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Fidelity Scale

Integrated Treatment Fidelity Scale

The Integrated Treatment Fidelity Scale has 14 program-specific items. Each item is rated on a 5-point scale, ranging from 1 (meaning not implemented) to 5 (meaning fully implemented). The items assess whether the program is provided as the evidence-based model prescribes.


Rating Scale (1 - 5)

                                                                             

Criteria

Descriptions

1

2

3

4

5

1

Multidisciplinary team:

Case managers, psychiatrist, nurses, residential staff, employment specialists, and rehabilitation specialists work collaboratively on mental health treatment team.

≤20% of consumers receive care from multidisciplinary team (i.e., most care follows a brokered case management or traditional outpatient approach)

OR

Cannot rate due to no fit

21%–40% of consumers receive care from a multidisciplinary team

41%–60% of consumers receive care from a multidisciplinary team

61%–79% of consumers receive care from a multidisciplinary team

>80% of consumers receive care from a multidisciplinary team with a strong emphasis on accessing a broad range of services and excellent communication among all disciplines

2

Integrated treatment specialists:

Integrated treatment specialists work collaboratively with the multidisciplinary treatment team, modeling integrated treatment skills and training other staff in evidence-based practice principles and practice.

No integrated treatment specialist connected with agency

OR

Cannot rate due to no fit

Consumers with co-occurring disorders are referred to a separate Integrated Treatment program within the agency (for example, referred to integrated treatment specialists)

Integrated treatment specialists serve as consultants to treatment teams, do not attend meetings, are not involved in treatment planning

Integrated treatment specialists are assigned to treatment teams, but are not fully integrated; attend some meetings; may be involved in treatment planning but not systematically

Integrated treatment specialists are fully integrated members of the treatment team, attend all team meetings, are involved in treatment planning, model and train other staff in Integrated Treatment for Co-Occurring Disorders

3

Stage-wise interventions:

All services are consistent with and determined by each consumer’s stage of treatment (engagement, persuasion, active treatment, relapse prevention).

≤20% of interventions are consistent with consumer’s stage of treatment

OR

Cannot rate due to no fit

21%–40% of interventions are consistent with consumer’s stage of treatment

41%–60% of interventions are consistent with consumer’s stage of treatment

61%–79% of interventions are consistent with consumer’s stage of treatment

≥80% of interventions are consistent with consumer’s stage of treatment

4

Access to comprehensive services

Consumers in the Integrated Treatment program have access to comprehensive services including the following:

  • Residential services
  • Supported employment
  • Family interventions
  • Illness management and recovery
  • Assertive community treatment

 

Fewer than 2 services are provided by the agency or consumers do not have genuine access to these services,

OR

Cannot rate due to no fit

2 services are provided by the agency and consumers have genuine access to these services

3 services are provided by the agency and consumers have genuine access to these services

4 services are provided by the agency and consumers have genuine access to these services

All 5 services are provided by the agency and consumers have genuine access to these services

5

Time-unlimited services:

Consumers in the Integrated Treatment program are treated on a time-unlimited basis with intensity modified according to each consumer’s needs.

Services are provided on a time-unlimited basis 20% or less of the time (for example, consumers are closed out of most services after a defined period of time),

OR

Cannot rate due to no fit

Services are provided on a time-unlimited basis 21%–40% of the time

Services are provided on a time-unlimited basis 41%–60% of the time

Services are provided on a time-unlimited basis 61%–79% of the time

Services are provided on a time-unlimited basis with intensity modified according to each consumer’s needs ≥80% of the time

6

Outreach:

Integrated treatment specialists demonstrate consistently well-thought out outreach strategies and connect consumers to community services, whenever appropriate, to keep consumers engaged in the Integrated Treatment program.

Integrated treatment specialists are passive in recruitment and re-engagement; almost never use outreach mechanisms,

OR

Cannot rate due to no fit

Integrated treatment specialists make initial attempts to engage, but generally focus efforts on most motivated consumers

Integrated treatment specialists try outreach mechanisms only as convenient

Integrated treatment specialists usually have plan for engagement and use most available outreach mechanisms

Integrated treatment specialists demonstrate consistently well-thought out outreach strategies and connect consumers to community services, whenever appropriate, to keep consumers engaged

7

Motivational interventions:

All interactions with consumers in the Integrated Treatment program are based on motivational interventions that include the following:

  • Expressing empathy
  • Developing discrepancy
  • Avoiding argumentation
  • Rolling with resistance
  • Instilling self-efficacy and hope
 

Integrated treatment specialists do not understand motivational interventions, ≤20% of interactions with consumers are based on motivational approaches,

OR

Cannot rate due to no fit

Some integrated treatment specialists understand motivational interventions, and 21%–40% of interactions with consumers are based on motivational approaches

Most integrated treatment specialists understand motivational interventions, and 41%–60% of interactions with consumers are based on motivational approaches

All integrated treatment specialists understand motivational interventions and 61%–79% of interactions with consumers are based on motivational approaches

All integrated treatment specialists understand motivational interventions and ≥80% of interactions with consumers are based on motivational approaches

