Academic journal article Social Behavior and Personality: an international journal

Fidelity in Mental Health Services: Clinical Strategies for Implementing Resource Groups

Academic journal article Social Behavior and Personality: an international journal

Fidelity in Mental Health Services: Clinical Strategies for Implementing Resource Groups

Article excerpt

Within treatment effectiveness research, fidelity is currently considered a component of the assessment process routinely used to ensure internal validity (Hohmann & Shear, 2002). Assessments of fidelity are also of importance in that they provide a foundation for making evaluations of whether unsuccessful outcomes are caused by a failure of the model or failure in correctly implementing the model, that is, in the process of transferring the model to the clinical setting (Chen, 1990). Fidelity has been defined as "the extent to which delivery of an intervention adheres to the protocol or program model originally developed" (Mowbray, Holter, Teague, & Bybee, 2003, p. 315).

Assertive community treatment (ACT) is a societally based treatment and rehabilitation program that was developed during the 1970s and 1980s in the USA. The program was primarily geared to treatment of people with chronic psychiatric illnesses who were in need of a great deal of inpatient care (Stein, 1990; Stein & Santos, 1998; Test & Stein, 1978). In its original form, ACT consisted of psychiatric-care teams in which all the members would work with all the clients and all the members had a case management function (Lewin Group, 2000). It was clearly outlined how many staffmembers there ought to be in those teams, what their function was, and which treatment techniques were to be used in the environment of the clients. Given that background, it gradually became clear that a reliable and valid instrument to assess the fidelity of the application of ACT should be developed. Such an instrument became available in the Dartmouth Assertive Community Treatment Scale (DACTS), which soon became the standard fidelity measure for ACT and undoubtedly contributed to improvements in regard to the implementation and application of the model (Bond & Salyers, 2004; Monroe-DeVita, Teague, & Moser, 2011; Teague, Bond, & Drake, 1998).

The DACTS, however, is not suited for use with all models and especially not for use with a model such as the resource group assertive community treatment (RACT; Falloon, 1999), which has as a starting point working with a network of clients with the help of a small but flexible team (Nordén, Eriksson, Kjellgren, & Norlander, 2012; Nordén, Ivarsson, Malm, & Norlander, 2011; Nordén, Malm, & Norlander, 2012). The construct of fidelity within the model was at first examined in accordance with a heuristic model in which the fidelity of the program was primarily controlled with the aid of different systems of results follow-up (Falloon et al., 1997). However, the need for a fidelity instrument was significant and, on the basis of experience, an instrument especially adjusted for work with resource groups was eventually constructed, namely the Clinical Strategies Implementation Scale (CSI; Falloon et al., 2005). With time, however, it was shown that the instrument needed further adjustments for use when working with resource groups, and the psychometric characteristics needed strengthening. A revision of the scale was commissioned by the Quality Star National Psychiatric Register in Sweden. The revised version (CSI-R) exhibited good psychometric characteristics (Andersson, Ivarsson, Tungström, Malm, & Norlander, 2014).

Staffin clinical psychiatric operations associated with the Quality Star National Psychiatric Register put forward a request for a manual for the CSI-R in order that even inexperienced raters might use the instrument in a reliable and valid fashion. An editorial committee was formed whose members began the process by analyzing how experienced raters used the instrument. On the basis of this analysis the topics of each of the nine items of the CSI-R were divided into components. Thereafter, the committee defined how many of the various components of each item should have been included in each step of the scale and it was then possible to decide the assignment of points to the five steps for a certain scale item as follows: scale point 0 = none or very few components executed; scale point 1 = two components executed; scale point 2 = in the work with the client three components have been executed; scale point 3 = all four components have been executed several times. …

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