Measurement of fidelity in psychiatric rehabilitation

Until recently, most psychiatric rehabilitation models have been poorly defined and few have had systematic methods for measuring their implementation. We review the historical roots for the development of fidelity measures and describe recent applications in both research and practice. KEY WORDS: fidelity; program implementation; program standards; program models; psychiatric reha-bilitation. Fidelity refers to the degree to which a particular program follows a program model. By program model we mean a well-defined set of interventions and procedures to help individuals achieve some de-sired goal. Fidelity measures are tools to assess the adequacy of implementation of program models. In-creasingly, measures of program model fidelity have become standard requirements in mental health ser-vices research (Heflinger, 1996; Henggeler, Pickrel, & Brondino, 1999) and in other applied fields, such as criminal justice, education, and medicine (Leith-wood & Montgomery, 1980; Rezmovic, 1984; Schreier & Rezmovic, 1983). Despite this attention, no systematic body of theory and research on fidelity has yet appeared in the mental health services area. In this paper we review the promise of fidelity measures for advancing the research and practice of one area of mental health services, namely, psychiat-ric rehabilitation. By psychiatric rehabilitation we mean services and programs intended to help adults with severe mental illness attain optimal integration into normal adult roles in the community. Psychiatric rehabilitation has evolved in an un-usually eclectic and pragmatic fashion because many areas lack clearly articulated models or theory explic-itly linked to the nature of severe mental illness (Ho-garty, 1995). In addition, many influential leaders i