Fidelity, adherence, and robustness of interventions.

A central question in mental health services research is how well an intervention of demonstrated efficacy works when applied under less-than-ideal conditions in practice settings. Most implementation studies have not systematically assessed important deviations from ideal protocols that commonly occur and the impacts of those deviations on outcomes. The vagaries of real-world practice settings make interventions vulnerable to variations. It is therefore important to address unavoidable departures from ideal conditions and to design robust interventions that will remain effective in practice settings. These concerns should be incorporated into early phases of studies used to design interventions.To achieve this goal, we must identify the essential components of an efficacious intervention, assess how each contributes to outcomes, and eliminate any unnecessary components. We also must identify common …