Strategies for Fidelity Monitoring a Solution-Focused Brief Intervention in a Randomized Clinical Trial

Background: Integrated Care (IC) models that include behavioral health providers to enhance patient care have increased, but the current mechanisms to analyze the efficacy and fidelity of behavioral interventions within IC models are limited. Method: A mixed methods concurrent process evaluation was utilized within the context of a randomized clinical trial to assess intervention fidelity for a Solution Focused Brief Therapy (SFBT) intervention implemented within an IC model. Data was collected through 1) participant surveys, 2) self-report surveys with the interventionist, and 3) data from patient charts. Descriptive statistics in addition to repeated measures ANOVA were utilized to acquire quantitative data. Qualitative data was acquired through content analyses and data triangulation was used to present findings. Results: The average SFBT intervention was 24.6 minutes with a range of 15-30 minutes. Of the 34 participants in the intervention group, 33 completed all 3 SFBT sessions. The majority of visits were weekly follow-ups (53.9%), followed by biweekly follow-ups (28.2%), and the remaining 3-week follow-ups (5.1%). The interventionist utilized session templates, and a self-report checklist to monitor intervention integrity. A SFBT scale was utilized to analyze the uptake of SFBT skills and there was a significant difference between those in the SFBT group and the treatment-as-usual group ( F [1, 64] = 22.7, p<.001): mean difference, 15.1 [95% CI, 11.2- 18.9]. Conclusion: Our study examined fidelity efficiently and comprehensively and provides a foundation for studies interested in fidelity monitoring of SFBT interventions as well as behavioral interventions within IC models. Trial Registration: The study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 01/05/2023.