice.

Staff Treatment Integrity

Staff Treatment Integrity PDF

Citation: Detrich, R., States, J., & Keyworth, R. (2017). Staff Treatment Integrity.Oakland, CA: The Wing Institute. https://www.winginstitute.org/staff-treatment-intergity.

For the best chance of producing positive educational outcomes for all children, two conditions must be met: (a) adopting effective empirically supported (evidence-based) practices and (b) implementing those practices with sufficient quality that they make a difference (treatment integrity) (Detrich, 2014). Both are necessary as neither on its own is sufficient to result in positive outcomes. Figure 1 describes the relationship between empirically supported practices and treatment integrity.

 

Probability Benefits

Figure 1. Relationship between empirically supported practices and treatment integrity

            If an intervention has strong empirical support and is implemented with high integrity, then there is a high probability that positive outcomes will be achieved (upper left quadrant). The other quadrants illustrate that the lack of either element reduces the probability of positive outcomes: If a well-supported, research-based intervention is not implemented with high integrity (lower left quadrant); if an intervention is implemented with high integrity but is not empirically supported (upper right quadrant); or if a nonempirically supported intervention is implemented poorly (lower right quadrant).

            It should be noted that some interventions are not empirically supported because sufficient research has demonstrated that they do not produce positive outcomes. Alternatively, some interventions are not empirically supported because they have not been experimentally evaluated. This latter class of interventions is still in the experimental phase of development. Using these interventions is tantamount to conducting research and all of the rules for engaging in research should be followed. Because these interventions are still experimental, their effectiveness is unknown and they should be implemented only with the fully informed consent of both educators and parents.

            The advent of the evidence-based practice movement in education has resulted in considerable effort to identify practices that are empirically supported. Organizations such as the What Works Clearinghouse (https://ies.ed.gov/ncee/wwc) and the Best Evidence Encyclopedia (http://www.bestevidence.org) have reviewed a large number of interventions to discern the research base for each intervention. Until the past 20 years, treatment integrity did not receive significant scholarly attention. Even with the increased attention, treatment integrity measures are reported in about half of the published intervention research reports (Sanetti, Dobey, & Gritter, 2012; Sanetti, Gritter, & Dobey, 2011). When treatment integrity data are not published in research reports, it is difficult to know if the intervention that the researchers reported was actually implemented and was responsible for the outcomes or if there was some undocumented variation of the intervention that actually accounted for the outcomes.

           As important as treatment integrity is in research, it is equally important in practice settings. Measures of treatment integrity are fundamental to data-based decision making. Effective interventions may be prematurely terminated if the level of treatment integrity is not known. Student performance data tell us only how well a student is responding to the intervention as it is implemented. Treatment integrity measures tell us how well the intervention is being implemented. Without knowing about treatment integrity, it is not possible to know if a student’s failure to benefit from an intervention is a function of an ineffective intervention or ineffective implementation (see Treatment Integrity in the Problem-Solving Process for more discussion).

References

Detrich, R. (2014). Treatment integrity: Fundamental to education reform. Journal of Cognitive Education and Psychology13(2), 258–271.

Sanetti, L. M. H., Dobey, L. M., & Gritter, K. L. (2012). Treatment integrity of interventions with children in the Journal of Positive Behavior interventions from 1999 to 2009. Journal of Positive Behavior Interventions14(1), 29–46.

Sanetti, L. M. H., Gritter, K. L., & Dobey, L. M. (2011). Treatment integrity of interventions with children in the school psychology literature from 1995 to 2008. School Psychology Review40(1), 72–84.

 

Publications

TITLE
SYNOPSIS
CITATION
Approaches to Increasing Treatment Integrity

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

Detrich, R., States, J. & Keyworth, R. (2017). Approaches to Increasing Treatment Integrity. Oakland, Ca. The Wing Institute

 

Treatment Integrity in the Problem Solving Process

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.

Detrich, R., States, J. & Keyworth, R. (2017). Treatment Integrity in the Problem Solving Process. Oakland, Ca. The Wing Institute.

