The clinical strategies implementation scale to measure implementation of treatment in mental health services.
OBJECTIVE
The authors describe the development of the Clinical Strategies Implementation Scale (CSI), an instrument designed to help providers measure the extent to which evidence-based strategies have been implemented in the treatment of persons with schizophrenia spectrum disorders.


METHODS
Nine ordinal scales were devised to measure key aspects of treatment strategies that have been associated with clinical and social recovery from schizophrenia: goal- and problem-oriented assessment, medication strategies, assertive case management, mental health education, caregiver-based problem solving, living skills training, psychological strategies for residual problems, crisis prevention and intervention, and booster sessions. A study of interrater reliability was conducted with 15 trained raters from participating centers in Athens, Auckland, Bonn, Budapest, Gothenburg, and Tokyo who assessed 54 cases. Each treatment strategy was weighted according to its effect size in clinical trials. Correlation analyses were conducted to explore associations between the total CSI score and ratings of clinical, social, and caregiver outcomes each year over four years of continued treatment of 51 patients.


RESULTS
Interrater reliability ranged from .93 to .99. Four annual total CSI ratings were significantly correlated with impairment, disability, functioning, work activity, and an index of recovery. Most correlations were stronger in years 3 and 4 than in years 1 and 2.


CONCLUSIONS
Reliable and valid assessment of the implementation of evidence-based strategies in clinical practice is feasible. The quality of integrated program implementation may be associated with improved clinical and social recovery from schizophrenic disorders.
Falloon
Ian R H
IR
Department of Psychiatry, Auckland University in New Zealand and with the Optimal Treatment Project Collaborative Group, 06050 Mercatello, Perugia, Italy. ifalloon@tiscali.it
Economou
Marina
M
Palli
Alexandra
A
Malm
Ulf
U
Mizuno
Masafumi
M
Murakami
Masaaki
M
D019317:Evidence-Based Medicine / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards*; D006284:Health Plan Implementation / Q000379:methods* / Q000592:standards*; D006801:Humans; D008605:Mental Health Services / Q000592:standards*; D015588:Observer Variation; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000628:therapy*