Implementing Dialectical Behaviour Therapy: An Exploratory Study of Fidelity and the Fidelity-adaptation Relationship

Objective: The aim of this study was to improve conceptual clarity of implementation fidelity, the degree to which a program adheres to the original program protocol, and the relationship between fidelity and adaptation of a complex health intervention, Dialectical Behavior Therapy (DBT). Methods: Employing a mixed-methods approach, this study utilized secondary DBT client outcome data collected over a one-year period and semi-structured interviews with DBT therapists (program implementers). The study design was informed by the Conceptual Framework for Implementation Fidelity (CFIF) (Carroll et. al, 2007). This framework was adapted to include three categories of factors: individual client (needs, trajectories), programmatic/organizational and program implementer perspectives. Results: Findings suggest that reconceptualization of fidelity and the fidelity-adaptation relationship may require integrating stakeholder knowledge of organizational constraints, experience and values of front-line staff and heterogeneous client trajectories to allow for a more realistically flexible model that is contextually and situationally sensitive. Conclusions: Expanding the CFIF framework offered new insights regarding factors that have the potential to affect the fidelity-adaptation relationship.Ph.D