Fidelity outcomes in the National Implementing Evidence-Based Practices Project.
OBJECTIVE
This article presents fidelity outcomes for five evidence-based practices that were implemented in routine public mental health settings in the National Implementing Evidence-Based Practices Project.


METHODS
Over a two-year period 53 community mental health centers across eight states implemented one of five evidence-based practices: supported employment, assertive community treatment, integrated dual disorders treatment, family psychoeducation, and illness management and recovery. An intervention model of practice dissemination guided the implementation. Each site used both human resources (consultant-trainers) and material resource (toolkits) to aid practice implementation and to facilitate organizational changes. External assessors rated fidelity to the evidence-based practice model every six months from baseline to two years.


RESULTS
More than half of the sites (29 of 53, or 55%) showed high-fidelity implementation at the end of two years. Significant differences in fidelity emerged by evidence-based practice. Supported employment and assertive community treatment had higher fidelity scores at baseline and across time. Illness management and recovery and integrated dual disorders treatment had lower scores on average throughout. In general, evidence-based practices showed an increase in fidelity from baseline to 12 months, with scores leveling off between 12 and 24 months.


CONCLUSIONS
Most mental health centers implemented these evidence-based practices with moderate to high fidelity. The critical time period for implementation was approximately 12 months, after which few gains were made, although sites sustained their attained levels of evidence-based practice fidelity for another year.
McHugo
Gregory J
GJ
Department of Psychiatry, Dartmouth Medical School, Lebanon, NH, USA. gregory.j.mchugo@dartmouth.edu
Drake
Robert E
RE
Whitley
Rob
R
Bond
Gary R
GR
Campbell
Kikuko
K
Rapp
Charles A
CA
Goldman
Howard H
HH
Lutz
Wilma J
WJ
Finnerty
Molly T
MT
D003156:Community Mental Health Services / Q000592:standards*; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D019370:Observation; D010818:Practice Patterns, Physicians'; D017150:Public Sector; D014481:United States