 

Performance Feedback in Education: On Who and For What
This paper reviews the importance of feedback in education reviewed the scientific model of behavior change (antecedent, behavior, consequences).
Daniels, A. (2013). Feedback in Education: On Whom and for What. In Performance Feedback: Using Data to Improve Educator Performance (Vol. 3, pp. 77-95). Oakland, CA: The Wing Institute.
Working with Staff to Promote Data-Based Decision Making: Recommended Strategies and Common Pitfalls [Publication]
This paper discusses evidence-based ways of working with staff to promote program intervention integrity and accurate data collection.
Reid, D. (2010). Working with Staff to Promote Data-Based Decision Making: Recommended Strategies and Common Pitfalls.Journal of Evidence-Based Practices for Schools, 11(2), 169–186.

 

Data Mining

TITLE
SYNOPSIS
CITATION
What Teacher Training Methods Result in Changes in Classroom Practices?

This analysis compares the effectiveness of staff development methods that include, didactic presentation, modeling, practice with feedback, and coaching.

States, J. (2011). What Teacher Training Methods Result in Changes in Classroom Practices? Retrieved from what-teacher-training-methods.

How does performance feedback affect the way teachers carry out interventions?
This analysis examined the impact of performance feedback on the quality of implementation of interventions.
Detrich, R. (2015). How does performance feedback affect the way teachers carry out interventions? Retrieved from how-does-performance-feedback.
How often are treatment integrity measures reported in published research?
This analysis examined the frequency that treatment integrity is reported in studies of research-based interventions.
Detrich, R. (2015). How often are treatment integrity measures reported in published research? Retrieved from how-often-are-treatment.
How well are Interventions Implemented in Educational Settings?
This analysis examined two studies to understand the reliability of self-reporting of practitioners implementing interventions.
Detrich, R. (2015). How well are Interventions Implemented in Educational Settings? Retrieved from how-well-are-interventions.
Does Feedback Improve Performance?
This review is a summary of the effect size of the effectiveness feedback to improve both student and teacher performance.
States, J. (2011). Does Feedback Improve Performance? Retrieved from does-feedback-improve-performance.
Does professional development make a difference in student performance?
This analysis looks at a systematic review of teacher professional development on student achievement.
States, J. (2011). Does professional development make a difference in student performance? Retrieved from does-professional-development-make.
Is there empirical research to validate the use of prereferral intervention teams (PIT) to reduce special education referrals, achieve gains, or improve student conduct?
This is a review of a meta-analysis of Prereferral Intervention Teams on student and system outcomes.
States, J. (2011). Is there empirical research to validate the use of prereferral intervention teams (PIT) to reduce special education referrals, achieve gains, or improve student conduct? Retrieved from is-there-empirical-research.
How does coaching compare with traditional staff development in improving student achievement?
This analysis compares the effectiveness of coaching compared to traditional forms of professional development for teachers.
States, J. (2012). How does coaching compare with traditional staff development in improving student achievement? Retrieved from how-does-coaching-compare.
What evidence do principals rely on in assessing the quality of a teacher’s instruction?
This analysis examines principal sources of information on teacher instructional competency and the amount of time spent assessing teacher's instructional skills.
States, J. (2015). What evidence do principals rely on in assessing the quality of a teacher’s instruction? Retrieved from what-evidence-do-principals.

 

Presentations

TITLE
SYNOPSIS
CITATION
Performance Feedback: Use It or Lose It

This paper examines the importance of performance feedback systems at all levels of school, staff and student outcomes to achieve desired results over time.

Keyworth, R. (2011). Performance Feedback: Use It or Lose It [Powerpoint Slides]. Retrieved from 2011-aba-presentation-randy-keyworth.

