Infant mental health home visiting therapists' fidelity to the Michigan IMH-HV model in community practice settings.

Implementation research suggests that fidelity to a therapeutic model is important for enhancing outcomes, yet can be difficult to achieve in community practice settings. Furthermore, few published studies have reported on characteristics of treatment fidelity. The present study examined fidelity to the Infant Mental Health Home Visiting (IMH-HV) model among 51 therapists with a range of experience practicing in community settings across the state of Michigan. IMH therapists completed fidelity checklists after every session with participating families to track use of 15 treatment strategies central to the IMH-HV model across the 12-month study period. Results indicated that the most commonly endorsed components utilized in home visits were developmental guidance and infant-parent psychotherapy, followed by the provision of emotional support. Use of IMH-HV components did not vary over time for the entire sample; however, patterns of strategies used showed somewhat more variability among more experienced therapists and when serving higher risk families. Findings demonstrate that IMH-HV therapists report a range of adherence to the model in community settings, with greatest fidelity to several model core components. Ongoing training in the flexible use of all core strategies may further enhance fidelity and contribute to positive outcomes for caregivers and their children receiving IMH-HV services.