Active Ingredients Across the 10 Safewards Interventions: Expert Consensus Towards Fidelity Measurement

Area of Science:

• Psychiatry
• Mental Health Research
• Implementation Science

Background:

• Safewards is an international framework aimed at reducing conflict and containment in psychiatric settings.
• While generally effective, studies show variable outcomes, highlighting a need for better implementation fidelity measurement.
• Lack of a robust fidelity measure hinders replication, refinement, and rigorous evaluation of Safewards.

Purpose of the Study:

• To develop a new implementation fidelity tool for Safewards.
• To identify key active ingredients and measurement levels for the 10 Safewards interventions.
• To establish a foundation for a valid and reliable Safewards fidelity measure.

Main Methods:

• A Delphi survey with an international expert panel was used to achieve consensus on active ingredients and measurement levels.
• A preliminary list was derived from Safewards.net and implementation fidelity theory.
• The proposed tool was pilot tested with end-users in an acute psychiatric clinic and refined based on feedback.

Main Results:

• The study identified 48 active ingredients and 122 measurements across the 10 Safewards interventions.
• Each intervention includes three to seven statements and up to four measurement levels.
• The developed ingredients and measurements provide a conceptually and content-valid basis for a fidelity tool.

Conclusions:

• This work provides the first steps towards a new, valid Safewards implementation fidelity tool.
• The identified active ingredients offer practical guidance for clinicians implementing Safewards.
• Improved fidelity measurement will enhance clinical quality assurance and scientific rigor in Safewards research.