Strategies for Improving Fidelity in the National Evidence-Based Practices Project

Abstract

Background: The National Evidence-Based Practices (EBPs) Project developed and tested a model for facilitating the implementation of five psychosocial EBPs for adults with severe mental illness in the United States. Methods: The implementation model was tested in 53 sites in 8 states. In each site, one of the five EBPs was adopted for implementation and then studied for a 2-year period using a combination of qualitative and quantitative methods. Findings: At baseline, none of the sites had programs attaining high fidelity. Four factors were identified as influencing fidelity: (a) EBP-specific factors, (b) governmental factors, (c) leadership factors, and (d) fidelity review factors. Conclusion: A multipronged implementation strategy was effective in achieving high fidelity in over half of the sites seeking to implement a new EBP.

Factors affecting implementation of an evidence-based practice in the Veterans Health Administration: Illness management and recovery.

“…The fit of IMR within extant program structures may also explain the relative passivity of leadership support necessary to implement IMR. However, it is important to note FACTORS AFFECTING IMR IMPLEMENTATION 16 that structural changes not commonly observed in the current study-namely IMR-specific supervision and adapting policies, procedures, and documentation-were found to affect IMR fidelity and quality in previous studies (Bartholomew & Kensler, 2010;Bond et al, 2009;Rychener et al, 2009), rather than adoption. Practically nothing is known regarding the fidelity of IMR within VHA and these factors may still prove relevant to fidelity.…”

“…Despite IMR's effectiveness, IMR implementation can vary widely. In the National Implementing Evidence-based Practices (EBPs) Project, only half of the programs providing IMR reached "successful" levels of fidelity (Bond, Drake, McHugo, Rapp, & Whitley, 2009) and subsequent multi-site studies showed substantial variation in fidelity (Hasson-Ohayon, Roe, & Kravetz, 2007;Salyers, Godfrey, et al, 2009). Importantly, higher program fidelity was associated with better consumer outcomes in one trial (Hasson-Ohayon et al, 2007).…”

The efficacy of case management with persons who have substance abuse problems: A three-level meta-analysis of outcomes.

“…The opposite end of the intensity spectrum is characterized by wraparound case management, usually in the form of ACT (Stein & Test, 1980). ACT offers an unlimited number of contacts between the individual substance abuser and a multidisciplinary team of professionals (Bond, Drake, McHugo, Rapp, & Whitley, 2009). Services may be provided directly by the ACT team or by referral to other resources.…”

Uses of strength-based interventions for people with serious mental illness: A critical review

“…Therefore mental health practitioners need to be creative and culturally sensitive when helping service users in exploring and identifying the strengths and virtue of characters within themselves and the wider environment. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r P e e r R e v i e w Bond, Drake, McHugo, Rapp, & Whitley, 2009;McHugo et al, 2007;Whitley, Gingerich, Lutz, & Mueser, 2009). ...…”

“…Strengths-based, recovery-oriented approaches are increasingly relevant to and 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r P e e r R e v i e w Bond, Drake, McHugo, Rapp, & Whitley, 2009;McHugo et al, 2007;Whitley, Gingerich, Lutz, & Mueser, 2009). Existing research provides little evidence-based guidelines on the best approaches to training staff in strengths-based approaches.…”