1. INTEGRATED RECOVERY The Evidence Base & Measuring Fidelity Dan Chandler, Ph.D. January 19, 2007

2. Integrated Recovery and the SAMHSA Toolkits

3. Summary of Evidence Standards used by CIMH Effective Efficacious Promising Emerging Not effective or harmful

4. Other Toolkits ACT: Effective Supported Employment: Effective Family Psychoeducation: Effective Illness Management and Recovery: Promising (but multiple components have different levels of support)

5. The IDDT Toolkit Rating for Integrated Approaches to Co- occurring Disorders—Promising Rating for the IDDT Model Embodied in the Fidelity Scale—Emerging

6. 2006 IDDT Summary by Developers “… after 20 years of research, there remains a lack of strong and clear evidence regarding effective engagement, treatment, and rehabilitation interventions for people with co- occurring disorders.”* *McHugo, G. J., Drake, R. E., Brunette, M. F., Xie, H., Essock, S. M., & Green, A. I. (2006). Enhancing Validity in Co-occurring Disorders Treatment Research. Schizophrenia Bulletin, 32(4), 655-665.

7. Context Though evidence is limited, the IDDT Toolkit model is basically the best that exists Each component is a “black box” that can be filled in different ways based on developing research Recent research also supports: –Integrated residential treatment –Contingency (reward) based treatment

8. A consistent finding… If a program can engage and retain clients they will show positive change Clients in Engagement and Persuasion stages need intensive services, particularly outreach

9. Two Approaches to “fidelity”

10. The traditional approach “Fidelity is adherence to the key elements of an evidence-based practice, as described in the controlled experimental design, and that are shown to be critical to achieving the positive results found in a controlled trial.” American College of Mental Health Administration

11. The IDDT Approach How the fidelity scale was developed –Established “principles” of treatment –Developed “anchors” for the principles It is not based on any particular effective programs as the ACT scale is High fidelity means the program is implemented as designed but may not correlate with good outcomes

12. How fidelity is measured Each scale consists of 12-28 items Items rated on 5-point continuum 1 = Not Implemented 5 = Fully Implemented ≥ 4.0 considered good implementation

13. Achieving fidelity Some of the SAMHSA EBPs are easier to implement than others The time required to achieve full implementation varies greatly

14. National EBP Study

15. National EBP Study (2)

17. Implementation as a start-up Same fidelity items as prior graph