Early Intervention and ABA program Quality Indicators: Intervention Fidelity

November 28, 2023

The Early Start Denver Model (ESDM) is the primary intervention modality that we use at UP Early Intervention. The ESDM is an evidence-based early intervention program designed for young children with autism spectrum disorder (ASD). ESDM is a comprehensive, play-based intervention approach that combines developmental and behavioral strategies to promote the development and learning of young autistic children.

 We can say that we are using the ESDM model, but how do we know for sure?

Intervention fidelity (also known as teaching fidelity, or teaching integrity) is the extent to which the individuals responsible for carrying out the therapy (i.e., behaviour Interventionists or Registered Behaviour Technicians) are implementing the programming as originally designed or intended. As the ESDM is a manualized intervention protocol, there are clear guidelines on how to implement the therapy (outlined in Appendix B of the Blue Book: The Early Start Denver Model Teaching Fidelity Rating System). When we measure implementation fidelity, we are checking to see how closely what our BI’s are doing in sessions lines up with what we have taught them to do (i.e., if they are implementing the therapy with fidelity). 

Monitoring ESDM fidelity is crucial to ensuring that our clients are receiving high quality therapy in our clinic, which leads to better outcomes in terms of improved social communication, language, and overall development. High intervention fidelity indicates that the intervention was delivered as planned, and makes it more likely that children will make progress with the therapy modality. It is important that the people monitoring fidelity are appropriately trained. The process for becoming a Certified ESDM Therapist involves specific training and mentorship toward implementing ESDM therapy with fidelity. At UP, all programs are overseen by ESDM Certified Therapists, and all managers are trained in monitoring ESDM fidelity by scoring and comparing scores with an ESDM Certified therapist until they achieve similar results. 

Following the ESDM teaching fidelity system also ensures that our interventionists are:

  • Providing intensive teaching with effective teaching strategies (i.e., frequent learning opportunities with active practice)
  • Teaching in fun, motivating, rewarding activities (because fun comes first!)
  • Co-constructing learning opportunities with the child (shared control, turn taking, and dyadic engagement)
  • Using a variety of strategies that are helpful for young children, regardless of whether than child has a specific goal in that area (e.g., all children help clean up each activity when it’s finished, we always promote turn taking, we model a variety of communicative functions even if it’s not a current goal, etc.). 

At UP, we train our employees carefully in intervention fidelity in two important ways: 

  • Training in ESDM Intervention Fidelity: is the final step in our Initial Behaviour Interventionist training program, a 3-month ish progression of training skills that all new hires will progress through once they begin working at UP
  • Clinic-wide fidelity checks: three times per year, our clinical team conducts a fidelity check within our regular sessions across at least two activities across all of our behaviour interventionists. These occur every year in January, May and October. Each BI receives individualized feedback, and once we finish the fidelity check, we review the results as a team. This allows us to identify areas of strength and areas that we as a clinic can improve in.
    • Selecting a focus area for the month that all clinical team members can support 
    • Providing resources and support for BI’s to review during prep time and session cancellations
    • Providing more structured re-training activities during our professional development days

We are a big fan of the mantra, “that which is measured, improves”, and we apply that to our internal staff training programs as well as our individual student objectives. We love repeating this process over the course of the year, as it gives everyone lots of practice and opportunities to build a deeper understanding with the ESDM fidelity strategies, and helps our therapists excel in delivering early intervention programming, which in turn ensures our students make great progress towards meaningful objectives.