Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway

Abstract

Background Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. Methods We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. Results The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users’ choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. Conclusions The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.

Accessibility and interventions of crisis resolution teams: a multicenter study of team practices and team differences in Norway

“…The provision of the interventions was consistent with the fidelity assessments of the CRTs in the present project, and with an earlier study conducted in Norway [ 5 , 19 ]. Psychological intervention was provided to almost all service users and in most sessions, which was much higher than in the UK, according to surveys there [ 8 , 10 ].…”

“…Medication was provided to few service users by Norwegian CRTs, which reflects the lower proportion of service users with severe mental illness. Practical support was provided to few service users, and this is consistent with other studies conducted in Norway and to findings in studies of CRTs in the UK [ 5 , 7 , 8 , 10 , 12 , 19 ]. The low family involvement was surprising because there has been enthusiasm in many Norwegian CRTs for an open dialogue approach involving family and their network [ 22 ].…”

“…The gatekeeping function for acute psychiatric beds is considered an important element in the model, but this is not a variable in Table 3 as no CRT in the present study had a gatekeeping function. The lower implementation of the CRT model in Norway than in the UK was discussed in an article on CRT fidelity of the Norwegian teams [ 5 ]. Influenced also by other developments in mental health services delivery, CRTs in Norway have partly aimed for earlier interventions with lower thresholds in crises and a broader target group, and they have partly adapted the CRT model to more rural areas with longer distances for staff or service users to travel.…”

“…Key components include rapid response time to referrals, 24/7 operating time, crisis intervention limited to weeks, high intensity of care, home-based care, gatekeeping of acute psychiatric beds, and facilitating early discharge from inpatient care. Estimates of CRT practices in national surveys and assessments of fidelity to the optimal CRT model have revealed numerous differences between teams regarding organization, staffing, target group, hours of operation, and key components listed above, but the provision of key components are seldom measured and analyzed in relation to individual service users [ 5 – 12 ].…”

Continuity of care and therapeutic relationships as critical elements in acute psychiatric care

“…The crisis resolution teams in Norway have emphasized early intervention and low‐threshold services in addition to community‐based crisis interventions for patients who would otherwise be admitted to an inpatient unit. Compared to those in the UK, the Norwegian teams provide crisis care to a broader patient group, with more psychological interventions and less psychotropic medication management 9 . This practice also includes longer visits or sessions with more time for psychological help and for developing a therapeutic relationship.…”