Faye S' Taxman

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Manualized Treatment and Program Fidelity

• Faye S. Taxman
• Virginia Commonwealth University
• Roger H. Peters
• University of South Florida
• Rod Mullen
• Amity Foundation
• Implementing and Sustaining Evidence-Based Drug
  Treatment in Criminal Justice Settings
• CEICA Conference
• Philadelphia, PA
• December 6-7, 2006

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A Researchers Guide to Manualized Treatment,
Program Fidelity, Adaptability

• Faye S Taxman, Ph.D.
• Virginia Commonwealth University

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Why Manualized Treatments?

• History of Manualized Treatment
• Researchers gift to the field
• Standardizing Treatment Sessions
• Guidance for TX Programs
• Presented as based on research
• Overcomes Skills of Staff
• Improve Fidelity by Having a Syllabus!
• 
  Avoiding the One Size Fits All Approach

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What is the Model to Replicate?

• Standards of evidence
• Consensus-Based
• Meta-Analysis (Systematic Review)
• Expert Driven, not yet tested
• Consistency of Evidence across settings,
  populations, and treatments
• Program vs. System Issues
• Program Fidelityof what dosage units, target
  population, setting

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What Are the Key Program Components?

• What are we (researchers) referring to
• Screening vs. Assessment
• Assessment vs. Diagnosis
• Clinical Therapies vs. Services/Programs
• Interventions vs. Therapies
• Programs vs. Treatment
• Tx Readiness vs. Pretreatment
• Dosage Units (Amount, Frequency, Type)

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ORDERING CHAOS
Interagency Efforts
Climate
Staffing
Communication Strategies
Resources
Skills
Leadership
Space (physical)
Clients
Judiciary
Workload
Pressures/Demands
Technology
Spatial Issues
Social Services
Probation/parole
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Factors that Impact Adaptation
External Environment
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Fidelity Adaptability Staffing

• Issues
• Skill Sets
• Workload/Caseload Size
• Education
• Gender/Racial Distributions
• Professionalism

• Tenets of Adaptability
• Skill Enhancement
• Role Clarification
• Use of Positive Reinforcements to Implement
• Focus on Outcomes/Benchmarks

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Fidelity Adaptability Dosage

• Issues
• Minimize Number of Sessions
• Minimize Length of Sessions
• Demand Less of Staff
• User FriendlyWorkbooks, videos
• Emphasis on Toys, not Processing/Quality

• Tenets of Adaptability
• Emphasize Skill Enhancements
• Monitor Treatment Outcomes, Not Sessions
• Provide Tools

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Fidelity Adaptability Dosage

• Issues
• Minimize Number of Sessions
• Minimize Length of Sessions
• Demand Less of Staff
• User FriendlyWorkbooks, videos
• Emphasis on Toys, not Processing/Quality

• Tenets of Adaptability
• Emphasize Skill Enhancements
• Monitor Treatment Outcomes, Not Sessions
• Provide Tools

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Fidelity Adaptability Dosage

• Issues
• Leadership
• MIS, Performance Systems
• Manage Contracts, Not Outcomes
• Position in the Organization

• Tenets of Adaptability
• Emphasize Performance Goals
• Emphasize Learning Organization
• Take Small Steps, Not Leaps
• Garnish Interagency Supports
• Benchmarks

Issues Leadership MIS, Performance
Systems Manage Contracts, Not Outcomes Position
in the Organization
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Innovation Management Process Model
Innovation Managment Process Model
Definition Key Programmatic Components
Implement Re-Adjust (External)
Align to Staff
Analyze Benchmarks
Align to Internal Environment
AdoptRealign
Align to Management
Routinize
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Discussion Questions

• What are the scientific principles of adaptation?
• What should science use to guide the field on
  dosage units when most studies do not have decent
  measures in this area (i.e. do not know if
  manualized tx was implemented as planned, etc.)?
• What type of management efforts are likely to
  impact improved adaptation?
• Will the development of a better taxonomy on
  programmatic components and fidelity lead to
  better adaptation?