The Effect of Intensive Implementation Support on Fidelity for Four Evidence‑Based Psychosis Treatments: A Cluster Randomized Trial

Abstract

Purpose Service providers need efective strategies to implement evidence-based practices (EBPs) with high fdelity. This study aimed to evaluate an intensive implementation support strategy to increase fdelity to EBP standards in treatment of patients with psychosis.<p> <p>Methods The study used a cluster randomized design with pairwise assignment of practices within each of 39 Norwegian mental health clinics. Each site chose two of four practices for implementation: physical health care, antipsychotic medication management, family psychoeducation, illness management and recovery. One practice was assigned to the experimental condition (toolkits, clinical training, implementation facilitation, data-based feedback) and the other to the control condition (manual only). The outcome measure was fdelity to the EBP, measured at baseline and after 6, 12, and 18 months, analyzed using linear mixed models and efect sizes.<p> <p>Results The increase in fdelity scores (within a range 1–5) from baseline to 18 months was signifcantly greater for experimental sites than for control sites for the combined four practices, with mean diference in change of 0.86 with 95% CI (0.21; 1.50), p=0.009). Efect sizes for increase in group diference of mean fdelity scores were 2.24 for illness management and recovery, 0.68 for physical health care, 0.71 for antipsychotic medication management, and 0.27 for family psychoeducation. Most improvements occurred during the frst 12 months.<p> <p>Conclusions Intensive implementation strategies (toolkits, clinical training, implementation facilitation, data-based feedback) over 12 months can facilitate the implementation of EBPs for psychosis treatment. The approach may be more efective for some practices than for others.