Performance Feedback in Education: On Who and For What
This paper reviews the importance of feedback in education reviewed the scientific model of behavior change (antecedent, behavior, consequences).
Daniels, A. (2011). Performance Feedback in Education: On Who and For What [Powerpoint Slides]. Retrieved from 2011-wing-presentation-aubrey-daniels.
Using Student Data as a Basis for Feedback to Teachers
This paper offers an alternative to evaluating teachers based on student performance on annual high stakes tests.
Detrich, R. (2011). Using Student Data as a Basis for Feedback to Teachers [Powerpoint Slides]. Retrieved from 2011-aba-presentation-ronnie-detrich.
Treatment Integrity: Necessary by Not Sufficient for Improving Outcomes
Treatment integrity is necessary to improve outcomes but it is not sufficient. It is also necessary to implement scientifically supported interventions.
Detrich, R. (2015). Treatment Integrity: Necessary by Not Sufficient for Improving Outcomes [Powerpoint Slides]. Retrieved from 2015-ebpindisabilities-txint-presentation-ronnie-detrich.
Teacher Induction: Where the Rubber Meets the Road
The paper examines one of the most critical components of teach training: an on-the-job, ongoing system of coaching and performance feedback to improve skill acquisition, generalization and maintenance.
Keyworth, R. (2010). Teacher Induction: Where the Rubber Meets the Road [Powerpoint Slides]. Retrieved from 2010-aba-presentation-randy-keyworth.
School Reform and Culture Change: What We Missed
This analysis reviews the ongoing failure of school reform efforts in the context of poor teacher preparation and performance feedback.
Keyworth, R. (2012). School Reform and Culture Change: What We Missed [Powerpoint Slides]. Retrieved from 2012-wing-presentation-randy-keyworth.
Teacher Coaching: The Missing Link in Teacher Professional Development
Research suggests that coaching is one of the most effective strategies in training teachers. This paper identifies the critical practice elements of coaching and their absence in teacher training.
Keyworth, R. (2013). Teacher Coaching: The Missing Link in Teacher Professional Development [Powerpoint Slides]. Retrieved from 2013-calaba-presentation-randy-keyworth.
Working with Staff to Promote Data-Based Decision Making: Recommended Strategies and Common Pitfalls
This paper discusses evidence-based ways of working with staff to promote program intervention integrity and accurate data collection.
Reid, D. (2009). Working with Staff to Promote Data-Based Decision Making: Recommended Strategies and Common Pitfalls [Powerpoint Slides]. Retrieved from 2009-wing-presentation-dennis-reid.

 

Student Research

TITLE
SYNOPSIS
CITATION
Effects of a problem solving team intervention on the problem-solving process: Improving concept knowledge, implementation integrity, and student outcomes.
This study evaluated the effects of a problem solving intervention package that included problem-solving information, performance feedback, and coaching in a student intervention planning protocol.
Vaccarello, C. A. (2011). Effects of a problem solving team intervention on the problem-solving process: Improving concept knowledge, implementation integrity, and student outcomes. Retrieved from student-research-2011.
TITLE
SYNOPSIS
CITATION
Increasing Pre-service Teachers’ Use of Differential Reinforcement: Effects of Performance Feedback on Consequences for Student Behavior

Differential reinforcement of appropriate behavior is an important skill for classroom teachers. This study examined the use of performance feedback to increase the rate of differential reinforcement by pre-service teachers.

Auld, R. G., Belfiore, P. J., & Scheeler, M. C. (2010). Increasing Pre-service Teachers’ Use of Differential Reinforcement: Effects of Performance Feedback on Consequences for Student Behavior. Journal of Behavioral Education, 19(2), 169-183.

Using performance feedback to enhance implementation fidelity of the problem-solving team process

This study examines the importance of implementation integrity for problem-solving teams (PST) and response-to-intervention models.

Burns, M. K., Peters, R., & Noell, G. H. (2008). Using performance feedback to enhance implementation fidelity of the problem-solving team process. Journal of School Psychology, 46(5), 537-550.

Using performance feedback to enhance implementation fidelity of the problem-solving team process

This study examines the importance of implementation integrity for problem-solving teams (PST) and response-to-intervention models.

Burns, M. K., Peters, R., & Noell, G. H. (2008). Using performance feedback to enhance implementation fidelity of the problem-solving team process. Journal of School Psychology, 46(5), 537-550.

Effects of immediate performance feedback on implementation of behavior support plans, 2005

The purpose of this study is to examine the effects of feedback on treatment integrity for implementing behavior support plans.

Codding, R. S., Feinberg, A. B., Dunn, E. K., & Pace, G. M. (2005). Effects of immediate performance feedback on implementation of behavior support plans. Journal of Applied Behavior Analysis, 38(2), 205-219.

