The Effect of Intensive Implementation Support on Fidelity for Four Evidence-Based Psychosis Treatments: A Cluster Randomized Trial

Torleif Ruud, Robert E Drake, Jūratė Šaltytė Benth, Karin Drivenes, Miriam Hartveit, Kristin Heiervang, Tordis S Høifødt, Vegard Ø Haaland, Inge Joa, Jan Olav Johannessen, Karl Johan Johansen, Bjørn Stensrud, Espen Woldsengen Haugom, Hanne Clausen, Eva Biringer, Gary R Bond, Torleif Ruud, Robert E Drake, Jūratė Šaltytė Benth, Karin Drivenes, Miriam Hartveit, Kristin Heiervang, Tordis S Høifødt, Vegard Ø Haaland, Inge Joa, Jan Olav Johannessen, Karl Johan Johansen, Bjørn Stensrud, Espen Woldsengen Haugom, Hanne Clausen, Eva Biringer, Gary R Bond

Abstract

Purpose: Service providers need effective strategies to implement evidence-based practices (EBPs) with high fidelity. This study aimed to evaluate an intensive implementation support strategy to increase fidelity to EBP standards in treatment of patients with psychosis.

Methods: The study used a cluster randomized design with pairwise assignment of practices within each of 39 Norwegian mental health clinics. Each site chose two of four practices for implementation: physical health care, antipsychotic medication management, family psychoeducation, illness management and recovery. One practice was assigned to the experimental condition (toolkits, clinical training, implementation facilitation, data-based feedback) and the other to the control condition (manual only). The outcome measure was fidelity to the EBP, measured at baseline and after 6, 12, and 18 months, analyzed using linear mixed models and effect sizes.

Results: The increase in fidelity scores (within a range 1-5) from baseline to 18 months was significantly greater for experimental sites than for control sites for the combined four practices, with mean difference in change of 0.86 with 95% CI (0.21; 1.50), p = 0.009). Effect sizes for increase in group difference of mean fidelity scores were 2.24 for illness management and recovery, 0.68 for physical health care, 0.71 for antipsychotic medication management, and 0.27 for family psychoeducation. Most improvements occurred during the first 12 months.

Conclusions: Intensive implementation strategies (toolkits, clinical training, implementation facilitation, data-based feedback) over 12 months can facilitate the implementation of EBPs for psychosis treatment. The approach may be more effective for some practices than for others.

Keywords: Evidence-based practice; Fidelity scale; Implementation support; Mental health services; Psychoses.

Conflict of interest statement

All authors declare that they have no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram showing pairwise cluster-randomization of practices and units to experimental sites (Exp) and control sites (Con)
Fig. 2
Fig. 2
Changes and differences in fidelity scores between experimental sites and control sites from baseline to 18 months: mean, 95% CI and significance of difference at each time point (*p 

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Source: PubMed

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