Evaluating Fidelity of Coordinated Specialty Care in First Episode Psychosis Clinics Across Massachusetts
Elizabeth S. Eberlin (1), Kelsey Johnson (2), Michael Stephanski (3), Donald E. Addington (4), Dost Ongur (5,6), Kim T. Mueser (7), Daphne J. Holt (1,6), Nicole R. DeTore (1,6)
1. Department of Psychiatry, Massachusetts General Hospital
2. Beth Israel Deaconess Medical Center
3. Massachusetts Department of Mental Health
4. Department of Psychiatry, University of Calgary
5. Department of Psychiatry, McLean Hospital
6. Department of Psychiatry, Harvard Medical School
7. Center for Psychiatric Rehabilitation, Boston University
Abstract
Background: Coordinated specialty care (CSC) programs are now the gold standard of care for those with a first episode of psychosis (FEP) in the United States. Many sites however differ in their adoption of CSC programing and thus it is unclear how many CSC components are delivered to fidelity. This study aimed to better understand how FEP programs in Massachusetts adhere to the overall CSC model, and more specifically to the supported education and employment (SEE) component. This study also examined how fidelity differed by the setting type, community mental health centers (CMHC) versus hospital affiliated programs.
Methods: This ongoing study conducted fidelity assessments utilizing two standardized fidelity scales: the FEP Services Fidelity Scale 1.0 (FEPS-FS), which measures fidelity to CSC, and the Individual Placement & Support Fidelity Scale for Young Adults (IPS-FS), which measures fidelity to SEE only. Fidelity across 11 Massachusetts community FEP sites was assessed, 64% were CMHC (n=7) and 36% (n=4) were hospital-affiliated.
Results: A total of 9 sites have completed the fidelity assessments. Sample-wide, the average fidelity of FEP-sites to the CSC model was 94.4%, per the FEPS-FS (good-high; m=170, sd=6.90, range=49-148; highest possible score=180). On the IPS-FS, FEP-sites averaged 76.6% fidelity to the IPS-employment model (fair, m=95.71, sd=24.60, range=49-120; highest possible score=125) and averaged 86.9% fidelity to the IPS-education model (good; m=43.43, sd=11.10, range=21-50; highest possible score=50). There were no statistically significant differences between site-types (CMHC versus hospital-based) using t-tests, on performance on the FEPS-FS (t=0.715, df=4, p=.514), the IPS-FS employment scale (t=1.45, df=5, p=.208), and the IPS-FS education scale (t=1.381, df=5, p=.226).
Conclusion: The results showed that Massachusetts FEP programs delivered high-quality services through the CSC model, with some room for improvement specifically regarding SEE services. Overall, these findings meet national standards, comparing favorably to prior work assessing fidelity of FEP programs nationwide (MHBG 10% set-aside study).