Innovation, Implementation Science, and Data-Based Decision Making: Components of Successful Reform

Over the last fifty years, there have been many educational reform efforts, most of which have had a relatively short lifespan and failed to produce the promised results. One possible reason for this is for the most part these innovations have been poorly implemented. In this chapter, the author proposes a data-based decision making approach to assuring high quality implementation.

Detrich, R. Innovation, Implementation Science, and Data-Based Decision Making: Components of Successful Reform. In M. Murphy, S. Redding, and J. Twyman (Eds). Handbook on Innovations in Learning, 31. Charlotte, NC: Information Age Publishing

Promoting teachers' implementation of culturally and contextually relevant class-wide behavior plans

Research suggests student of differing racial groups are unequally impacted by school disciplinary interventions. This study examines whether teachers who self-assessed their own use of culturally and contextually relevant practices would implement a class-wide behavior plan with high levels of implementation fidelity. Results indicated that teachers who engaged in self-assessment and training did implement the plan with high levels of implementation fidelity, particularly when given performance feedback. 

Fallon, L. M., Cathcart, S. C., DeFouw, E. R., O'Keeffe, B. V., & Sugai, G. Promoting teachers’ implementation of culturally and contextually relevant class‐wide behavior plans. Psychology in the Schools.

Treatment integrity in applied behavior analysis with children.

This study reviewed all intervention studies published between 1980-1990 in Journal of Applied Behavior Analysis in which children were the subjects of the study. The authors found that treatment integrity was reported in only 16% of the studies.

Gresham, F. M., Gansle, K. A., & Noell, G. H. (1993). Treatment ?integrity in ?applied behavior analysis with children. Journal of Applied ?Behavior Analysis, 26(2), 257-263.

Increasing intervention implementation in general education following consultation: A comparison of two follow-up strategies.

This study compared the effects of discussing issues of implementation challenges and performance feedback on increasing the integrity of implementation. Performance feedback was more effective than discussion in increasing integrity.

Noell, G. H., & Witt, J. C. (2000). Increasing intervention implementation in general education following consultation: A comparison of two follow-up strategies. Journal of Applied Behavior Analysis, 33(3), 271.

Increasing Teacher Intervention Implementation in General Education Settings through Consultation and Performance Feedback

This study looks at treatment integrity with which general education teachers implemented a reinforcement based intervention designed to improve the academic performance of elementary school students.

Noell, G. H., Witt, J. C., Gilbertson, D. N., Ranier, D. D., & Freeland, J. T. (1997). Increasing teacher intervention implementation in general education settings through consultation and performance feedback. School Psychology Quarterly, 12(1), 77.

