Table 4.

Treatment Fidelity Strategies for Training Providers

Goal	NIH BCC Description	SMART Strategies
Standardize training.	Ensure that training is conducted similarly with different interveners.	Standardized treatment protocols/training manuals. Standardized training session content: Study overview Theories underlying the problem and intervention Clinical overview of SCT and AYA development Intervention protocol training Low dose condition training Intervener responsibilities & workflow/communication Quality assurance procedures Online database and study management website Strategies to minimize communication bias and unblinding Participant evaluation of training sessions.
Ensure provider skill acquisition.	Train interveners to well-defined performance criteria.	Role playing an essential feature of training. External quality assurance monitoring until interveners meet set criteria for adherence.
Minimize “drift” in provider skills.	Ensure that intervener skills do not decay over time (e.g., show that intervener skills demonstrated halfway through the intervention period are not different than skills immediately after initial training).	External quality assurance monitoring includes periodic checks once intervener reaches competency. Bi-weekly intervention team conference calls.
Accommodate provider differences.	Ensure adequate level of training in interveners of differing skill level, experience, or professional background.	Individualized supervision and monitoring. Position description. Minimum competencies.