improvement initiatives. We have demonstrated that an external audit is feasible, acceptable, and, preliminary evidence suggests, adequately reliable. The CRT Fidelity Scale could in principle also be used for internal audit within health organisations, or self-audit by teams (although the reliability of scores when the scale is used this way is yet to be tested). Third, at a local or national level, the CRT Fidelity Scale can be used to generate benchmarking data about CRTs’ model fidelity, against which individual teams’ model fidelity can be assessed, or with which changes to service provision across a region or country over time could be explored. Our survey demonstrates that such a large-scale use of the CRT Fidelity Scale can be achieved. (All 75 reviews in our study were completed in less than one year.) The value of the CRT fidelity scale to service planners and policy-makers is demonstrated by the speed with which it has been promoted and used by expert bodies and policy-making organisations nationally in the UK. The CRT Fidelity Scale is advertised as a “national inspiration” in the Crisis Care Concordat campaign led by NHS England [40]. Benchmarking data from our 75-team survey have been used by the Care Quality Commission, the body responsible for quality inspections of health and social care services in England [20], and the Royal College of Psychiatrists [41] in recent reports presenting recommendations for CRT care. Research implications: An important next step in developing the CRT Fidelity Scale is investigating its criterion validity. Fidelity scales assess elements of service or intervention structure and process: these can only be legitimately used as measures of service quality if a positive relationship to outcomes has
improvement initiatives. We have demonstrated that an external audit is feasible, acceptable, and, preliminary evidence suggests, adequately reliable. The CRT Fidelity Scale could in principle also be used for internal audit within health organisations, or self-audit by teams (although the reliability of scores when the scale is used this way is yet to be tested). Third, at a local or national level, the CRT Fidelity Scale can be used to generate benchmarking data about CRTs’ model fidelity, against which individual teams’ model fidelity can be assessed, or with which changes to service provision across a region or country over time could be explored. Our survey demonstrates that such a large-scale use of the CRT Fidelity Scale can be achieved. (All 75 reviews in our study were completed in less than one year.) The value of the CRT fidelity scale to service planners and policy-makers is demonstrated by the speed with which it has been promoted and used by expert bodies and policy-making organisations nationally in the UK. The CRT Fidelity Scale is advertised as a “national inspiration” in the Crisis Care Concordat campaign led by NHS England [40]. Benchmarking data from our 75-team survey have been used by the Care Quality Commission, the body responsible for quality inspections of health and social care services in England [20], and the Royal College of Psychiatrists [41] in recent reports presenting recommendations for CRT care. Research implications: An important next step in developing the CRT Fidelity Scale is investigating its criterion validity. Fidelity scales assess elements of service or intervention structure and process: these can only be legitimately used as measures of service quality if a positive relationship to outcomes has
Development%20of%20a%20measure%20Crisis%20Resolution%20Teams_311016.docx