A Fidelity Assessment of Early Psychosis Intervention Services in British Columbia, Canada

Established standards and guidelines for early psychosis intervention (EPI) in British Columbia (BC) and across Canada define the intent and scope of individual EPI programs. EPI programs are a critical mental health service both in BC and internationally, providing a range of pharmacological, psychological, and social supports under one service. If EPI principles and practices are applied, positive outcomes are expected, including greater reduction of psychotic symptoms compared to standard treatment, improved treatment adherence, fewer recurrent episodes of psychosis, and greater client satisfaction. Low fidelity, or difficulty adhering to the principles associated with the EPI model, may jeopardize attaining these positive outcomes.

Evaluation of program fidelity to established EPI practice standards and guidelines was conducted at 16 mental health service sites in BC that provide care to young adults with early psychosis. Fidelity assessment was performed via utilization of the EPI Fidelity Scale (EPI-FS).

Based on the EPI-FS, two sites (12.5%) met criteria for high fidelity, nine (56.3%) attained moderate fidelity, three (18.8%) attained low fidelity, and two (12.5%) attained very low fidelity. Specialized EPI programs were linked to higher fidelity, while many generic mental health and substance use centres had difficulty following the EPI model. Identified weaknesses included provision of psychological therapy, family education, ongoing program evaluation, and supervision and mentorship for clinicians. Sites with sufficient resources and staff development opportunities had higher overall fidelity.

These findings underscore the importance of equitable resource allocation and the need for specialized EPI services, especially in underserved areas in BC.