Ensuring Fidelity in STEP-BD Posted on December 3, 2007 Noreen Reilly-Harrington (bio) describes how video and audiotapes were instrumental in her team's fidelity checks.

In terms of training, STEP-BD was designed to be a real-world trial, so the training itself was actually fairly limited. We conducted an in-person workshop, which was videotaped. And clinicians who joined the project after that first initial training viewed the videos of our training sessions.

Therapists were also required to audiotape sessions of the treatment. And one of my roles was to listen to numerous audio tapes of the therapy sessions and to provide phone supervision to therapists. And we rated these sessions carefully for fidelity and for overall skill in terms of delivering the therapy.

They sent those tapes in at several points during the trial. So each therapist sent in two sessions from the beginning of treatment, two sessions from the middle of treatment, and two sessions towards the end of treatment.

We actually had a set formula. So it was the first two sessions, the middle two sessions, and two sessions towards the end of the treatment. And we also did spot checks of adherence, which were also very important in terms of randomly selecting several tapes to monitor.

We also had conference calls which were very important in the early days of STEP. We conducted conference calls where clinicians could talk about difficult cases and get feedback from myself and David Miklowitz and some of the other investigators. I think that was a very helpful aspect as well.

Overall, things went very smoothly. I think that we had a lot of variance in terms of experience level, so that we had some clinicians at sites who were very seasoned cognitive therapists or very seasoned family therapists. Alternatively, at some sites we had some new therapists that were unfamiliar with these modalities and needed a little bit more training and support.

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