Strategies to Ensure Fidelity in the Implementation of a Evidence Based Intervention in Latin America

Introduction:

Familias Unidas (FU) is a family-centered, evidence-based substance use and sexual risk behavior preventive intervention developed at the University of Miami (UM). The program is currently being tested in Chile by the San Carlos de Maipo Foundation (FSCM). Since 2015, the FCSM has carried out two pilot studies (N=89), one efficacy trial (N=240) and is currently implementing the program through 2018 (N=144) and 2019. The current study reports on the strategies used to ensure intervention fidelity in the pilots, efficacy trial, and implementation of FU in Chile. The provided information may prove useful in the implementation and dissemination of other evidence-based interventions in the region.

Method:

To pilot test, evaluate efficacy, and implement FU in Chile, seven facilitators were trained by a Master Trainer/Clinical Supervisor from the UM, in the procedures, methodologies and contents of the intervention. To ensure intervention fidelity during the research continiuum, 3 strategies were used: (1) Technical assistance via weekly reunions of mentoring dyads between Chile and UM, (2) weekly clinical and technical supervision by the supervisor of Chile (3) video recording of the sessions, which are supervised by a team from Chile and UM. Utilizing a randomization procedure, video recorded sessions (N=561) were selected to be reviewed by a team of trained fidelity raters from Chile and UM. During the pilots and efficacy trial the Chilean team conducted fidelity ratings on all the group sessions and 50% of family sessions. Of these rated sessions, UM rated 25% of the group sessions, and 14 family sessions. During implementation, Chilean professionals rated 50% of the group sessions and at least one family session per facilitator. All videos were reviewed according to 2 dimensions: (1) Adherence to the intervention content, using Yes or No, indicated if the facilitator adhered, or not, to the session components and if session objectives were met, and (2) overall quality of session, which evaluated the facilitators’ adherence on a scale from 0 to 6, with 0=insufficient and 6=excellent.

Results

From the supervision of the recorded sessions we can say that in more than the 85% of the sessions the facilitators adhered correctly to the content of the sessions. In regards to session quality, the pilot 1 had an average of 5.2 (SD=0.66), and pilot 2 had an average of 5.1 (SD=0.55). Meanwhile ratings from the efficacy trial had an average of 5.4 (SD=0.56) and ratings from the implementation study had an average of 5.6 (SD=0.5), with a top score of 6.0.

Conclusions

The fidelity procedures implemented in FU Chile demonstrated be highly effective in sustaining high levels of fidelity across the research continuum. Although the amount of supervision decreased over time, the rates of adherence stayed consistently high. Additionally, high standards of supervision, are critical in guaranteeing that the intervention is being implemented according to its original model. The fidelity procedures described here may be helpful in disseminating other evidence based interventions. For 2019, with the support of the Chilean government, and UM, FSCM is going to conduct a broad scale dissemination of FU with 2,000 families, implementing the procedures reported here.