Making Fidelity an Intramural Game: Localizing Quality Assurance Procedures to Promote Sustainability of Evidence-Based Practices in Usual Care


Address correspondence to Aaron Hogue, Treatment Research Division, The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 633 Third Avenue, 19th floor, New York, NY 10017. E-mail:


Although the science of disseminating empirically supported behavioral treatments has made remarkable advances, the ultimate goal of dissemination—sustaining the implementation of evidence-based practices (EBPs) in usual care with a high degree of fidelity—remains challenging. This article presents a rationale and guidelines for transitioning from conventional purveyor-driven dissemination methods to intramural quality assurance procedures that can be maintained with routine agency resources. Three innovations for localizing EBP quality assurance are described: adaptation of observational fidelity methods for therapist self-report and supervisor observation of EBPs, process control benchmarking methods for continuous tracking of EBP fidelity strength and consistency, and development of intramural clinical expertise grounded in local management of EBP implementation and outcome data. These innovations exemplify a fundamentally empirical approach to sustaining quality EBP implementation in frontline settings.