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Implementation Fidelity

Evidence-based practices such as SBIRT, have been thoroughly researched and found to be effective. In order to ensure a high level of efficacy and positive patient outcomes, SBIRT must be implemented as intended. Implementation fidelity is a term used to describe the degree to which a program is delivered as intended.

It is common for programs and practices to have low implementation fidelity (not fully implemented), which can decrease effectiveness. This may happen for a variety of reasons, such as lack of a specific implementation guide or training. A program may also gradually change over time, especially in organizations with a high employee turn-over rate, causing implementation fidelity to drop over time.

In order to implement and maintain a program with a high level of fidelity, regular quality management reviews are recommended. Several instruments and checklists have been developed to assess fidelity of specific SBIRT programs. 

When selecting a fidelity instrument, it is crucial to determine which tool will work best for your organization. Consider who will be responsible for completing the checklist, how often it will be completed, and how the results will be used to assess your organization’s SBIRT process.

Once an instrument has been selected, it is necessary to consider your organization’s patient flow and how a fidelity assessment can efficiently be incorporated. Consider the following questions:

  • Does the same healthcare professional that performs and interprets the screening results also provide the brief intervention?
  • Does the same healthcare professional refer the patient to treatment and schedule follow-up visits?
  • How will the designated reviewer (observer) accurately assess the full SBIRT process?
  • Can this quality management review be completed as part of other existing review processes or through self-evaluation?

Below are three instruments that your organization can use to assess fidelity. ¬†Because the SBIRT process varies between different organizations, it is likely that the instruments below will not fully capture your organization’s procedures. Instruments may be adapted to better fit your organization, allowing for a more accurate measure of fidelity. However, modifications should not take away from the key components of SBIRT.

PROJECT ED HEALTH: BNI Adherence & Competence Checklist

This fidelity checklist was developed by the Yale School of Medicine and is designed to be completed by a reviewer (observer). This instrument is relatively simple; “Yes” or “No” is checked for each of the SBIRT concepts.

SBIRT Proficiency Checklists

The Program Evaluation and Research Unit (PERU) at the University of Pittsburgh School of Pharmacy (in collaboration with Baylor School of Medicine and Mercer University School of Medicine) developed and validated two proficiency checklists (short-form and long-form).  Click here to read the full study.

Short-form Proficiency Checklist

The SBIRT Proficiency Checklist Validation Study (PERU, 2014) concluded that the Short-Form Proficiency Checklist was valid in the assessment of SBIRT fidelity. This tool is a simple 13 question checklist separated into five categories: Screening (3 items), Brief Intervention (4 items), Referral to Treatment (2 items), Follow-Up (1 item), and Motivational Interviewing Spirit (3 items). This checklist was designed to be completed by a reviewer (observer) who determines whether the 13 components of the SBIRT process were present (or not present) in the SBIRT session.

Long-Form Proficiency Checklist

The SBIRT Proficiency Checklist Validation Study (PERU, 2014) concluded that the Long-Form Proficiency Checklist was valid in the assessment of SBIRT fidelity. This instrument contains 22 items, and is designed to be completed by a reviewer (observer) who rates the healthcare professional on a scale of 1 (component not met) to 5 (component met) in 5 key areas: Screening (4 items), Brief Intervention (5 items), Referral to Treatment (5 items), Follow-Up (2 items), and Motivational Interview Spirit (6 items).

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