Treatment Integrity

In order to properly evaluate a program, it needs to be implemented as intended. This is referred to as treatment integrity, and is necessary in not only programs in applied behavior analysis programs, but in all treatment programs. Parents and professionals will NEVER be able to identify the effectiveness of a plan without proper implementation. Without proper implementation, false conclusions may be drawn.

For example, take the example of a picture exchange communication system (PECS). This is a system that has a lot of evidence to support its effectiveness in teaching communication skills to students with severe disabilities (Bondy & Frost). Used properly that is. However, PECS has significant training that goes with it, and requires this training and knowledge of the research base to go with it. I have often heard parents say "we tried that but it didn't work". Why didn't it work? How was it implemented? How did you monitor the implementation of it? Was it implemented consistently? Across people? Across environments? There many factors that influence treatment integrity and they need to be accounted for.

In order to maintain treatment integrity, several supports are needed:
- Supervision (everyone observing each other, teachers, parents, school psychologists, etc.)
- The program should be clearly written out for all to implement correctly.
- Visual supports for staff and family should be in sight to provide cues about the steps of more complicated programs.
- Communication about the plan should be ongoing
- Feedback should be provided to the implementer consistently and frequently.
- Data collection is necessary in order to monitor the effectiveness of the program. Data collection should be conducted not only on the target behavior, but also on the steps implemented.

Treatment integrity is under-rated and under-discussed in most school and home programs for children with and without developmental disabilities. Important to consider is the complexity of a plan. It would be more effective implement a good plan or instruction intervention, that has fewer components, than to never be able to implement a phenomenal plan accurately.