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

Area of Science:

• Mental Health Services Research
• Implementation Science
• Psychosis Treatment

Background:

• Effective implementation of evidence-based practices (EBPs) is crucial for quality patient care in mental health services.
• Fidelity to EBP standards is essential for achieving desired outcomes in treating complex conditions like psychosis.
• Existing implementation strategies often lack the intensity needed for widespread, high-fidelity adoption.

Purpose of the Study:

• To evaluate an intensive implementation support strategy designed to enhance fidelity to EBPs in the treatment of patients with psychosis.
• To compare the effectiveness of an intensive support strategy against a standard manual-only approach.

Main Methods:

• A cluster randomized design was employed across 39 Norwegian mental health clinics, with practices assigned to experimental (intensive support) or control (manual only) conditions.
• Four key EBPs were targeted: physical health care, antipsychotic medication management, family psychoeducation, and illness management and recovery.
• Fidelity to EBPs was measured at baseline and 18 months using a 1-5 scale, with analysis via linear mixed models and effect sizes.

Main Results:

• The intensive implementation strategy led to significantly greater increases in EBP fidelity scores compared to the control condition (mean difference in change: 0.86, p=0.009).
• Effect sizes varied by practice, with illness management and recovery showing the largest increase (2.24), followed by antipsychotic medication management (0.71), physical health care (0.68), and family psychoeducation (0.27).
• Most fidelity improvements were observed within the initial 12 months of the intervention.

Conclusions:

• Intensive implementation strategies, incorporating toolkits, training, facilitation, and feedback, effectively enhance EBP fidelity in psychosis treatment over 12 months.
• The effectiveness of intensive implementation support may differ across various EBPs, suggesting a need for tailored approaches.
• This study provides a scalable model for improving the quality of care in mental health settings through structured implementation support.