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:
|
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:
|
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:
|
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:
|
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:
|
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 |