8

Motivational interventions:

All interactions with consumers in the Integrated Treatment program are based on motivational interventions that include the following:

  • Expressing empathy
  • Developing discrepancy
  • Avoiding argumentation
  • Rolling with resistance
  • Instilling self-efficacy and hope

 

Integrated treatment specialists do not understand motivational interventions, ≤20% of interactions with consumers are based on motivational approaches,

OR

Cannot rate due to no fit

Some integrated treatment specialists understand motivational interventions, and 21%–40% of interactions with consumers are based on motivational approaches

Most integrated treatment specialists understand motivational interventions, and 41%–60% of interactions with consumers are based on motivational approaches

All integrated treatment specialists understand motivational interventions and 61%–79% of interactions with consumers are based on motivational approaches

All integrated treatment specialists understand motivational interventions and ≥80% of interactions with consumers are based on motivational approaches

9

Group treatment for co-occurring disorders:

Consumers in the Integrated Treatment program are offered group treatment specifically designed to address both mental health and substance abuse problems.

OR

Cannot rate due to no fit

20%–34% of consumers regularly attend group treatment

35%–49% of consumers regularly attend group treatment

50%–65% of consumers regularly attend group treatment

>65% of consumers regularly attend group treatment

10

Family interventions for co-occurring disorders:

With consumers’ permission, integrated treatment specialists involve consumers’ family (or other supporters), provide education about co-occurring disorders, offer coping skills training and support to reduce stress in the family, and promote collaboration with the treatment team.

Consumers are not asked for permission to involve family (or other supporters) or

OR

Cannot rate due to no fit.

Consumers are asked for permission to involve family (or other supporters) and 20%–34% of families (or other supporters) receive family interventions for co-occurring disorders

Consumers are asked for permission to involve family (or other supporters) and 35%–49% of families (or other supporters) receive family interventions for co-occurring disorders

Consumers are asked for permission to involve family (or other supporters) and 50%–65% of families (or other supporters) receive family interventions for co-occurring disorders

Consumers are asked for permission to involve family (or other supporters) and >65% of families (or other supporters) receive family interventions for co-occurring disorders

11

Alcohol and drug self-help groups:

Consumers in the active treatment or relapse prevention stages attend self-help programs in the community.

OR

Cannot rate due to no fit

20%–34% of consumers in the active treatment or relapse prevention stages attend self-help programs in the community

35%–49% of consumers in the active treatment or relapse prevention stages attend self-help programs in the community

50%–65% of consumers in the active treatment or relapse prevention stages attend self-help programs in the community

>65% of consumers in the active treatment or relapse prevention stages attend self-help programs in the community

12

Pharmacological treatment:

Prescribers for consumers in the Integrated Treatment program are trained in the evidence-based model and use the following strategies:

  • Prescribe psychiatric medications despite active substance use
  • Work closely with consumers and the treatment team
  • Focus on increasing adherence to psychiatric medication
  • Avoid prescribing medications that may be addictive
  • Prescribe medications that help reduce addictive behavior
 

Prescribers use less than 2 of the strategies listed,

OR

Cannot rate due to no fit.

Approximately 2 of 5 strategies used

Approximately 3 of 5 strategies used

4 of 5 strategies used

Evidence that all 5 strategies are used: medications are prescribed despite active substance use, prescribers receive pertinent input from the treatment team about medication decisions, use strategies to maximize adherence to psychiatric medications; avoid prescribing medications that are addictive and offer medications known to be effective for reducing addictive behavior

13

Interventions to promote health:

Integrated treatment specialists promote health by encouraging consumers with co-occurring disorders to do the following:

  • Avoid high-risk behavior and situations that can lead to infectious diseases
  • Find safe housing
  • Practice proper diet and exercise.

 

Integrated treatment specialists offer no interventions to promote health,

OR

Cannot rate due to no fit

Integrated treatment specialists may have some knowledge of reducing negative consequences of substance abuse, but rarely use concepts

Less than half of all consumers receive services to promote health; integrated treatment specialists use concepts unsystematically

50%–79% of consumers receive services to promote health; all integrated treatment specialists are well versed in techniques to reduce negative consequences of substance abuse

>80% of consumers receive services to promote health; all integrated treatment specialists are well versed in techniques to reduce negative consequences of substance abuse

14

Secondary interventions for non responders:

The Integrated Treatment program has a protocol to identify consumers who do not respond to basic treatment for co-occurring disorders, to evaluate them, and to link them to appropriate secondary interventions.

≤20% of non responders are evaluated and referred for secondary interventions

OR

There is no recognition of a need for secondary interventions for non responders,

OR

Cannot rate due to no fit

21%–40% of non responders are evaluated and referred for secondary interventions

OR

Secondary interventions are not systematically offered or available to non responders

Program has protocol and 41%–60% of non responders are evaluated and referred for secondary interventions

OR

No formal method to identify non responders

Program has protocol to identify non responders and 61%–79% of non responders are evaluated and referred for secondary interventions

Program has protocol to identify non responders and >80% of non responders are evaluated and referred for secondary interventions