Adaptation of the First Episode Psychosis Services-Fidelity Scale for Use in New and Small Programs

Fidelity assessments can support healthcare services to deliver care consistent with best practises. However, early psychosis (EP) fidelity assessment tools typically require a volume of service data that is often unavailable to small or new programmes. In this study, we pilot a formative fidelity assessment approach to address these challenges.

A formative assessment approach to using the First Episode Psychosis Services-Fidelity Scale (FEPS-FS) was developed to enable the assessment of small and new EP programmes. Over 48 months, EPI-CAL EP learning health care network programmes completed standard FEPS-FS fidelity assessments, formative assessments for new programmes, or formative assessments for small programmes, depending upon programme eligibility.

Of 27 remote fidelity assessments completed with EP programmes across California, nine (33.3%) had insufficient service data to complete a standard FEPS-FS assessment. Utilising the proposed formative assessment approach, one programme met the criteria for a new programme assessment, and seven for a small programme assessment. In the new programme assessment approach, 34 of 36 items could be assessed. In the small programme assessments, a median of 19 items was scored, with a mean FEPS-FS score range from 3.45 to 4.12.

These findings suggest that a formative approach to fidelity assessment can generate a meaningful amount of data, capture known variability between programmes, and potentially identify areas for service improvement to enhance quality for small and new programmes. However, critical data regarding the delivery of pharmacological and psychosocial care were not captured, highlighting the limitations of the approach.