(PS7-89) Fidelity to the First-episode Psychosis Coordinated Specialty Care Model: Massachusetts Sites Compared to the Overall United States

Coordinated specialty care (CSC) programs are the gold standard of care for those who have experienced a first episode of psychosis (FEP) in the United States. A previous study by Addington, 2020, examined the fidelity of 36 sites across the US, finding that only 6% showed excellent fidelity, while 69% were rated as good, and 25% rated as fair. This study aimed to better understand overall adherence of Massachusetts specific FEP programs to the CSC model compared to the previous study of sites around the United States.

Assessments were conducted utilizing the FEP Services Fidelity Scale 1.1 (FEPS-FS) to measure fidelity to the CSC model, an updated version of the scale used in the Addington, 2020 study. Eleven Massachusetts FEP sites were assessed by individuals trained to administer the FEPS-FS through on-site visits, staff interviews, and chart reviews ted by two independent raters who came to consensus on all ratings.

Of the 11 Massachusetts FEP sites, 36% of sites showed excellent fidelity and 64% showed good fidelity; none were at fair or below fidelity. From the prior nation-wide work, the mean FEPS-FS item rating was 4.16, while the Massachusetts sites achieved an average item rating of 4.37. Across the US, 1 item (3%) was rated with excellent fidelity, 22 items (67%) with good fidelity, 6 items (18%) with fair fidelity, and 4 items (12%) were low or below fidelity. Comparably, in the Massachusetts sites, 9 items (25%) were rated with excellent fidelity, 20 items (56%) with good fidelity, 4 items (11%) had fair fidelity, and 3 items (8%) were low or below fidelity. Of the items rated with the highest fidelity, both US and Massachusetts FEP programs rated highest on having an assigned case manager and antipsychotic prescription present. Both US and Massachusetts programs had the lowest fidelity ratings in family psychoeducation and supported employment.

The results showed that Massachusetts FEP programs delivered high-quality services CSC model services. Both Massachusetts and nationwide FEP programs had shared items that rated with highest and lowest fidelity, indicating that there are similar challenges with implementation nationwide. Overall, these findings meet national standards, comparing favorably to prior work assessing fidelity of FEP programs nationwide.