EPA-0721 – Measurement of fidelity in case management practice

Abstract

Introduction Implementation research is crucial in the mental health field given that evidenced-based care still lack implementation, even in developed countries. In Portugal, the National Mental Health Plan included actions to change the operational model for mental health teams and a case-management (CM) training program was launched by the Ministry of Health. Objectives This study aims to evaluate the fidelity of a CM programme implementation process, according to the measurement of intervention techniques and resources used by mental health professionals. Methods The study was carried out at public and private mental health services in mainland Portugal. The implementation process started with a CM course (SAMHSA procedures), in which mental health professionals were trained by means of guidelines, demonstrative videos, scenarios and role-playing. Implementation fidelity was assessed by the Illness Management Fidelity Scale (Mueser, 2009). Results Mental health professionals assessment (n=71) showed a 15% good implementation rate and a 43% fair implementation rate, but still not enough implementation in 42%. Mean use of the model resources (e.g. duration and family involvement) was lower when compared with the use of techniques (e.g. goals definition, psychoeducation and relapse prevention). Conclusions Despite the fair global implementation rate of the CM model in the Portuguese mental health services, the rate of good implementation is still low. Implementation science may help to reduce the gap between evidence-based practices and their use in routine care, and thus contribute to improve the fidelity of evidence based care models for patients with severe mental illness.