From Policy to Practice: Evidence-based Practice and IDEIA
No Child Left Behind (NCLB) as federal policy required the use of scientifically based instruction to improve educational outcomes. It is a long way from policy to impacting what actually happens in a classroom. In this chapter, the author reviews what is known from implementation science to assure that policy becomes practice.
Detrich, R. (2008). From Policy to Practice: Evidence-based Practice and IDEIA. In Grigorenko, E. L. (Ed.) Educating Individuals with Disabilities: IDEIA 2004 and Beyond, 85. Springer Publishing Company
A Decade of Evidence-Based Education: Where Are We and Where Do We Need to Go?
No Child Left Behind (NCLB) emphasizing scientifically based instruction became law in 2001. In this paper, the authors review the progress that has been made in implementing NCLB and conclude that the greatest threat to its effectiveness is the quality of the implementation of the scientifically based instructional practices.
Detrich, R., & Lewis, T. (2012). A Decade of Evidence-Based Education: Where Are We and Where Do We Need to Go?. Journal of Positive Behavior Interventions, 1098300712460278.
Evolution of the Treatment Integrity Concept: Current Status and Future Directions
The article discusses treatment integrity.
Gresham, F. M. (2009). Evolution of the Treatment Integrity Concept: Current Status and Future Directions. School Psychology Review, 38(4), 533-540.
Treatment integrity of school-based behavioral intervention studies: 1980-?1990.
The authors reviewed seven journals known for publishing behavioral intervention research in school settings were reviewed to establish the percent of articles that reported treatment integrity measures between 1980-1990. Only 14% reported measures of treatment integrity.
Gresham, F. M., Gansle, K. A., Noell, G. H., Cohen, S., & Rosenblum, S. (1993). Treatment integrity of school-based behavioral intervention studies: 1980-1990. School Psychology Review, 254-272.
Treatment integrity in learning disabilities intervention research: Do we really know how treatments are implemented
The authors reviewed three learning disabilities journals between 1995-1999 to determine what percent of the intervention studies reported measures of treatment integrity. Only 18.5% reported treatment integrity measures.
Gresham, F. M., MacMillan, D. L., Beebe-Frankenberger, M. E., & Bocian, K. M. ?(2000). Treatment integrity in learning disabilities intervention research: Do we really know how treatments are implemented. Learning Disabilities ?Research & Practice, 15(4), 198-205.
Toward Developing a Science of Treatment Integrity: Introduction to the Special Series
This article provides an overview of the current state of conceptual models of treatment integrity and suggest future directions for research, practice, and policy related to treatment integrity.
Hagermoser Sanetti, L. M., & Kratochwill, T. R. (2009). Toward Developing a Science of Treatment Integrity: Introduction to the Special Series. School Psychology Review, 38(4), 445-459.
Balancing Fidelity With Flexibility and Fit: What Do We Really Know About Fidelity of Implementation in Schools
Treatment fidelity is critical for the effective implementation of evidence-based practices. It is assumed that evidence-based practices implemented with high fidelity will result in improved outcomes, whereas low fidelity will lead to poorer outcomes. This article discusses treatment fidelity as well as the implications for measuring and analyzing it in relation to student outcomes.
Harn, B., Parisi, D., & Stoolmiller, M. (2013). Balancing Fidelity With Flexibility and Fit: What Do We Really Know About Fidelity of Implementation in Schools?. Exceptional Children, 79(2), 181-193.
Treatment integrity of school-based interventions with children in the journal of applied behavior analysis 1991-2005.
The authors reviewed all intervention studies published in the Journal of Applied Behavior Analysis between 1991-2005 that occurred in school settings to determine the percent of studies that reported treatment integrity measures. In this review, 30% of the studies reported treatment integrity.
McIntyre, L. L., Gresham, F. M., DiGennaro, F. D., & Reed, D. D. (2007). Treatment integrity of school-based interventions with children in the ?journal of applied behavior analysis 1991-2005. Journal of Applied Behavior Analysis, 40(4), 659-672.
The Use of Weekly Performance Feedback to Increase Teacher Implementation of a Pre-referral Academic Intervention
This study investigates the effects of performance feedback on the implementation of a reinforcer-based classroom intervention.
Mortenson, B. P., & Witt, J. C. (1998). The use of weekly performance feedback to increase teacher implementation of a prereferral academic intervention. School Psychology Review.
The use of weekly performance feedback to increase teacher implementation of a prereferral academic intervention.
Accurate implementation of an intervention is a pre-requisite to determining its effectiveness. The study examined the effects of weekly performance feedback on the accuracy of implementation of an academic intervention.
Mortenson, B. P., & Witt, J. C. (1998). The use of weekly performance feedback to increase teacher implementation of a prereferral academic intervention. School Psychology Review, 27, 613-627.
Increasing teacher intervention implementation in general education settings through consultation and performance feedback
This study evaluated the effects of consultation and performance feedback in a public school setting.
Noell, G. H., Witt, J. C., Gilbertson, D. N., Ranier, D. D., & Freeland, J. T. (1997). ?Increasing teacher intervention implementation in general education settings through consultation and performance feedback. School Psychology Quarterly, 12(1), 77-88.
Treatment Implementation Following Behavioral Consultation in Schools: A Comparison of Three Follow-up Strategies
This study examines teachers' implementation of treatment plans following consultation.
Noell, G. H., Witt, J. C., Slider, N. J., Connell, J. E., Gatti, S. L., Williams, K. L., ... & Duhon, G. J. (2005). Treatment implementation following behavioral consultation in schools: A comparison of three follow-up strategies. School Psychology Review.

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