Development of a measure of model fidelity for mental health Crisis Resolution Teams.

Brynmor Lloyd‐Evans ,David Hindle,Nicola Morant,Ada Ivanecka,Sonia Johnson,Richard Gray,Beth Paterson,Kate Fullarton,Angela Sweeney,Johanna Frerichs,Kathleen Kelly,Claire Henderson,Fiona Nolan,Danielle Lamb,Torleif Ruud,Sarah Fahmy,Steve Onyett,Oliver Mason,Gareth Ambler,Nicky Goater,David Osborn,Gary R Bond,Edward H Brown

doi:10.1186/s12888-016-1139-4

Abstract

BackgroundCrisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a fidelity scale to assess adherence to a model of best practice for CRTs, based on best available evidence.MethodsA concept mapping process was used to develop a CRT fidelity scale. Participants (n = 68) from a range of stakeholder groups prioritised and grouped statements (n = 72) about important components of the CRT model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day fidelity review process. Trained reviewers (n = 16) rated CRT service fidelity in a vignette exercise to test the scale’s inter-rater reliability.ResultsThere were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT model. A 39-item measure of CRT model fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT model fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76).ConclusionsThe CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1139-4) contains supplementary material, which is available to authorized users.

Highlights

Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis
Developing the focus for conceptualisation: Potential characteristics of CRT resources, organisation and service delivery for inclusion in a fidelity scale were identified from three sources: a literature review of quantitative and qualitative studies and guidelines relating to CRT implementation [23]; a UK national survey of CRT managers, reporting description of teams’ organisation and service delivery and managers’ views on priorities for effective CRT implementation [22]; and over 100 interviews and focus groups with CRT stakeholders (CRT service users, carers, staff and managers; and other stakeholders from organisations which refer to or work with CRTs) conducted for the CORE study [28]
Participants were sought from the following six CRT stakeholder groups: i) service users; ii) family and friends supporting service users; iii) CRT staff; iv) other mental health staff staff from voluntary sector organisations providing support to people with mental health problems; and vi) academic researchers involved in acute care research

Summary

Introduction

Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. We aimed to develop and test a fidelity scale to assess adherence to a model of best practice for CRTs, based on best available evidence. Fidelity measures are tools to assess the implementation of intervention or programme models [1], and as such, can help address the major challenge for mental health services of translating scientific knowledge into patient benefit [2]. Crisis Resolution Teams (CRTs) provide short-term, intensive home treatment to people experiencing a mental health crisis, with the aim of averting hospital admission wherever possible, or supporting people to return home as promptly as possible following an acute admission [6]. They form part of national mental health policy in Norway [10] and have been implemented regionally in a number of countries including Australia and the Netherlands

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