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VOLUME 14, ISSUE 1, January 2026 - Evidence in Action Research Brief Evidence in Action A quarterly research brief from the Center on Trauma and Children
Providers’ Perceptions of Trauma-Focused EBT/EBP Implementation Fidelity: Implementation Process and Individual Influences
Gusler, S., Sprang, G., Eslinger, J., & Whitt, A. (2025). Providers’ Perceptions of Trauma-Focused EBT/EBP Implementation Fidelity: Implementation Process and Individual Influences. Community Mental Health Journal, 1-12. https://doi.org/10.1007/s10597-025-01553-x
The Study
Unlike randomized controlled trials—where fidelity is supported through intensive training, supervision, and monitoring—most real-world organizations lack the resources needed to ensure that trauma-focused interventions are delivered as designed. Given the complexity and comorbidities common among trauma-exposed clients, especially children, understanding what supports fidelity in routine practice is critical. Guided by the Consolidated Framework for Implementation Research (CFIR), this study focuses on two domains: individual characteristics (secondary traumatic stress [STS], compassion satisfaction, and perceived personal effectiveness) and implementation processes (training methods, consultation, supervision, and use of organizational implementation strategies). A nationwide sample of 598 mental health providers completed an online survey reporting on these factors and selecting one trauma-focused evidence-based treatment/practice (EBT/EBP) they routinely used.
Key findings showed that providers who reported higher EBT/EBP fidelity also tended to report greater compassion satisfaction, more frequent use of implementation strategies by their organization, and stronger perceived personal effectiveness. Higher STS was associated with lower perceptions of fidelity, compassion satisfaction, and personal effectiveness. Providers working exclusively with children experienced higher STS and reported lower fidelity and effectiveness than those serving mixed-age groups. Consultation calls and in-person supervision were consistently linked with higher fidelity and lower STS. Importantly, a significant two-way interaction indicated that strong organizational implementation supports buffered the negative impact of individual provider’s STS on their perceptions of fidelity. A three-way interaction further revealed that the highest perceived fidelity occurred when providers had low STS, high perceived effectiveness, and worked within organizations that used extensive implementation strategies.
The authors conclude that maintaining fidelity in trauma-focused EBT/EBPs requires coordinated attention to both provider well-being and organizational support systems.
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Translational Tips
1. Build strong implementation supports through supervision and consultation: This study showed that organizational implementation strategies—such as regular supervision and consultation—was associated with greater perceptions of fidelity, as well as lower provider STS. As such, these supports are important to plan and coordinate, organizationally, when implementing a trauma-focused EBT/EBP.
2. Actively monitor and reduce secondary traumatic stress (STS): STS was a strong negative correlate of fidelity—particularly among child-serving clinicians. This implies that STS monitoring should be integrated into routine practice using validated tools (e.g., STSS) and provide organizational strategies for STS reduction (e.g., peer support, reflective supervision, workload balance).
3. Strengthen providers’ sense of personal effectiveness: Perceived personal effectiveness was also a strong correlate of fidelity and played a key role in interaction effects. This result suggests the importance of using targeted skill-building, feedback loops, and practice opportunities (like role plays and training cases) to boost providers’ confidence in their ability to deliver the trauma-focused EBT/EBP.
4. Prioritize compassion satisfaction as a protective factor: Compassion satisfaction (i.e., finding joy and fulfillment in helping others) was associated with greater fidelity and lower STS. To promote compassion satisfaction, organizations can incorporate activities that cultivate meaning and positive professional identity (e.g., recognition, celebrating clinical successes, and reflective dialogue).
5. Tailor additional supports for child-serving providers: Those serving only children had higher STS and lower fidelity, personal effectiveness, and organizational implementation support. This indicates that it is necessary to provide enhanced emotional and implementation supports (e.g., reflective supervision and structured coaching) for child-serving teams. These settings require greater scaffolding due to higher emotional burden and system complexity.
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