Measurement of fidelity of implementation of evidence-based practices: Case example of the IPS fidelity scale

Authors: Bond, G. R., Becker, D., Baker, S., Carlson, L., Flint, L., Howell, R., Lindsay, S., Moore, M., Reeder, S., & Drake, R.
Year Published 2011
Publication Clinical Psychology: Science and Practice
Volume 18
Number 2
Pages 126-141
Publisher Wiley Periodicals, Inc.

Increasing the use of evidence-based interventions is the central theme of current mental health reforms.Fidelity, as adherence to evidence-based program models (Bond, Evans, Salyers, Williams, & Kim, 2000), has also emerged as a central concept in these efforts. A fidelity scale is an assessment procedure to measure the extent to which an intervention or practice is implemented as intended. Fidelity can be measured at the system, organization, program, practitioner or client level.


The purpose of the study was to examine the literature on the Individual Placement and Support Fidelity Scale to illustrate the strengths and limitations of this methodology.


The setting included a mixed group of Supported employment programs.


Review of 20 articles that examined the psychometric adequacy and practical utility of the IPS Fidelity Scale.

Data Collection

This article reviews the emerging literature examining the psychometric adequacy and practical utility of the IPS Fidelity Scale, addressing the following questions: (1) Does the IPS Fidelity Scale display appropriate psychometric properties (adequate reliability, content and discriminative validity, and sensitivity to change)? (2) Do programs that score higher in IPS fidelity have better employment outcomes? (3) Is the IPS Fidelity Scale a useful tool for guiding implementation in multisite projects? (4) Is the IPS Fidelity Scale useful for accrediting programs for funding decisions? (5) Is the IPS Fidelity Scale useful for monitoring purposes in formal research studies? For the first two questions, we provide quantitative evidence from published and unpublished studies. Our evidence for the remaining three questions is primarily descriptive and anecdotal.


There was no control or comparison condition.


Findings illustrate that this scale has excellent psychometric properties. Nine of 10 studies assessing its predictive validity found positive associations with employment outcomes. Its use in quality improvement was supported by positive reports from seven multisite projects. Although not yet evaluated as an accreditation tool, three states have adopted the scale for reimbursement purposes.


Mental health reform rests on the wide-scale adoption of EBPs that are faithfully implemented. Fidelity scales are the lynchpin of both scientific advances and quality improvement. For fidelity scales to be useful, however, they must demonstrate discriminative and predictive validity. This review has documented the considerable evidence supporting the use of a fidelity scale for one EBP. Research is also needed to increase the efficiency of fidelity assessment so that it can be integrated into routine practice in the public mental health system.

Disabilities Emotional disturbance
Populations Male & Female
Outcomes Other
NIDILRR Funded Not Reported
Research Design Systematic reviews and meta-analysis
Peer Reviewed Yes