Who delivers an intervention is an important decision that must be made early on in the development of an intervention. The level of expertise needed for intervention delivery needs to be driven by the purpose of the intervention and the desired outcomes as well as other considerations. These include but may not be limited to the availability of the type of staff needed for the delivery of an intervention, whether staffing requirements will be able to be met if the intent is to disseminate and widely implement the intervention, and costs associated with training and supporting the level of expertise required. Balancing all of these factors and the implications for dissemination and wide-scale uptake of an intervention is further explored in Part IV. As noted, most behavioral interventions address complex issues that cannot be viewed from a single lens and may require multidisciplinary expertise in the delivery of different components of the intervention. For example, the Advancing Better Living for Elders (ABLE) program involved occupational therapists, physical therapists, and home modification specialists in the delivery of a six-visit intervention designed to improve daily function and enhance the ability of older frail adults to stay at home (Gitlin et al., 2009).
In terms of project staffing, important issues to consider include the number of needed staff and their roles and responsibilities; prior experience (e.g., experience with the target population or the intervention); and skill/certification/educational requirements (e.g., certified neuropsychologist, bilingual, at least a master’s degree). It is a good idea to conduct a task analysis of the intervention and planned study design to identify staffing needs. This involves identifying the intervention objectives, specific activities, and how each will be delivered and by whom. Another important issue is ensuring that the roles and responsibilities of all of the team members are clearly specified and communicated within the team. A study manual (Manual of Operations [MOP], see Chapter 6) detailing all operations should be created that includes protocols for communication, lines of authority, and decision-making parameters. Protocols also need to be developed for staff training. Clearly, all members of the study team should understand the goals and aims of the study and be trained on all aspects of the protocol (including the protocols for both the intervention and comparison conditions). It is critically important that staff members understand the importance of adhering to the study protocol (e.g., delivery of the intervention) for all treatment conditions and also understand the importance of equipoise. Training should also be provided on the topical domain of the intervention (e.g., family caregiving) and on strategies for interacting with study participants so that staffs have the knowledge needed to adequately perform their role on the study. Other important training topics include staff safety protocols, resolution protocols for adverse events, ethical conduct of research and confidentiality, and data handling. To prevent drift among assessors and interventionists, the treatment fidelity plan should include protocols for monitoring and regularly scheduled booster training (see Chapter 12).