Program / Treatment Design
Piloting a new approach to fidelity in coordinated specialty care: The NAV-FS fidelity scale
Madelyn E. Neill, B.A.
Research Coordinator
University of Minnesota
Minneapolis, Minnesota
Grace E. Owens, B.S.
Research Coordinator
University of Minnesota - Twin CIties
Minneapolis, Minnesota
Piper Meyer-Kalos, Ph.D.
Psychologist/Assistant Professor/Investigator
University of Minnesota
Minneapolis, Minnesota
Kim Mueser, Ph.D.
Psychologist/Professor/Researcher
Boston University
Boston, Maryland
Results and Future Directions: The results from the NAVIGATE clinic fidelity assessment will be provided. Scores from each cluster of items will be discussed alongside descriptive statistics of outcome variables. This pilot of the NAV-FS will explore possible relationships between outcomes and adherence to specific aspects of the NAVIGATE manual. Results from this pilot will provide recommendations that could support improvements in the NAV-FS. Based on these results, a feedback report, with suggestions to improve the implementation of the model, will be created in the future. This pilot collects fidelity ratings and outcome measures from only one clinic. Therefore, further analyzes of other NAVIGATE programs will need to be conducted in the future to improve the accuracy of the NAV-FS and gather the most reliable results. Once finalized, the NAV-FS has the potential to be a resource for NAVIGATE clinics to accurately assess their program and identify suggestions for their clinics to better serve their clients.
Aim: The First Episode Psychosis Services Fidelity Scale (FEPS-FS) was developed to evaluate evidence-based practices in non-specific coordinated specialty care models across the US. NAVIGATE is an evidenced-based, CBT model of treatment developed as part of the Recovery After Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) that led to the dissemination of coordinated specialty care (CSC) across the US. Recently, we have created a NAVIGATE fidelity scale (NAV-FS) to assess adherence to NAVIGATE specific practices. Six NAVIGATE clinics compose the Early Psychosis Intervention Network - Minnesota hub (EPI-MINN); each clinic utilizes standard clinical measures and aims to gather data that informs future clinical directions. Using data from EPI-MINN, this project pilots the NAV-FS and discusses potential relationships between fidelity and client’s clinical and functional outcomes. Fidelity within NAVIGATE clinics ensures clients are receiving the evidence-based care that has been effective in improving symptoms, mood, and functional outcomes.
Methods: The project team collaborated with NAVIGATE developers to create NAV-FS, which was based on the FEPS-FS. Components of the original scale are included, along with modified and new items to evaluate NAVIGATE specific interventions. Rating procedures were developed for the fidelity assessment process and include: chart review, outcome data, surveys, and interview questions. An urban NAVIGATE program was evaluated with the NAV-FS. This clinic completes EPI-MINN assessments at time of intake and every 6 months after the date of enrollment into the program. This project reviews the first 12 months of EPI-MINN data on clients’ clinical and functional outcomes. Clinical outcomes are determined by changes in symptoms and number of hospitalizations between intake and follow-up assessments; the Illness Management and Recovery Scale and the Colorado Symptom Index are used to evaluate symptom severity. Functional outcomes are measured by changes in education and employment status between each time point.
