Attachment I Fidelity Process Form

Fidelity Process Report Form for TPP2020 Grantees
The grantee project director should complete the questions below each reporting period.
There are a total of 13 items in this scale. Score 0 for each item you mark “not at all”, 1 for each item you score as
“somewhat,” and 2 for each item you score as “completely.” Your total score is what will be entered into the web-based
performance measures reporting system. A total of 26 points are possible, if you score a 2 on every item.

Orientation and Training
1. Have all facilitators received training on the program intervention?
Not at all

Somewhat

Completely

2. Have all independent observers received training on the program intervention?
Not at all

Somewhat

Completely

3. Does staff training include the use of a logic model to facilitate staff understanding of the “logic” or “theory” supporting
the intervention?
Not at all

Somewhat

Completely

4. Does staff training provide staff with an understanding of the core components of the intervention?
Not at all

Somewhat

Completely

5. Are all of the intervention structures and processes stated in written training materials and are these communicated in
staff training?
Not at all

Somewhat

Completely

6. Does staff training include detailed instructions on the use of and expectations for completing fidelity monitoring logs
after each session?
Not at all

Somewhat

Completely

Ongoing Fidelity Management
7. Does the grantee have a fidelity monitoring plan in place?
Not at all

Somewhat

Completely

8. Is the grantee implementing its fidelity monitoring plan as intended?
Not at all

Somewhat

Completely

9. Does the grantee’s fidelity monitoring plan include:
a. Facilitator completion of fidelity monitoring logs after each session
Not at all

Somewhat

Completely

b. Independent observation of at least 10% of all sessions
Not at all

c.

Somewhat

Completely

Systematic review of completed fidelity monitoring logs and observation reports
Not at all

Somewhat

Completely

10. Does the grantee use data collected through fidelity monitoring logs and observations to provide periodic feedback to
program facilitators to support continuous quality improvement?
Not at all

Somewhat

Completely

11. Is there evidence that corrective feedback has been used by program staff to increase fidelity?
Not at all

Somewhat

Completely