By Rick Goscha, MSW, Director of Training, Consultant/Trainer, Office of Mental Health Research & Training, School of Social Welfare, University of Kansas 

It has now been four years since the EBP Strengths Model Case Management Fidelity Scale was developed and piloted at Pawnee Mental Health Center. Since that time nine mental health centers encompassing thirteen teams (Pawnee, Labette, South Central – two teams, Horizons – two teams, Bert Nash – two teams, COMCARE – one team, Central Kansas – two teams, Sumner, and Breakthrough Club – Wichita) have participated as EBP Strengths Model Case Management project sites. As a project site, an agency agrees to work towards high fidelity implementation of the Strengths Model. The University of Kansas, School of Social Welfare agrees to offer onsite consultation and support for approximately two years in order to achieve this goal. 

                The overall goal of implementing any EBP practice is to improve the lives of people receiving the service. In previous issues of the EBP Times, we have looked at individual agency data and saw that there was a positive correlation between an increase in fidelity and improvement in client outcomes. Improvement varied by agency and the particular outcome area. All agencies made a significant improvement in at least one outcome area, usually the one they focused on most intensely during implementation.

            Here, we wish to look at the cumulative impact on outcomes by all EBP Strengths Model Case Management sites combined. We have taken each project site that has completed six months of implementation (only excludes Breakthrough Club) and created an average fidelity score at baseline, regardless of when they began implementation. We then totaled their client outcome scores at baseline in the areas psychiatric hospitalization, competitive employment, post-secondary education, and independent living.  We did the same for the current reporting period (Quarter 3 - 2008). All agencies submit quarterly outcome data on all clients served by project teams.

Table 1: Change in Fidelity and Outcome Scores (Baseline to Quarter 3 2008)

Table 1 shows that the average baseline fidelity score for all project sites was 23.5, which is low fidelity (60 point fidelity scale). During the current reporting period, the average fidelity scored had raised to 42.4, which is moderate fidelity. This corresponds to an 80% increase in fidelity for all project sites combined. High fidelity is defined as a score of 48 or over, which only one site has currently achieved (South Central – Andover/Augusta team).

            Table 1 also shows us that as fidelity has increased, client outcomes have improved in all of the four areas measured. The greatest increase can be seen in the area of post-secondary education, an area which was not on the radar for a majority of the project sites, but which significantly increased once staff focused on this area. The smallest increase was in the area of independent living, an area where the majority of the centers scored above state average even prior to beginning the project.

            This data suggests that a link between increased fidelity to the Strengths Model and client outcomes is emerging. It is important to note that the average fidelity score for all project sites combined is still only at the moderate level. This leads us to speculate what might occur with outcomes once the majority of sites achieve high fidelity. It is also important to note that only six of the thirteen teams have completed 18 months of implementation. While most teams make the largest increases in fidelity scores during the first 12 months of implementation, changes in overall outcomes scores seem to improve most substantially within the second year of implementation, when staff are beginning to get more comfortable using the tools and developing their skills.