Model fidelity and implementing IPS

IPS is a proven effective method and the degree of its success is dependent on it being carried out correctly and in accordance with its methodology (model fidelity). The more closely the IPS model is followed, the higher the chance of positive outcomes for clients. This means:

• More often better paid regular jobs
• More working hours
• Fewer problems with symptoms
• Better self-image
• Greater satisfaction with the financial situation

An instrument has been developed to help you to check if you are following the method by the book: fidelity scale. Using this instrument, teams who offer IPS are able to map out how they are using the method, what they are doing well and what they could improve on. Phrenos Center of Expertise for severe mental illness has arranged with the agencies that implement the IPS programme that it will periodically carry out the programme fidelity measurements to maintain optimal quality of practice. Two months after an agency has completed has implemented IPS, a baseline assessment will take place with the teams that offer IPS. If fidelity to the model is adequate, then this measurement will be repeated every two years. If necessary, plans for improvement will be compiled and carried out between measurements.

How is model fidelity measured?

The measurement is carried out by teams of trained reviewers. A team comprises a main reviewer (expert from Phrenos Center of Expertise for severe mental illness) and a reviewer (IPS teacher). The IPS supervisor from Phrenos makes an appointment in good time with the mental health care agency. The measurement lasts one full working day and requires the agency to be well prepared. There are costs involved with this process.

During the visit to the agency, the reviewers will speak with the IPS supervisor, a minimum of two IPS specialists, three members of the multidisciplinary treatment team, the treating physician/psychiatrist, two or three clients who are currently following, or have followed, an IPS programme, and one or two family members. They will also attend an IPS team meeting, and if possible a meeting of the treatment team. In addition, the reviewers will study other relevant sources of material such as case files and management plans.

The reviewers will score the results on a the fidelity scale. This results in a score for model fidelity which may vary between ‘no IPS’ to ‘excellent IPS’. The mental health care agency will receive a report containing the score, explanatory remarks and suggestions for improvements.