Using branching simulations in treatment fidelity plans.

The purpose of this article is to present a new approach to treatment fidelity using branching simulations. Branching simulations are case scenarios that require the user to generate a series of step-by-step decisions and actions. The user is given immediate feedback on the consequences of his or her decisions and actions. Branching simulations may be a particularly useful fidelity strategy for interventions that require clinical decision making represented in terms of a flow of critical thinking and action steps. Results of fidelity testing in the current study using branching simulations revealed that 15 (22%) of 67 interventionists scored below the study's a priori 80% criterion for full retraining and retesting. Thirty (45%) interventionists needed partial retraining in using specific components of the intervention. Potential threats to internal validity posed by inadequate or erroneous adherence to multicomponent intervention protocols can be decreased through treatment fidelity using branching simulations.