Browsing by Subject "fidelity"

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment
    (Springer, 2017-09) Rollins, Angela L.; Kukla, Marina; Salyers, Michelle P.; McGrew, John H.; Flanagan, Mindy E.; Leslie, Doug L.; Hunt, Marcia G.; Department of Psychology, School of Science
    Successful implementation of evidence-based practices requires valid, yet practical fidelity monitoring. This study compared the costs and acceptability of three fidelity assessment methods: on-site, phone, and expert-scored self-report. Thirty-two randomly selected VA mental health intensive case management teams completed all fidelity assessments using a standardized scale and provided feedback on each. Personnel and travel costs across the three methods were compared for statistical differences. Both phone and expert-scored self-report methods demonstrated significantly lower costs than on-site assessments, even when excluding travel costs. However, participants preferred on-site assessments. Remote fidelity assessments hold promise in monitoring large scale program fidelity with limited resources.
  • Thumbnail Image
    Item
    The “Critical” Elements of Illness Management and Recovery: Comparing Methodological Approaches
    (Springer, 2016-01) McGuire, Alan B.; Luther, Lauren; White, Dominique; White, Laura M.; McGrew, John H.; Salyers, Michelle P.; Department of Psychology, School of Science
    This study examined three methodological approaches to defining the critical elements of Illness Management and Recovery (IMR), a curriculum-based approach to recovery. Sixty-seven IMR experts rated the criticality of 16 IMR elements on three dimensions: defining, essential, and impactful. Three elements (Recovery Orientation, Goal Setting and Follow-up, and IMR Curriculum) met all criteria for essential and defining and all but the most stringent criteria for impactful. Practitioners should consider competence in these areas as preeminent. The remaining 13 elements met varying criteria for essential and impactful. Findings suggest that criticality is a multifaceted construct, necessitating judgments about model elements across different criticality dimensions.
  • Thumbnail Image
    Item
    Illness management and recovery in community practice
    (American Psychological Association, 2016-12) McGuire, Alan B.; Roudebush, Richard L.; Bartholomew, Tom; University, Rutgers; Anderson, Adrienne I.; Bauer, Sarah M.; McGrew, John H.; White, Dominique A.; Luther, Lauren; Rollins, Angela; Roudebush, Richard L.; Pereira, Angela; Salyers, Michelle P.; Psychology, School of Science
    Objective To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence. Methods IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR treatment integrity scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation). Results Average IMR competence scores were in the “Needs Improvement” range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review. Conclusions and Implications for Practice IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed.
  • Thumbnail Image
    Item
    Illness management and recovery in community practice
    (American Psychological Association, 2016-12) McGuire, Alan B.; Roudebush, Richard L.; Bartholomew, Tom; University, Rutgers; Anderson, Adrienne I.; Bauer, Sarah M.; McGrew, John H.; White, Dominique A.; Luther, Lauren; Rollins, Angela; Roudebush, Richard L.; Pereira, Angela; Salyers, Michelle P.; Psychology, School of Science
    Objective To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence. Methods IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR treatment integrity scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation). Results Average IMR competence scores were in the “Needs Improvement” range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review. Conclusions and Implications for Practice IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed.
  • Thumbnail Image
    Item
    Re-Implementing Assertive Community Treatment: One Agency's Challenge of Meeting State Standards
    (2012-03-20) Godfrey, Jenna Lynn; Bond, Gary R.; Salyers, Michelle P.; McGrew, John H., 1953-; Horton-Deutsch, Sara L.
    Assertive Community Treatment (ACT) is a widely implemented evidence-based practice for consumers with severe mental illness. However, fidelity to the model is variable and program drift, in which programs decrease in fidelity over time, can occur. Given substantial variability in fidelity and program drift in evidence-based practices, a study to examine how to re-implement ACT to high fidelity on established teams was warranted. The present study examined three teams providing moderate fidelity services prior to a state-wide policy change to the definition of ACT. Two of the teams attempted to implement ACT in accordance with state standards, while the third team served as a quasi-control for factors related to other state policy changes, such as a change to the funding mechanism. The implementation effort was examined using qualitative and quantitative measures over a 14-month period at a large, psychosocial rehabilitation center. Themes that were common across all three teams included the perceived negative impact of fee-for-service, ambiguity of stipulations and lack of guidance from the Department of Mental Health (DMH), difficulties with the managed care organization, importance of leadership within the agency, and familiarity with the services. Perceived barriers specific to the implementation of ACT standards included DMH stipulations, staff turnover, lack of resources, and implementation overload, i.e., too many changes at once. One team also had the significant barrier of a misalignment of requirements between two funding sources. Staff attitudes represented both a facilitator and a barrier to ACT implementation, while management being supportive of ACT was viewed as a major facilitator. One of the two teams seeking ACT status was rated at high fidelity within 6 months and maintained high fidelity throughout the study. The other team seeking ACT status never achieved high fidelity and decertified from ACT status after 6 months. The agency’s focus on productivity standards during the implementation effort hampered fidelity on the two teams seeking ACT status and greatly contributed to burnout on all three teams. The team achieving ACT status overcame the barriers in the short-term; however, DMH requirements may have threatened the long-term sustainability of ACT at the agency.
  • Thumbnail Image
    Item
    Skills on Wheels: Program Dissemination and Fidelity
    (2023-04-14) Havala, Claire; Chase, Tony; Department of Occupational Therapy, School of Health and Human Sciences; Chase, Tony
    The doctoral capstone experience is a 14-week self-directed learning experience for doctoral occupational therapy students. The purpose of this capstone was to advance career skillsets in a unique manner that align with the Accreditation Council for Occupational Therapy Education (ACOTE) educational standards (DeIuliis & Bednarski, 2019). The capstone experience is client-centered and needs based project, with a needs assessment and literature review completed. The capstone was completed with the Skills on Wheels (SoW) program and targeted the following ACOTE standards: program development, research skills, administration, and leadership. These standards were achieved through conducting research with another SoW site, initiating and completing program development tasks for the third iteration of the program, and creating a program manual outline for dissemination purposes.
  • Thumbnail Image
    Item
    Staff Turnover in Statewide Implementation of ACT: Relationship with ACT Fidelity and Other Team Characteristics
    (2010-09) Rollins, Angela L.; Salyers, Michelle P.; Tsai, Jack; Lydick, Jennifer M.
    Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature.