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Fidelity scales, performance measures and early intervention in psychosis services

Commissioned by the International Early Psychosis Association (IEPA), Addington et al. (2018) have provided a timely review of the use of fidelity scales and performance measures that could be used to support implementation of first episode psychosis services. Based on their informal review of the literature, they conclude that there is consensus on what elements are required for a service to be effective and that fidelity scales and performance measures are available to assess the quality and outcome of such services. The introduction of early intervention (EI) services for psychosis and the evidence to support their effectiveness have indeed been the most significant developments in mental health services since deinstitutionalization decades ago. The evidence-informed support for such services has helped with their implementation at national and regional levels in several high-income countries. However, as Addington et al. (2018) indicate the continued implementation of EI services at a larger scale requires evaluation of the quality of such services and their continued effectiveness as judged by outcomes at several levels. It is imperative that such services show an impact in the real-world setting, outside research settings. This requires fidelity to a set of interventions that constitute the package of an EI service to establish quality and a set of outcome measures to assess their performance. The latter, as they indicate, must address outcome for the service consumer (patient and family), clinical service, program, system and population served. While we agree with the thrust of this report, there are several issues that may need further and, perhaps, deeper examination. We have tried to list them as follows: