The community mental health team fidelity scale: A measure of program fidelity of social networks interventions for severe mental illness

Abstract

Open dialogue (OD) is a multi-component therapeutic and organizational intervention for crisis and continuing community mental health care with a therapeutic focus on clients’ social networks. The development and implementation of this model of care in the United Kingdom requires considerable contextual adaptations which need to be assessed to support effective implementation. Program fidelity–the extent to which core components of an intervention are delivered as intended by an intervention protocol at all levels–is crucial for these adaptations.AimsTo develop, pilot, and implement a program fidelity measure for community mental health services providing OD and ‘treatment as usual’ (TAU) or standard NHS crisis and community care.MethodsMeasure structure, content, and scoring were developed and refined through an iterative process of discussion between the research team and OD experts. Measure was piloted in the 6 OD and 6 TAU services participating in a large-scale research program.ResultsInitial data suggests that the Community Mental Health Team Fidelity Scale (COM-FIDE) is a potentially reliable and feasible measure of the fidelity of community mental health services and specific OD components of such services.

Psychiatrization of Society

“…There have been and still are extensive discussions within the OD community about the extent to which OD should be formalized, also to be able to demonstrate and investigate its implementation fidelity. While some studies report resistance against standardization and replicable criteria for training and evaluation (Alvarez Monjaras, 2019;Florence et al, 2020;Hopper et al, 2020), different scales have been developed to assess organizational fidelity and clinical adherence (Olson et al, 2014;Alvarez-Monjaras et al, 2021;Lotmore et al, 2021). These scales operationalize the essential aspects of OD well and is being used in connection with the above-mentioned trial in England and upcoming studies.…”

Development of the peer-supported open dialogue attitude and competence inventory for practitioners: A Delphi study

“…Otherwise, the validity of treatment outcomes becomes limited, making it difficult to conclude the efficacy of the approach ( Waltz et al, 1993 ). In the ODDESSI trial, the fidelity of service delivery was measured using the COM-FIDE instrument ( Alvarez Monjaras, 2019 ) and adherence was measured using the Open Dialogue Adherence Scale ( Lotmore, 2019 ; Lotmore et al, 2023 ), but no instrument was included in the trial to measure competence.…”

Open Dialogue services around the world: a scoping survey exploring organizational characteristics in the implementation of the Open Dialogue approach in mental health services

“…Moreover, the fact that the OD approach has not gone through the process of manualisation -that is, the development of a procedure that can be replicated with sufficient uniformity (Waters et al, 2021) poses additional challenges, especially in assessing OD-fidelity. A measure called COMFIDE (Alvarez Monjaras, 2019;Alvarez-Monjaras et al, 2023) was developed as part of the ODDESSI trial to evaluate a good standard of care for community mental health services providing OD and standard crisis and community care. Although more research on OD-fidelity is needed to identify specific and measurable elements (Waters et al, 2021), items and topics from the COMFIDE scale may currently be used for fidelity assessments at a global level.…”