title: Development of a measure of model fidelity for mental health Crisis Resolution Teams.
abstract: BACKGROUND
  Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a fidelity scale to assess adherence to a model of best practice for CRTs, based on best available evidence.
  
  
  METHODS
  A concept mapping process was used to develop a CRT fidelity scale. Participants (n = 68) from a range of stakeholder groups prioritised and grouped statements (n = 72) about important components of the CRT model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day fidelity review process. Trained reviewers (n = 16) rated CRT service fidelity in a vignette exercise to test the scale's inter-rater reliability.
  
  
  RESULTS
  There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT model. A 39-item measure of CRT model fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT model fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76).
  
  
  CONCLUSIONS
  The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK. b.lloyd-evans@ucl.ac.uk.
authors.forename: Brynmor
authors.identifier: http://orcid.org/0000-0001-9866-788X
authors.initials: B
authors.lastname: Lloyd-Evans
authors.affiliation: Department of Psychiatry, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03766, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Bond
authors.affiliation: Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Torleif
authors.initials: T
authors.lastname: Ruud
authors.affiliation: Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
authors.forename: Ada
authors.initials: A
authors.lastname: Ivanecka
authors.affiliation: Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Gray
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: David
authors.initials: D
authors.lastname: Osborn
authors.affiliation: Research Department of Clinical, Education and Health Psychology, University College London Gower Street, London, WC1E 6BT, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Nolan
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Henderson
authors.affiliation: Research Department of Clinical, Education and Health Psychology, University College London Gower Street, London, WC1E 6BT, UK.|School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Mason
authors.affiliation: West London Mental Health NHS Trust, Uxbridge Road, Southall, London, UB1 3EU, UK.
authors.forename: Nicky
authors.initials: N
authors.lastname: Goater
authors.affiliation: Oxfordshire Healthcare NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kelly
authors.affiliation: Department of Statistical Science, UCL, Gower Street, London, WC1E 6BT, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Ambler
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Morant
authors.affiliation: Onyett Entero Ltd, care of University of the West of England, Health and Life Sciences Coldharbour Ln, Bristol, BS16 1QY, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Onyett
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Danielle
authors.initials: D
authors.lastname: Lamb
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fahmy
authors.affiliation: Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
authors.forename: Ellie
authors.initials: E
authors.lastname: Brown
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Paterson
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Sweeney
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: David
authors.initials: D
authors.lastname: Hindle
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Fullarton
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Johanna
authors.initials: J
authors.lastname: Frerichs
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
mesh_terms: D003419:Crisis Intervention / Q000592:standards*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services / Q000592:standards; D011594:Psychometrics; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: Acute care; Crisis Resolution Team; Fidelity; Implementation; Mental health services